After significant internal division about how to replace the Affordable Care Act, House Republican lawmakers unveiled two bills that, taken together, would repeal and replace President Obama’s signature health care reform law, Tara Culp-Ressler reported at ThinkProgress.org (3/6).
Here’s what you need to know about the legislation, and what it says about the House GOP’s plan for the future of health insurance in America:
The proposed replacement bill includes big cuts to Medicaid, the government program that provides coverage for low-income Americans.
It would phase out the Medicaid expansion under “Obamacare,” which extended coverage to more than 11 mln low-income people in 31 states, beginning in 2020. It would also restructure the way the entire program is funded . It offers states a lump sum to administer Medicaid coverage, rather than providing however much funding states need to cover the pool of Medicaid eligible residents, putting the future of Medicaid in jeopardy.
It defunds Planned Parenthood for family planning services as well as abortion coverage. It would prevent the women’s health organization from providing birth control and mammograms to 2.5 mln current patients who are covered through Medicaid. It also would prevent Americans from using tax credits to help pay for plans that include coverage for elective abortion services — essentially, singling out abortion care as a service that won’t be covered like other medical procedures and forcing low-income people to bear the full out-of-pocket cost of ending a pregnancy.
It includes a big tax break for insurance companies that pay their CEOs more than $500,000 per year.
A significant portion of the bill is devoted to ensuring lottery winners don’t have access to Medicaid.
It could trigger a “death spiral” in the individual insurance market. The GOP’s proposal would maintain Obamacare’s requirement that insurers need to cover people with preexisting conditions. But it would also scrap the law’s main avenue of balancing out those sick people with younger, healthier enrollees — the individual mandate that requires all Americans to sign up for health insurance or pay the IRS a fee.
Instead, the GOP measure introduces a provision that requires “continuous coverage.” Essentially, anyone who goes without insurance for two or more months and then tries to sign up for coverage again will be required to pay 30% more on their premiums for the next year.
There are two issues with this change. First of all, instead of paying the IRS, Americans will be required to give more of their money to insurance companies. And second of all, it’s unclear that this surcharge will be enough of a deterrent for young and healthy people who’d rather not have coverage. This could trigger what policy experts call a “death spiral,” threatening the collapse of the entire insurance industry as the individual market destabilizes.
It will result in a lot fewer people having health insurance. House Republicans are still awaiting more detailed analysis of the new legislation from the Congressional Budget Office and nonpartisan health policy groups. But experts in the field agree there’s no way that it will maintain the same levels of coverage as Americans currently have under Obamacare, which extended health care to 20 mln people. We’ll find out just how many fewer people will be covered after the CBO examines it.
Republican lawmakers involved in crafting the legislation acknowledge that fewer people will be able to access health insurance under their plan. Some legislators have construed this as a good thing, saying that more uninsured people signals a greater embrace of personal liberty and that some low-income people simply don’t want to take responsibility for their insurance.
House Republicans released the new plan with the blessing of President Trump and hope to pass it quickly before Democrats can mobilize opposition. But Republican infighting ensures this legislation may have a rocky road ahead.
Some members of the right-wing House Freedom Caucus oppose the way the legislation extends tax credits to help Americans purchase insurance, calling this provision a “new entitlement” — and aren’t likely to support the measure’s delayed repeal of multiple Obamacare taxes.
Republicans plan to pass the bills in the budget reconciliation process to avoid a filibuster in the Senate, where Republicans have only a 52-48 majority, but four Republican senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska — signed a letter saying the House draft that they had reviewed did not adequately protect people in states like theirs that have expanded Medicaid under the Affordable Care Act, the New York Times reported.
Three conservative Republicans in the Senate — Mike Lee of Utah, Rand Paul of Kentucky and Ted Cruz of Texas — had already expressed reservations about the House’s approach.
Rep. Mark Meadows, R-NC and the chairman of the House Freedom Caucus, also warned Republican leaders to pursue a “clean repeal” of the health care law. Even the new approach they view as a big government program.
“Conservatives don’t want new taxes, new entitlements and an ‘ObamaCare Lite’ bill,” they wrote on the website of Fox News. “If leadership insists on replacing ObamaCare with ObamaCare-lite, no repeal will pass.”
