Wednesday, September 27, 2017

Heads up: GOP's Repeal/replace Obamacare is a cat with 9 lives

Heads up. GOP's dire plan to repeal/replace Obamacare is a cat with 9 lives. It just needs calling up for a vote by the Senate leaders  or being rolled into tax "reform" during  the next budget reconciliation opportunity..There is one coming up. Flipping Rand Paul's vote with special considerations is always possible. Sen. Lisa Murkowski of Alaska went from a leaning "no" vote to neutral after the GOP offered her special deals.  Likewise, those GOP Congresspeople who claimed they opposed Graham-Cassidy because it did not "do it by regular order", hearings, CBO scores, etc., would not  use that excuse to oppose it again.  Regular order in theory would free more GOP members to support whatever comes out of committee. 
The Congressional committees must demand CBO scores on any health care repeal/replace/fix bills they are considering at the bare minimum so that the number of those losing affordable insurance, including Medicaid, will be known to the public.  That is part of regular order. 

 The battle for 2018 Congressional makeup should be started now by Democrats. They have a rich opportunity to force their opponents to tell how they would vote on any repeal/replace/fix bill or to justify why they voted as they did. It will be a very hot issue whether it is  sneaked through sooner or closer to the 2018 midterms.  The only way consumers can be assured they will not lose their insurance will be to flip the House to a Democratic majority and to protect what Democratic Senate votes they have. The GOP plans so far have only garnered 17-24% approval by voters and voters see this as family pocket book issues presenting a direct threat and loss to them. It is even much easier to understand than tax reform which will only relieve them (or not) of a  marginal tax burden. Putting money in a pocket is always politically easier than taking money/benefits  away.

Pres. Trump just announced he will issue an executive order to allow consumers to buy insurance across state lines, Rand Paul's proposal. Watch what Rand Paul does. Will he switch from "no" to "yes"on a promise?   It is going to be after Friday or  January,  February, or March Trump  says, putting the question into "regular order".and/or requiring 60 votes and bringing along some Democrats.  He says is fine  to go through regular process and still have a vote on Graham/Cassidy or others like them.

 Buying insurance across state lines is a mirage. The CBO has already scored it as only helping 3 million people more to  afford insurance under Obamacare. . Furthermore, under Obamacare,  multi- state  group plans were permitted, and they never took off.  There are reasons. Consumers lose easy appeal if they have a complaint about of state insurers since they would have to register and fight for  appeal in  the insurer's  home state. . Furthermore, big insurers  with affiliates  in many other states like Blue Cross and United can collude to set prices  across state lines since insurance companies are exempted from  federal anti trust laws. They could hike prices in other states . Without essential benefits being required, there would be .a full out race to the price  bottom of useless,  deceptive insurance with few benefits.

Expect, too, that the political problem of doing end runs around each state insurance commissions may create another potential opposition group.  State Insurance Commissions are long, old political plums and state by state control would be lost.

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