March 13th, 2017

Is it GOPcare or Trumpcare?

Whatever you call it, Trump and the GOP seem to be on the same page.

From Trump:

The House plan follows the guidelines I laid out in my recent address to Congress – expanding choice, lowering costs, and providing healthcare access for all.

This plan is part of a three-pronged reform process. In concert with the plan in front of Congress, I have directed Dr. Tom Price, our Secretary of Health and Human Services, to use his authority to reduce regulations that are driving up costs of care.

We are also working on reforms that lower the costs of care, like allowing Americans to purchase health insurance across state lines. You’ve heard me say that many, many times during the debates.

And from Paul Ryan:

We are going to repeal and replace Obamacare and we’re going to do it with a three-pronged approach…

That’s called reconciliation. That’s the American Health Care Act. There are only so many things you can do in that bill because of the Senate floor rules for reconciliation. You can’t put everything you want in that legislation because if you did, it would be filibustered and you couldn’t even bring it up for a vote in the Senate.

Number two, administrative action. This law, Obamacare, has 1,442 sections or instances that gives the secretary of HHS enormous amounts of discretion to administer health care, meaning I don’t think Barack Obama, Nancy Pelosi and Harry Reid when they crammed this bill through ever thought Donald Trump would be president and Tom Price would be the secretary of HHS.

So, number two in our three-pronged approach, administrative action where the health and human services secretary deregulates the marketplace and allows more choice and more competition to come in the marketplace.

Number three, and this is where I think there’s a lot of confusion all over the map — additional legislation that we feel is important and necessary to give us a truly competitive health care marketplace. So, think of things like interstate shopping. That’s a reform that we’ve long believed in; that we think is really important to get regulatory competition to give people even more choices.

Those of you who think the feds should get out of the health care reform business will not be pleased by any of this.

Those of you who think the GOP consists of a bunch of liars and charlatans will not be pleased by any of this.

Those of you who think there’s no way back to total lack of federal involvement, and who think the GOP in Congress includes a significant number of people (although hardly all!) who are competent and mean well, should be reassured that the proposed bill is just the beginning of the process.

What is that I often say? We’ll see.

19 Responses to “Is it GOPcare or Trumpcare?”

  1. Geoffrey Britain Says:

    If it turns out that once again the public has been sold a bill of goods, how many more times shall we play Charlie Brown to the GOPe’s Lucy?
    I wonder if the establishment republicans realize just how thin is the ice upon which they skate? I wonder if they care? Someone (Sen Cotton?) recently pointed out that a once again burned and fedup base could hand control of the Senate back to the dems in 2018 and even Congress and the Presidency in 2020…
    Would either of those scenarios trouble Ryan & McConnell?

  2. Oldflyer Says:

    Oh, good grief. In politics, as in war, the other side has a vote–even when they are in a minority. As we know the GOP majority in the Senate is razor thin; the arcane Senate rules were designed to make sure the minority has a voice; so the Democrats wield some clout. (I know the Democrats corrupted the rules when they were in power; and we hated it.)

    Someone, and I won’t bother to research who, because it doesn’t really matter, said: “Politics is the art of the possible”. The flip side of the political process is generally called “tyranny”.

    I just don’t know why people continually hold the GOP “establishment” to impossible standards, and always impute nefarious motives to them.

    There is a process underway to reform health care. An easy prediction is that no one will be completely satisfied. Actually, that would be an impossible task.

  3. parker Says:

    GB,

    I don’t trust Ryan. His math skills are poor when it comes to budgets and deficit reduction scams. Paul, Cruz, Cotton, and Lee should be enough to crush Ryan’s phase one.The ACA is a BIGLY issue, but IMO border control and enforcing existing immigration laws should be the top priority this year.

    IMO discarding the ACA is a land mine. It needs to be neutered carefully.

  4. DirtyJobsGuy Says:

    This is an issue that requires a Reagan to champion and explain. The current GOP bill is a milquetoast version of Obamacare without any bold actions and for those reasons will fail. This requires the President to champion and educate the nation on what he wants to do. Unfortunately Trump has neither the talent nor the desire.

    The public is conservative in not wanting uncertain change because they have been whipsawed by changes before. The key is to convince the public that owning their own policies and HSA’s is better than depending on employers or the state. Recall that much of the fear of pre-existing conditions was not that people wanted to scam insurers, but that the insurance market did not really exist. If you left or lost your job, there was no guarantee you could pick up similar insurance on your own. You were trapped by your benefits. Any hybrid ACA that retains employer based insurance is doomed by the same measure. (I say this as an employer!) I’ve had my auto insurance with State Farm for 40+ years in multiple states, why couldn’t I have the same medical insurance policy? In our small firm we’ve had to narrow choices and pay higher costs every year so as an owner I have changed carriers frequently.