Meanwhile, AARP and its allies are bombarding congressional offices with objections to the Republicans’ bill, Robert Pear reported in the New York Times (3/5).
If the law is repealed, the groups say, people in their 50s and 60s could see premiums rise by $2,000 to $3,000 a year or more: increases of 20% to 25% or higher.
Under current rules, insurers cannot charge older adults more than three times what they charge young adults for the same coverage. House Republican leaders would allow a ratio of five to one — or more, if states choose.
Jerry C. Fleming, a retired health insurance executive who worked at Kaiser Permanente for more than 35 years, told the Times that the House Republican plan could produce “breathtaking increases in premiums” for older people with low incomes.
Their share of the premium could, in some cases, more than double, he said.
TRUMP’S WAY: ALWAYS ATTACK, NEVER APOLOGIZE. Donald Trump’s approach to crisis management continues to be guided by the Roy Cohn playbook, James Hohmann of the Washington Post noted (3/6). “This is McCarthyism!” Trump said (3/4), as he attacked Obama for supposedly wiretapping him. There was great irony to this, Hohmann wrote. Cohn, after all, was Joe McCarthy’s chief counsel on the Senate Permanent Subcommittee on Investigations during the early 1950s. Two decades later, Cohn became one of Trump’s biggest mentors during a formative phase of his life.
Cohn’s creed was to always be on the attack, to counterpunch whenever punched and to never apologize. Never, ever, ever apologize. He believed that you never yield an inch, even if you’re in the wrong, because your opponents will take a mile.
“The man who showed Trump how to exploit power and instill fear” is how the Post’s Robert O’Harrow Jr. and Shawn Boburg described Cohn in a story (6/16/16): “Trump was a brash scion of a real estate empire, a young developer anxious to leave his mark on New York. Cohn was a legendary New York fixer, a ruthless lawyer in the hunt for new clients. They came together by chance one night at Le Club, a hangout for Manhattan’s rich and famous. Trump introduced himself to Cohn, who was sitting at a nearby table, and sought advice: How should he and his father respond to Justice Department allegations that their company had systematically discriminated against black people seeking housing? ‘My view is tell them to go to hell,’ Cohn said, ‘and fight the thing in court.’ It was October 1973 and the start of one of the most influential relationships of Trump’s career.”
Cohn represented the Trumps throughout their protracted legal fight with DOJ. In 1973, looking to change the storyline, Cohn had a news conference to announce that Donald and Fred were countersuing the federal government for $100 mln. He claimed the government was trying to force “subservience to the Welfare Department.” Ultimately, the Trumps settled without admitting guilt, which allowed them to declare victory.
Trump was even quoted in the Post’s 1986 obituary of Cohn, who died of complications from AIDS. “If you need someone to get vicious toward an opponent, you get Roy,” he said.
This same approach is on display when Trump tries to repurpose the very attacks being leveled against him against his accusers. On 3/3, he literally called for investigations into Democratic leaders Chuck Schumer and Nancy Pelosi for meetings they had (in public) with the Russian ambassador. Hohmann wrote, “It’s a slightly more adult version of, ‘I know what you are, but what am I?’”
RECESS ACTIONS SPUR HEALTH CARE ACCOUNTABILITY. Citizens have refused to take no – or no-shows – as answers when elected officials sidestep questions at town hall meetings about Republican plans to cut health care and repeal the Affordable Care Act (ACA), Sarah Warner and Cynthia Ward Wikstrom reported at OurFuture.org (3/5).
“They have a right to hear what policy proposals are on the table, and how they will be impacted before any vote,” says Mary Clark, Regional Director at Citizen Action of New York (CANY).
New York, Nevada, Wisconsin and Maine are among the states where People’s Action affiliates organized over eighty events to publicly challenge officials during the Congressional recess in February. They will do so again when representatives return to their home districts April 10-23.
“Given how much heat there was this recess, I can’t imagine what April will be like if the House votes on these life and death matters before people get a voice,” says Clark.
New York Republican Reps. Claudia Tenney, David Donovan, Elise Stefanik and John Faso all refused to meet with voters in February – in Faso’s case, so he could attend a $1,000-a-plate fundraiser instead.
In response, People’s Action affiliates hosted “empty chair” town halls, often to overflowing crowds, where voters’ voices could be heard.
