It was bad policy, not poor tactics or negotiating skills, that doomed the GOP’s efforts to repeal and replace Obamacare.
he and his allies crafted a poorly constructed and radical bill that would sharply cut support to low-income Americans and those with serious health conditions, while enacting big tax cuts for the wealthy.
.. Speaker Ryan’s crafting of AHCA was a slapdash enterprise.
.. even leading health-care experts were confused by the changes. As Timothy Jost noted at Health Affairs: “This comprehensive a repeal of the ACA would have far-ranging consequences for our health care system that can scarcely be described, much less understood, in the hours that remain before a vote.”
.. wondered whether the game plan was just for the House to pass something—anything—and then let the Senate do the real work.
.. So why did Republicans fail? In a word: insincerity.
.. they might have refined another conservative model, such as Avik Roy’s modifications to ACA exchanges, to turn ACA’s exchanges in a more conservative direction.
.. Secure in the knowledge that they would face President Obama’s veto, Republicans rammed through a succession of extreme repeal-and-replace bills that resembled AHCA’s original draft. These bills excited the Republican base, but would have horrified most other Americans if they ever found sufficient reason to look.
.. Congressional Republicans suffered what George W. Bush might call a “catastrophic success” with Donald Trump’s unexpected victory.
.. leaving people in plans where the “deductibles are so high that it’s really not worth much to them.”
.. He vowed to replace the “failing,” “horrific” Obamacare with “something terrific.”
.. Republican plans are designed around higher deductibles and narrower benefits, not to mention more limited Medicaid.
.. smaller financial subsidies for people with chronic health conditions. That was the clear intention, but Ryan refused to admit it.
.. Many in the GOP, above all President Trump, seemed strangely uninterested in the policy details.
.. To the extent Republicans did have an animating passion, it was to puncture President Obama’s legacy—and to avoid looking foolish by failing to honor their “repeal and replace” rhetoric.
.. For all their endless warnings about how Obama’s signature health law was hurting American families, driving up costs and putting us on the path toward socialism, it turns out they didn’t care enough to put in the work.
Why Wasn’t Trumpcare More Popular?
Conservative health-care analysts on why the GOP couldn’t come up with a stronger replacement for Obamacare
.. outside groups—he implicated Heritage Action and Club for Growth—were urging Republicans to repeal Obamacare as quickly as possible. Because of that, House Republicans “didn’t give themselves enough time
.. “Repeal and replace” seemingly meant different things to different Republicans. Moderates wanted to protect the law’s more popular provisions while tweaking its subsidy structure.
.. the AHCA was authored in a way such that it would cut federal spending—the goal of conservative Republicans—not necessarily boost health-care coverage.
.. a 1989 plan from the Heritage Foundation—the one that started it all—also included tax credits and an individual mandate.
.. “The original outline was their idea!”
.. That’s because there are two basic models for health systems, Laszewski says: single-payer or Obama/Ryan/Trump/Heritage/PriceCare. One is a government-run system offers a rudimentary plan to everyone. The other one is a delicate Jenga tower of mandates, credits, and incentives, all balanced on the rickety table of the private-insurance industry.
.. Republicans had to go with the AHCA, that is, because there just aren’t that many other, non-socialist ways to do health insurance coverage... Ultimately they settled on Obamacare, helping the poor at the expense of the better-off, while the AHCA would have done the opposite... “We used to say Republicans didn’t have the health-care gene,”
The Passion of Southern Christians
Turns out a gay couple had bought or inherited a farm just down the road from her. The good ladies of that rural community welcomed the couple with poundcakes and homemade jelly, but would they have voted for a political candidate who supported marriage equality? Not a chance.
Partly this divide comes down to scale: You can love a human being and still fear the group that person belongs to.
A friend of mine recently joined a continuing-ed class made up about equally of native-born Americans and immigrants. The two groups integrate seamlessly, joking around like any co-workers, but the day after the election my friend said, “I think half my class might’ve just voted to deport the other half.”
.. But what’s being planned in Washington will hit my fellow Southerners harder than almost anyone else. Where are the immigrants? Mostly in the South. Which states execute more prisoners? The Southern states. Which region has the highest poverty rates? The South. Where are you most likely to drink poisoned water? Right here in the South. Where is affordable health care hardest to find? You guessed it. My people are among the least prepared to survive a Trump presidency, but the “Christian” president they elected is about to demonstrate exactly what betrayal really looks like — and for a lot more than 30 pieces of silver.