    In theory, Donald Trump should be able to explain how a 20 year old with good contributions to an HSA could accumulate a considerable medical fund available when he entered his 50’s. Backed up by major medical insurance this seems an ideal solution. Either generous tax deductibility similar to employer based treatment or a lower flat tax would make this possible for most people.

  5. expat Says:

    DirtyJobsGuy,
    I have also wondered why no one is pointing out that times have changed and that people no longer stay in the same place and with the same employer their whole working life. If your company moves but your spouse has a decent job in your town, it might be a good time to stay put and try something new. Owning your own insurance gives you the flexibility to adapt. Explaining this might encourage the young and healthy to sign up sooner. And if we stop rewarding employers and their employees for their gold cadillac health plans, people may develop a more realistic sense of what insurance really costs. It will certainly take a while to change people’s thinking, but you have to start somewhere.

    Like Oldflyer, I get tired of those who constantly criticize the GOPe for not creating the utopia tey want. They just don’t understand that they don’t have the votes. It’s so much easier to stamp your feet.

  6. J.J. Says:

    Oldflyer and expat. Amen!

  7. huxley Says:

    I wonder if the establishment republicans realize just how thin is the ice upon which they skate?

    GB: Is the Trump administration now part of the GOPe?

    Trump was great at leading chants for repealing Obamacare, but when he got specific and spoke of healthcare which covers everyone it seemed clear nothing major would occur.

    I don’t know the best way to proceed with American healthcare, but I am tired of hearing smack about the “GOPe.”

    Trump is President now. The buck stops with him.

  8. parker Says:

    As a Cruz partisan, I believe a president elect Cruz would have rolled into inauguration day with thoroughly vetted appointees, well thought out plans to overhaul the DC bureaucracies, and without 5 am tweets. But that is just me.

    Trump has done things with which I agree, but when it comes to battling the ‘deep state’ he lacks the depth of knowledge required to handle the entrenched establishment. Bluster and shooting from the hip only carries an agenda so far. 

  9. huxley Says:

    Trump has done things with which I agree, but when it comes to battling the ‘deep state’ he lacks the depth of knowledge required to handle the entrenched establishment. Bluster and shooting from the hip only carries an agenda so far.

    parker: Good old Scott Adams argued, while supporting Trump in his peculiar way, that it doesn’t take that much expertise to run the USA as President.

    American citizens seem to be exploring the minimums on that score with Obama and Trump, but I have my doubts.

  10. Liz Says:

    In other news…. https://www.whitehouse.gov/the-press-office/2017/03/13/presidential-executive-order-comprehensive-plan-reorganizing-executive

    “Sec. 2. Proposed Plan to Improve the Efficiency, Effectiveness, and Accountability of Federal Agencies, Including, as Appropriate, to Eliminate or Reorganize Unnecessary or Redundant Federal Agencies. (a) Within 180 days of the date of this order, the head of each agency shall submit to the Director a proposed plan to reorganize the agency, if appropriate, in order to improve the efficiency, effectiveness, and accountability of that agency. ”

    So, along with the budget cuts, and Part 2 of the health care plan to roll back the regulations and reorganizing the Executive Branch, I’ll be happy.

    Things I would like to see deregulated –

    Get rid of the FTE requirement since it is healthier for a person to work one job for 40 hours than two or more jobs to get the same hours.

    Also, get rid of the requirement of what to cover in a plan. If I want to offer employees a golden plan to keep them at my company, fine. If I want to offer to pay into a HSA and let the employee buy their own plan in the open market, great because it is their choice and it is truly free and portable.

    Finally, get rid of the requirement that if you have over 50 employees, you have to provide health insurance. Give the employer the flexibility to offer insurance, a HSA plan or gasp…higher wages!

    The number of employees and hours per employee is being kept artificially low and hindering growth of the small companies.

  11. huxley Says:

    The number of employees and hours per employee is being kept artificially low and hindering growth of the small companies.

    Liz: Excellent point!

  12. AesopFan Says:

    J.J. Says:
    March 13th, 2017 at 6:49 pm
    Oldflyer and expat. Amen!
    * *
    and Liz — gettin’ crowded in here.
    Why can’t government officials see how easy this all is?
    Well, for one reason: shrinking government and axing regulations has no pay-off.