“In all the years I’ve been organizing, I’ve never seen a spontaneous upsurge of engagement like this,” says Ciera Pennington, Field Director of the West Virginia Citizen Action Group (CAG). “People who have never been active before are demanding access to, and answers from, their elected officials, and I don’t see this energy leveling off.”
This surge of interest in accountability has also prompted West Virginia communities to host “Citizen Lobbyist” trainings, in which CAG teaches community members how to effectively engage their elected officials.
“These have been everyday citizens, people who just want to get involved,” says Pennington. “We teach them how you can make policy change actually happen.”
West Virginia Sen. Joe Manchin, a conservative Democrat, is one of the handful of supporters of changes to the Affordable Care Act who has agreed, after pressure from CAG, to meet with constituents in April.
New Jersey Rep. Tom MacArthur’s office was flooded with calls after he alleged town hall meetings were organized by paid agitators. NJ Citizen Action partnered with South Jersey Indivisible to hold “empty chair” town halls in his and other districts.
“This brought on a whole new level of communication from constituents,” says NJCA Associate Director Dena Mottola Jaborska. “People from the district who turned out – many who have never been active before – were furious at this characterization of our intent.”
MacArthur has since agreed to a town hall meeting, and the groups have renewed their calls for Reps. Freulinghausen and Smith, who have also avoided voters, to meet constituents in the upcoming recess.
“It looks like the message is getting through,” says Mottola Jaborska. “We’re neither bused in or paid, but have very real concerns about the future of our health care.”
TRUMP’S SPEECH SAMPLES DISREGARD FOR THE TRUTH. Donald Trump’s speech to the joint session of Congress (2/28) was studded with some of his greatest lies and misstatements.
Trump repeated his exaggeration that the Affordable Care Act (“ObamaCare”) has been a disaster and “Obamacare premiums nationwide have increased by double and triple digits.” Many people purchasing health care through federal and state insurance marketplaces have seen double and even triple digits, as he said, but other states have not seen such dramatic changes and experts say health care costs broadly are increasing at a rate lower than before the health care reforms took effect. And for people on the health care exchanges, federal subsidies are offsetting premium increases for many. PolitiFact rated his statement “half true.”
“Ninety-four million Americans are out of the labor force.” This is an another retread of his misuse of Bureau of Labor Statistics, which showed that, as of January 2016, 94.4 mln Americans 16 years and older were “not in labor force.” The unemployment rate, at 4.8% when Trump took office, means 7.6 mln people actively are looking for a job and cannot find one. The 94 mln not in the labor force includes people who are retired, students, stay-at-home parents or disabled.
“America has spent approximately $6 tln in the Middle East, all this while our infrastructure at home is crumbling. With this $6 tln we could have rebuilt our country — twice.”
Trump often incorrectly claims that the US has spent $6 tln on the wars in the Middle East, but the Washington Post reported the wars in Iraq (in the Middle East) and Afghanistan (in South Asia) together cost about $1.6 tln from 2001 to 2014. The $6 tln figure adds in estimates of future spending, such as interest on the debt and veterans care for the next three decades. Yet Trump says that this money (not yet spent) could have rebuilt the US economy.
President Obama’s proposals for a major bill to rebuild infrastructure and the economy were ignored by the GOP Congress.
Trump said, “The murder rate in 2015 experienced its largest single-year increase in nearly half a century. In Chicago, more than 4,000 people were shot last year alone — and the murder rate so far this year has been even higher. This is not acceptable in our society.”
While that’s basically correct, it leaves out the context. FBI data shows a 10.8% increase between 2014 and 2015, the biggest percentage jump in a single year since 1970-1971, but murders declined 42% from 1993 to 2014, so homicide levels remain far below their high levels in the 1990s. In 2016, there was an uptick in the homicide rate in the 30 largest cities.
Chicago was responsible for 43.7% of the total increase in homicide rates in 2016. But the Windy City ranks eighth among big cities when homicide is measured per-capita, TheTrace.org reported (1/18). In 2016, Chicago had a rate of 27.9 killings per 100,000 residents — half that of top-ranked St. Louis, whose 188 murders amounted to 59.3 homicides per 100,000 people. Baltimore placed second, with a homicide rate of 51.2, followed by Detroit (45.2), New Orleans (44.5), Cleveland (34.7), Newark (33.4) and Memphis (32.5).
