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Republicans Claim That Their New Plan to Repeal Obamacare Is a Moderate Compromise. LOL.

Republicans Claim That Their New Plan to Repeal Obamacare Is a Moderate Compromise. LOL.

by Jordan Weissmann @ Slate Articles

On Monday, two plucky Senate Republicans are set to embark on one final madcap effort to repeal and replace Obamacare. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana have promised to introduce a piece of practical, compromise legislation that will simply let states decide whether to keep the Affordable Care Act or ditch it for something they prefer.

“It would leave in place taxes on the wealthy, taking that money and giving it back to governors to come up with better health care,” Graham has told CNN. “If you like Obamacare, you can keep it. If you want to replace it, you can.”

This modest pitch is wildly misleading. Graham and Cassidy have been shopping versions of their bill for months now, and submitted a detailed version as an amendment in July. As it stands, the legislation would make it virtually impossible for dozens of states to continue operating Obamacare as we know it without kicking in unrealistic amounts of their own money. That’s because, in the short term, the law is designed to penalize states that embraced the ACA while rewarding those that resisted it. Further down the line, the legislation simply zeroes out all of Obamacare’s spending, a de facto repeal of the entire program that doesn’t include a replacement. As policy, it’s a bit like walking into somebody’s house, lighting the whole ground floor on fire, then telling them, “Hey, you can keep living here—if you like it.”

In its early years, Graham-Cassidy is about robbing Peter to pay Paul—or, to be more precise, raiding California’s health-care budget in order to temporarily lavish some extra dough on North Dakota. The bill would take all of the money Washington currently spends on Obamacare’s Medicaid expansion and premium subsidies, then distribute it to states in the form of block grants that, in theory, lawmakers in Albany or Topeka could use to fund whatever health care system they desired. Meanwhile, it leaves in place some of Obamacare’s consumer protections for patients with pre-existing conditions.

Sounds reasonable? There’s a catch. Instead of determining each state’s block grant based on how much money it receives under Obamacare today, the bill would doll out funding based on a baroque formula that favors poorer, older, sparsely populated parts of the country. As a result, it shifts spending from large states that expanded Medicaid, like California and New York, to small states that did not, like Mississippi and Alabama. There are some exceptions to this rule. For instance, nonexpansion states like North Carolina and Florida could see their health-care funding slashed, since lots of their residents get premium subsidies through the ACA’s exchanges today. Nevada, which did take up the expansion, could see a slight funding bump. But, as a whole, the bill starts off as a giant slap at states that committed the sin of trying to get more of their residents insured through Obamacare.

It gets worse. Graham-Cassidy schedules its block grants to grow slower than the cost of health care or insurance, thus eroding their value over time. According to the progressive Center on Budget and Policy Priorities, the system would would lead to a 34 percent spending cut by 2026. Nine states—California, Connecticut, Delaware, Florida, Massachusetts, New Jersey, New York, North Carolina, and Virginia—would see their federal health-care funding cut in half under the block grant system, compared to what they would have received from Obamacare’s Medicaid expansion and subsidy spending. Keeping the ACA in place would require spending vastly more of their own state revenue, which would be prohibitively expensive.

And what about the winners under the block grant setup? Many of them turn out to be losers, too. That’s because, like previous Republican House and Senate health-care bills, Graham-Cassidy would impose a per-capita cap on traditional Medicaid, designed to throttle its spending over time. By 2026, just eight states would end up with more overall health care funding than under current law—and many of them would probably be better off if lawmakers just swallowed their irrational animosity toward the ACA and expanded Medicaid.

But the real kicker comes after 2026. At that point, the block grant simply disappears, leaving states to fund whatever insurance scheme they’ve set up without federal assistance. As CBPP’s Edwin Park noted to me, this is even more draconian than what Republicans dreamed up in the previous House and Senate bills, both of which would have left in place subsidies that Americans could use to buy insurance. “Looking past 2026, both the House and Senate had their grossly inadequate tax credits, but they were permanent. Here, all funding for expanded coverage, the marketplace subsidies and Medicaid expansion, disappears,” Park said.

So far, nobody seems to be taking Graham and Cassidy too seriously, mostly because time is working against them. While Senate Majority Leader Mitch McConnell has dangled the possibility of a vote, few seem to think the pair can move their bill before the end of the month, when the legislative vehicle Republicans are counting on to pass repeal with a bare majority expires.”I don’t think there’s much of a chance,” Sen. Orrin Hatch of Utah, the Senate Finance Committee chairman, told Politco. Plenty of other Republicans apparently agree. President Trump, meanwhile, has not-so-subtly nudged everybody to move on.

