At first glance, it's not as bad as the previous drafts on most axes. Still terrible, but it could have been a lot worse. Which is worrying in terms of its chances of being passed.
McConnell signals GOP ACA bill will go straight to the floor after House passage. "I hope to call it up when we receive it from the House"
So refreshing after the Dems rammed the ACA through with no deliberation or Republican input.
Just do the motherfucking tax cut for the rich and blow up the deficit rather than trying to actually do something substantive you stupid fucks. (But this ain't passing in this form... I don't think anyway. But who the fuck actually knows.)
My quote not from the link in the OP.
(1) PROHIBITED ENTITY.--The term ''prohibited entity'' means an entity, including its affiliates, subsidiaries, successors, and clinics--
(A) that, as of the date of enactment of
this Act--
(i) is an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from tax under section 501(a) of such Code;
(ii) is an essential community provider described in section 156.235 of title 45, Code of Federal Regulations (as in effect on the date of enactment of this Act), that is primarily engaged in family planning services, reproductive health, and related medical care; and
(iii) provides for abortions, other than an abortion--
[Hyde Amendment exceptions]
and
(B) for which the total amount of Federal and State expenditures under the Medicaid program under title XIX of the Social Security Act in fiscal year 2014 made directly to the entity and to any affiliates, subsidiaries, successors, or clinics of the entity, or made to the entity and to any affiliates, subsidiaries, successors, or clinics of the entity as part of a nationwide health care provider network, exceeded $350,000,000.
How you specify Planned Parenthood without naming the organization.
Paraphrasing myself elsewhere, they're in a hard place entirely of their own making. They tried to ram through full repeal without replace, failed. Now this weak attempt is trying to square the circle of getting the deathculty Freedom Caucus on side while also making a token of effort to keep it from disenrolling too many millions. Impossible.
The lottery thing wasn't in their leaked draft last month. I heard it was maybe some other legislators's hobbyhorse that had previously been in its own bill?
Indeed. There are plenty of lawyers here. How Bill-of-Attaindery is that provision? I presume (especially with the expenditure threshold), that only one entity qualifies in practice. I'd have thought tying it to a specific fiscal year would make it too specific, even if the rest of it somehow flies. Would it pass constitutional muster if they just said "in the previous fiscal year" or similar? Even if PP was the only entity likely to meet the definition?
So say, fine, exclude lottery winners, but by the same token cap benefits for white people.
There's a slight smackery of intelligent evil where they only withdraw enhanced Medicaid funding for the expansion population at a trickle, and don't directly force anyone off. Expansion states keep 90% federal funding for anyone who was enrolled in that category 12/31/2019 and stays enrolled continuously thereafter. Anyone entering that category later, in a state that keeps expansion, still gets federal funding, but at the regular lower matching rate. So it makes a gesture at "states can keep people enrolled as long as the people do the work to stay enrolled". But in that income range (since we're talking about adults without dependent children: evil where they only withdraw enhanced Medicaid funding for the expansion population at a trickle, and don't directly force anyone off. Expansion states keep 90% federal funding for anyone who was enrolled in that category 12/31/2019 and stays enrolled continuously thereafter. Anyone entering that category later, in a state that keeps expansion, still gets federal funding, but at the regular lower matching rate. So it makes a gesture at "states can keep people enrolled as long as the people do the work to stay enrolled". But in that income range (since we're talking about adults without dependent children:
(Chrome doesn't redline "shitload"!)
7: It's only applicable to lotteries held after 1/1/2020.
9: Chrome knows other ways to exact revenge.
I think its cute how they got rid of the individual mandate by having insurance companies charge 30% more for a year if your coverage has lapsed for more than 60 days in the next 12 months. But I'm not sure how making it less affordable to get coverage is supposed to encourage people to get covered. I think the intent is to scare people away from letting their insurance lapse - but once people have a lapse, they won't be getting back on board.
And it seems like this is going to blow up the adverse selection problem... the folks who will shell out the extra 30% are the people who really need coverage due to an acute health problem, while healthy people will take their chances by remaining uncovered. So, the pool gets less healthy, and prices go up for everyone.
Its as if this thing was written by rabid howler monkeys.
It's mildly interesting, I suppose, that getting rid of guaranteed issue and community rating are barely even seriously discussed anymore - and though individual mandate is the third leg of the stool, there's no debate that you need to encourage participation in some way, so they have this crapsauce surcharge as the alternative. They're still a deathcult, but some of the policy understanding has stubbornly leaked in.
And it seems like this is going to blow up the adverse selection problem... the folks who will shell out the extra 30% are the people who really need coverage due to an acute health problem, while healthy people will take their chances by remaining uncovered. So, the pool gets less healthy, and prices go up for everyone.
Indeed. If you're "part of the problem", a healthy young 'un, it's entirely rational to go uncovered until you need it. Unless you need it that year, it's always going to be cheaper.
BTW, everyone's kind of marveling at what a shitshow this is, but here's my take: Trump genuinely made this so much harder as to be impossible.