Deporting the “bad ones.” Trump said, “As we speak, we are removing gang members, drug dealers and criminals that threaten our communities and prey on our citizens. Bad ones are going out as I speak and as I have promised throughout the campaign.” Trump signed an executive order (1/25 directing the Department of Homeland Security to prioritize the removal of immigrants in the country illegally. But 25% of the arrests that grabbed headlines in early February were people who had lesser charges and noncriminal convictions, or were simply swept up with criminals. And research shows noncitizens are not more prone to criminality than US-born citizens. The vast majority of unauthorized immigrants are not criminal aliens or aggravated felons.
Trump said his budget "calls for one of the largest increases in national defense spending in American history." PolitiFact called that “a bit of a stretch, noting that Trump is calling for about a 10% hike in spending. But in the past 30 years, there have been 10 years when the base defense budget has gone up by more than what Trump has requested. In some years, the increase was more than double Trump’s. PolitiFact rates it mostly false.
“Jamiel’s 17-year-old son was viciously murdered by an illegal immigrant gang member, who had just been released from prison. Jamiel Shaw Jr. was an incredible young man, with unlimited potential who was getting ready to go to college where he would have excelled as a great quarterback. But he never got the chance. His father, who is in the audience tonight, has become a good friend of mine.”
Trump likes to use anecdotes as evidence for associating violent crimes with illegal immigration, telling stories of victims of homicide by undocumented immigrants. He brought family members of those killed by illegal immigrants as his guests for Tuesday night’s speech. He often talks about the death of Jamiel Shaw Jr., a 17-year-old football star who was killed in 2008 by a gang member who was in the country illegally.
Clearly, stories like this exist. But the vast majority of unauthorized immigrants do not fit Trump’s description of aggravated felons, whose crimes include murder. US Sentencing Commission data show homicides are a small percentage of the crimes committed by noncitizens, whether they are in the United States illegally or not.
The Congressional Research Service found that the vast majority of unauthorized immigrants do not fit in the category of aggravated felons, whose crimes include murder, drug trafficking or illegal trafficking of firearms.
In one of his shots against his predecessor, Trump said, “We have the worst financial recovery in 65 years.”
PolitiFact noted this is something of an odd phrasing, since the term that’s typically used is “economic” recovery. (“Financial” recovery suggests a focus purely on how the financial-services sector bounced back, meaning Wall Street and banks.) In a strict sense, the recovery from the 2001 recession was weaker than the one after the Great Recession. In the earlier recession, employment didn’t crawl out of negative territory for about 28 months. By comparison, in the recovery following the 2007 recession, it took only 21 months.
But GDP growth after the Great Recession has been slower than in other recent recoveries. For a few quarters, the recovery from the Great Recession did better than the one that followed the 1980 recession, but after that, the 1980 recovery consistently outpaced it.
More broadly, the economy Trump inherited from Obama was generally strong, though not without its shortcomings. Obama handed Trump the reins of an economy with a 4.7% unemployment rate; 75 consecutive months of job growth; rising stock prices, home values, corporate profits and consumer confidence; low inflation; and a record spike in middle-class incomes.
However, income inequality remains persistently high. Food stamp use and poverty rates have not returned to their pre-recession levels. Gross domestic product growth — the engine of long-term economic prosperity — remains sluggish, and job gains have been relatively modest in scale compared to some previous recoveries. And even those who credit Obama’s actions worry about a declining labor-force participation rate, which hasn’t been this low since the 1970s.
Trump pointed to the US trade deficit as an example of the “mess” he inherited from Obama. “Our trade deficit in goods with the world last year was nearly $800 billion dollars,” he said. PolitiFact noted that Trump’s figure is slightly high, and it needs some additional context.
The country’s overall trade deficit in 2016 was about $502 bln, just a hair higher than it was in 2015. But this number is calculated from two separate figures: the trade balance in goods, which includes all manufactured products, oil and agriculture products, and the trade balance in services, which is more intangible economic activity.
For years, the US has run a big deficit in the trade of goods, but a smaller surplus in the trade of services. On balance, that makes the overall trade deficit — the $502 billion figure cited above — smaller than it would be if it counted goods alone.