The Limbaugh Health Care Reform Plan
Because I don’t think it really has anything to do with health care. I think it’s just the redistribution of wealth, the power.
.. Well, what do you think liberalism is, in part? About making these people feel good about the messes that they’ve made, all because they care and they have great compassion. And they’re great at using other people’s money, which is what Medicaid and Medicare are, to take care of people and keep ’em away from you. If put everyone on Medicaid and Medicare then you can assume they’re gonna have health care, problem solved. You don’t have to hear them complain anymore, you don’t see ’em, you don’t run into ’em.
.. it seems simple to fix this. Just use a little common sense, trust the free market, get the players that have made the mess out of the way
.. Trump is probably finding out just how deeply intertwined the tentacles of this are throughout our society.
.. And what happens when you remove one tentacle? Yeah. And then you find six more pop up that you didn’t know were there. That nobody knew were there, is how deeply embedded some of this stuff is.
.. Providing health care for people with preexisting conditions is the equivalent of selling somebody a homeowner’s policy for a hundred dollars while the fire is burning their house down. It just doesn’t happen, yet in health care we’re doing it. And it screws up all of the actuarials. It screws up all the calculations, it screws up all the numbers, it screws everything up.
.. I’m just saying that once you include people with preexisting conditions in the pool with everybody else and then you go get premiums based on that, it’s not gonna work. You just can’t do it because you’re not talking insurance on preexisting conditions; you’re talking welfare. And nobody in Washington has the guts to eliminate coverage for preexisting conditions.
.. I have no desire to run anybody else’s life. I don’t care whether somebody can run theirs or not; that’s their responsibility and their problem.
.. I do not live under any illusions that I should tell everybody how to live.
.. My health care reform plan is real simple. For everybody who can, and we would have to have a very, very honest assessment of that, you buy your own. You can either get it from your employer as part of your deal there, or you don’t and you go out and make your own deal. You’ll be able to make your own deal because the government’s not involved and there are insurance companies all over this country selling health insurance, and they’re competing with one another
.. “But Mr. Limbaugh, Mr. Limbaugh, what about the people that can’t afford it?”
.. Well, what’s made it different today than the way it was then? And I would argue it’s a bunch of people dipping their hands in it and being involved in it who are not in the business. Trying to buy votes with it, trying to insure and secure power with it and trying to basically tell people, “You know what? You don’t have to be responsible. We’ll do that for you. Just vote for us.”
.. if it’s this bad, how in the world can the people in charge of it not know it’s this bad? If it is this bad, then why do the Republicans want to hand power back to the Democrats? Why do the Republicans want to hurt Trump’s base?
.. this bill makes it illegal to check an enrollee’s immigration status. You ask why would they do that? Well, well, we’re talking about the open borders crowd. We’re talking about a party that’s been telling us for the last 10 years they don’t think they will ever become a political majority without paying homage to Hispanics.
.. They’ll hire actors to portray these old people and indigents who’ve been left behind. That’s just what they do.
.. to compare subsidies and tax credits is purposefully misleading, and you can’t compare the value. They each have different political values and so forth, but tax credits end up — that’s money you get a credit for on your tax, you don’t pay as much, so that leaves you with more money to spend theoretically shopping for a better deal on health care. Subsidies just help you pay for something. You never see the subsidy, somebody else writes the check or sends the money or what have you.
.. one of the new CEOs, it was either General Motors or Ford took over and after about six weeks this guy said, “I thought I was getting in the business to make and sell cars. I didn’t know I was getting into the health care business.”
Because his job, the number one cost at his automobile manufacturing company was health care for his employees.
.. make it single payer, where nobody worries about cost except they theoretically do as they ration and deny certain people, but in reality they don’
.. If employers are going to be given tax credits for the health insurance they buy for their employees, why shouldn’t individuals get it? Why shouldn’t it become a deductible item?
.. Tax credits end up you having a little bit more money in your back pocket, which, if we’re gonna start applying degrees of conservatism, that’s a pretty conservative thing to do, have a policy where people get to keep more of their money in this.
.. So how can the Democrats complain about tax credits for the self-employed? Poets, painters, and that’s who Pelosi talked about. Free from job lock so you can become a poet, so you could become a painter.
.. Job lock, as though everybody was locked in a job they didn’t want because they needed the health care. So Obamacare was gonna come along and free you from all that.
.. people like Obama, Hillary, they love subsidies because it makes you dependent. You never see the money.