Stipulating that of course the GOP was never remotely serious* about health care, I think the reason that this bill is so laughably bad is that the shitty things they were always planning on doing--pulling back Medicare, effectively nuking subsidies--would be horrible, but really do appeal to their Tea Party voters, and so they'd do it, chaos and collapse be damned.
But Trump voters =/= Tea Party voters, and Trump promised them things on health care that Ryan never wanted to deliver. And of course now Republicans fear Trump voters even more than they fear Tea Party voters, so that means placating them**, and that means a self-contradictory, unworkable mess that most likely can't pass.
By contrast, had Cruz somehow won, he'd have done so without making any promises that Ryan couldn't keep, and they'd write up a garbage bill, pass and sign it, and let the chips fall where they may (I think the shitshow would still hurt them in that scenario, but their first commitments would be cutting taxes for the wealthy and killing Obamacare, and they'd expect their base to agree).
There were a lot of hot takes after the election about how Trump would somehow keep the GOP from doing their worst; those were almost all crap. But in this case, I think he more or less inadvertently torpedoed repeal. I'm sure he never understood that he was doing so, but the constraints are what they are, and they're his campaign promises (without which, to a great extent, he couldn't have won).
*in an intellectual or policy sense; in terms of intent, they were/are serious as a heart attack
**Trump himself seems so detached from reality that I'm not convinced they had to placate him to get his signature
Just following up that last bit:
We've all seen the myriad interviews with his voters in which they are just religiously committed to him protecting them. A lot of that is creepy authoritarianism, but it also has to do with specific commitments he made to them, and that included breaking from GOP orthodoxy on SS/Medicare. Without that break, I don't think he gets the last 100k votes he needed in PA/MI/WI.
15/16: Yeah, it feels like we've got some rudimentary Gleichschaltung going on where people study his words and try not to go against them.
Trump voters =/= Tea Party voters
Except for the 90-95% overlap, sure.
Yes but you can't expect them to remember what they were rabidly insistent about four whole years ago.
Its not that I disagree with JRoth's point, its that I don't think its the voters that the Death Eaters in Congress are afraid of. Rather, its the whole funding infrastructure and institutional infrastructure behind movement conservationism.
Most of the Tea Party/Trump voters don't actually give a shit about details - anything that pisses off liberals is fine with them - but the Koch Bros. and Heritage have come out hard against this thing. Members of the far right aren't about to break their alliances with their entire support structure just to come to the rescue of Ryan and Trump.
They want to piss off the libs without paying any personal price. Trump promised they could.
People can be fooled about a lot of things, but deductibles and premiums aren't among them.
It all shows that Trump was right -- nobody realized that healthcare was so gosh darn complicated!
Except for the 90-95% overlap, sure.
I would presume that 90-95% of the Tea Party voted for Trump (and the rest voted for Johnson), but I wouldn't presume that 90-95% of Trump voters identify with the Tea Party.
5: It's a very general rule, just like ones only applying to Pennsylvanian Cities of the Second Class.
18, 23: Right, I don't believe that any Tea Partiers* failed to vote Trump, just that Trump also won some other people who, basically, liked the racism combined with the promise to protect their bennies. And of course the "Keep the Gov't Out Of My Medicare" folks were Tea Partiers who were incoherent except that Trump said what they wanted to hear (and that Ryan would never say, since his wanking material is old people dying because Medicare block grants haven't kept up with inflation).
One of the reasons I thought Cruz would be a preferable opponent to Trump was that all the evidence said that he would run hard on a "Gov't will screw you all over" platform and drive away the "KtGOOMM" voters.
*feeling super-generous, there may have been some TPers who dropped out after the early days, but in terms of the people who voted in '10? All Trumpers.
I have to advise against mentioning a lo//ery in the post text at this point.
Ah, of course. I was wondering why the spambots had showed up so soon.
Or maybe they're just lonely. You guys are such dicks sometimes.
I have a dumb question. These tax credits Republicans are proposing in their Trumpcare Ryancare plan -- $2,000-$4,000 depending on age -- are these to be taken once per year as deductions from one's taxes? In other words, one is to pay the full-price monthly insurance premium for a year, and be reimbursed the following year via tax return?
I've read any number of overviews of the Ryancare plan, and haven't yet stumbled across one that makes this clear.
It looks like the credit can be advanced to insurance providers directly to reduce the premium cost, much like the ACA currently does. The text even directs the program to "to the greatest extent practicable, use the methods and procedures used to administer the programs created under sections 1411 and 1412 of the Patient Protection and Affordable Care Act".
If you have the text handy, look for ""Sec. 7259. Advance Payment of Health Insurance Coverage Credit".
Thanks, Minivet. I see there's another thread on this general topic.
I will say that it's funny as hell that Sean Spicer went to comical lengths to show the White House press corps that the Ryancare plan is a much smaller stack of paper than Obamacare ("This Obamacare stack is government, this smaller stack of paper isn't").
But from what I understand, since this is a budget reconciliation bill, it's not actually a law laying out a whole new (replacement) plan, and doesn't have to spell out huge devilish details like establishment of the exchanges and so on: the reconciliation bill just says in effect, over and over again "see the existing ACA for that".
No wonder it's a smaller stack of paper.