Trump did specifically mention goods, and for 2016, that figure was a deficit of $750 bln. It’s worth noting the deficit in goods was higher from 2005 to 2008.
Trump vowed to deliver on corporate tax reform. “Right now,” he said, “American companies are taxed at one of the highest rates anywhere in the world.”
The US has a higher corporate tax rate than most of its industrial peers, PolitiFact noted, with a 39.1% tax on corporate profits. But in practice, US companies can pay substantially less because they can claim deductions and exclusions.
Trump said his budget “calls for one of the largest increases in national defense spending in American history.” PolitiFact called that “a bit of a stretch, noting that Trump is calling for about a 10% hike in spending. But in the past 30 years, there have been 10 years when the base defense budget has gone up by more than what Trump has requested. In some years, the increase was more than double Trump’s. PolitiFact rates it mostly false.
Trump repeated his claim that “We’ve saved taxpayers hundreds of millions of dollars by bringing down the price of the fantastic new F-35 jet fighter, and will be saving billions more dollars on contracts all across our government.” The Washington Post noted that the Pentagon announced cost reductions of $600 million before Trump began meeting with Lockheed Martin’s chief executive.
Trump also overstated his claim that “We have cleared the way for the construction of the Keystone and Dakota Access Pipelines — thereby creating tens of thousands of jobs — and I’ve issued a new directive that new American pipelines be made with American steel.” This is another retread where Trump appeared to combine two disputed figures — 28,000 jobs for Keystone XL and 12,000 for the Dakota Access pipeline, but most of those jobs are short-term and the actual number of Keystone construction jobs is 3,900 on an annualized basis, with a similar gap in claimed Dakota Access jobs vs. the annualized number. And while he said the pipelines would be made with American steel, TransCanada had already bought the pipe it needed for Keystone XL in 2013, and half of it was imported, with the rest coming from an Arkansas plant that got its steel from India, the Washington Post reported.
As of 3/6, PolitiFact, a nonpartisan fact-checking group run by the Tampa Bay Times, has rated 375 statements by Trump and found that 4% were true, 12% were mostly true, 14% were half true, 20% were mostly false, 33% were false and 17% were Pants on Fire lies.
TRUMP TOSSES MORE THAN 90 REGS h. Telecommunications giants like Verizon and AT&T will not have to take “reasonable measures” to ensure that their customers’ Social Security numbers, web browsing history and other personal information are not stolen or accidentally released.
Wall Street banks like Goldman Sachs and JPMorgan Chase will not be punished, at least for now, for not collecting extra money from customers to cover potential losses from certain kinds of high-risk trades that helped unleash the 2008 financial crisis.
And Social Security Administration data will no longer be used to try to block individuals with disabling mental health issues from buying handguns, nor will hunters be banned from using lead-based bullets, which can accidentally poison wildlife, on 150 million acres of federal lands.
These are just a few of the more than 90 regulations that federal agencies and the Republican-controlled Congress have delayed, suspended or reversed in the month and a half since President Trump took office, according to a tally by the New York Times (3/5).
The regulatory retrenchment is unfolding on multiple fronts.
Congress, with Trump’s approval, has erased three Obama-era rules in the last month, lifting regulations related to coal mining and oil and gas exploration, as well as the sale of guns to the mentally ill. More than 25 additional rules could also be erased in the coming weeks, with the House having already voted to eliminate nearly half of them.
Trump has separately signed executive orders directing agencies to pursue the reversal of other rules, including a requirement that financial advisers act in the interest of their clients, and a rule aimed at protecting drinking water from pollution.
New White House appointees at agencies including the Federal Communications Commission, the Securities and Exchange Commission, the Interior Department and the Environmental Protection Agency have also personally intervened in recent weeks to block, delay or start the process to nullify other rules, such as a requirement that corporations publish tallies comparing chief executive pay with average employee wages.
The Trump administration has also imposed a broad regulatory freeze, instructing agencies to delay the adoption of any rules not already in effect, and to consider whether those rules should be targeted for elimination.
And, through yet more executive orders, it has set up barriers to enact any new regulations — such as a requirement that for each new rule, at least two others must be identified for repeal — and ordered every federal agency to create a team of employees to look for more rules that can be eliminated.
From The Progressive Populist, April 1, 2017
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