    Somewhat tangential but evocative for this issue as well:
    http://www.nationalreview.com/article/445705/corporate-leaders-progressive-activists

  13. Frog Says:

    Liz’s points are excellent.
    I have seen no one here comment on the the Ryan bill’s apparent misnomer: the bill is not about Health Care, but about insurance and its availability.
    There is a penalty in it, just like Obamacare, and it may be more onerous: anyone who goes more than 63 days without coverage must pay a 30% surcharge to the new insuror, over and above the age-adjusted, health-adjusted (pre-existing conditions) insurance premium.

    The AHCA does include tax credits, like Obamacare.

    The CBO “score” must be taken with a large grain of salt. CBO has an institutional bias in favor of Leviathan. But even it finds that getting people off Medicaid will reduce Federal costs!

    The number of putatively disabled Americans has skyrocketed since Obamacare began, which grants them Medicare enrollment. That trend may continue.
    Case report: A former acquaintance of mine is a high-end car mechanic (Porsches, Ferraris, etc.), age 62. Because of a painful foot consequent to podiatric surgery (a big toe joint replacement!) he is now “disabled” because he must walk and stand while working, which hurts, so got Medicare; and now “unemployed”, he repairs cars on the quiet for cash only. Pain is like Hillary’s poor memory; no one can prove either is a fraud.
    The entire AHCA is apparently online (surprise, Pelosi!) and I’m going to try to read it.

  14. Liz Says:

    Thanks to JJ, Frog and Huxley. I try to mention points that I am concerned about and haven’t seen written.

    The copy of the bill that I saw is about 163 pages. And, it is written so that you need to print it out and then have a website open to read where you can eliminate this word and add that word and then try to figure out the impact of the word change.

    In business, I see documents which are strike out and add copies. In this age of computers, you would expect that at least they could provide embedded links to the law section

  15. Brian E Says:

    “There is a penalty in it, just like Obamacare, and it may be more onerous: anyone who goes more than 63 days without coverage must pay a 30% surcharge to the new insuror, over and above the age-adjusted, health-adjusted (pre-existing conditions) insurance premium.”- Frog

    I think the surcharge is for one year.

    Washington state has required insurance companies to cover pre-existing condition since 1993. The program was apparently abused by women who sought coverage when they became pregnant and then dropped coverage after the baby was born. In 1999, I believe the legislature amended coverage to include a 9 month waiting period. Problem solved. Not sure if this was the best way to handle it, though people with life threatening illnesses could join a high risk pool.

    https://www.washingtonpost.com/blogs/ezra-klein/post/health-reform-without-a-mandate-lessons-from-washington-state/2012/06/16/gJQAosKghV_blog.html?utm_term=.0b60332923b4

  16. David Says:

    Its everyone’s duty to buy insurance so in the event of you going into ER for an emergency the bill can be taken care of without using taxpayers’ money and in the process contribute into bankrupting our country. I Do not understand Conservatives, Romneycare was created to target the exact problem, taxpayer money being used to pay for the expensive ER medical Bills from people without insurance, but they are furious when Obama purposed the exact same thing. No, anyone can get sick at any time, and no one should have the choice not to get insured, if you don’t have the money, government can lend you the money to buy it but I do not see what’s the problem for the government to force everyone to buy insurance. No outrages from republicans when everyone is forced to buy third person auto-insurance..

  17. Brian E Says:

    An obvious solution to the individual mandate is to require each person to sign a waiver saying the person would pay for their own care, would not ask the government or any agency for help and would refuse Medicaid after they were bankrupt in exchange for not buying health insurance.

    Since, of course, do-gooders would help the person even after signing such a waiver, the individual mandate may be the only practical solution to the issue.

  18. neo-neocon Says:

    David:

    You not only don’t understand conservatives, you don’t understand history. Or perhaps you don’t bother to do your own research, so you think slogans about Romneycare are history.

    Romneycare was a program tailored for an overwhelmingly Democratic state, with its 85% Democratic legislature. Romney tried to introduce as many conservative aspects into the bill as possible under the circumstances, but his ability to do this was very limited and a lot of them were vetoed by the legislature. Still other liberal policies were added after he left the governorship.

    See this for some of the early history. See also the NOTE towards the end of this post for some of the later history, and see this for some of the even later history.

  19. Frog Says:

    There’s just a leetle more to it than what you wrote, David. Try harder. Much harder.

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