Even so, this bill should make Obamacare’s supporters nervous, at the very least. It doesn’t merely shuffle Obamacare’s funding around, but rather chokes it off entirely over the course of a decade. Graham and Cassidy may be attempting the legislative equivalent of a half-court buzzer beater. But we’re in big trouble if they just happen to sink it.

Bernie Sanders’ Big Single-Payer Proposal Skips Over the Hardest Thing About Single-Payer

Bernie Sanders’ Big Single-Payer Proposal Skips Over the Hardest Thing About Single-Payer

by Jordan Weissmann @ Slate Articles

After weeks of buildup, Sen. Bernie Sanders has finally released his latest plan to create a single-payer health care system in the United States, tugging along 16 Democrats as co-sponsors of the Medicare-for-all legislation, many of whom appeared with him at a buoyant press conference Wednesday afternoon. On its face, the rollout was an impressive show of political support for an idea that, not so many years ago, was widely considered a patchouli-scented left-wing fantasy, on par with dragging George W. Bush before a war-crimes tribunal and cutting the defense budget in half.

But in some subtle ways, Wednesday’s health care pep rally also showed what an uphill climb Medicare for all still faces, even among Democrats.

The fact that one-third of Senate Democrats have now endorsed Sanders’ version of Medicare for all mostly affirms something that’s been obvious for a while: Thanks to America’s favorite irascible socialist, single-payer health care is now a mainstream liberal policy idea. Even more telling is the number of potential 2020 contenders who have decided to get on board with the plan. Sens. Kamala Harris, Kirsten Gillibrand, Cory Booker, and Elizabeth Warren each took turns at the podium Wednesday extolling the virtues of socialized health insurance. Such a scene that would have been utterly unimaginable eight years ago. Their support may or may not be 100 percent heartfelt, but it’s pretty clear where they think Democratic primary voters will be standing on this issue in four years.

It’s also important that these senators have planted a flag on what they mean by “Medicare for all.” For months now, Democrats have been murmuring the phrase without fully defining it. Now, they’re getting specific. The new bill would not only extend Medicare to the entire population, but—much like the plan Sanders campaigned on—make it dramatically more generous by eliminating co-pays and deductibles while adding benefits for dental and eye care. It’s a truly all-encompassing vision of publicly financed government health care. And it will be extremely hard for other Democrats to brand less ambitious ideas—even interesting, Medicare-related ones, like blowing out Medicare Advantage—as “Medicare for all.”

But the reality is that 16 Democrats did not back a fully workable single-payer plan Wednesday. At best, they backed half of one. While the Sanders bill details how a “Medicare for All” system would work, it tap dances around the all-important question of how to pay for it.

The legislation itself does not include any taxes. Instead, its authors have written up a complementary white paper titled “Options to Fund Medicare for All” with a menu of tax hikes that add up to about $16.9 trillion over a decade (which, for what it’s worth, might not actually be enough to cover the cost of a single-payer system). That might give wonks a sense of what the bill’s backers are thinking. But it definitely gives the co-sponsors a convenient out from endorsing any specific tax increase that could be used against them in a campaign ad. More importantly, at least if you’re a single-payer fan, it means they haven’t committed themselves to some of the more controversial trade-offs that would be necessary to make single-payer a reality. If four years from now Democrats win control of Washington, it’s entirely possible some of the politicians jumping on the Medicare for all bandwagon now will jump off once Congressional Budget Office scores start rolling in and they have to reckon with the actual cost, just as some Republicans have suddenly had second thoughts about repealing Obamacare now that they’ve had to write a bill.

It’s not especially surprising that Sanders & co. would choose to leave the sticky question of taxes for a later date. As the senator himself said, this legislation is just an appetizer designed to “begin the debate” about the future of health care and single-payer. The unveiling functioned as an early head count of Democrats who are at least enthusiastic about the idea in theory. At such an early stage, it would be political malpractice to alienate potential allies by forcing them to sign on to $17 trillion of carefully spelled out tax hikes when Democrats barely have enough power in Washington to rename a post office.

And, to be sure, the senators who endorsed Sanders’ bill Wednesday did take some risks. The polling on single-payer is mixed—the Kaiser Family Foundation describes support as “malleable”—and some voters are still going to hate the idea of giving up their current coverage for whatever plan Washington cooks up. Moreover, Wednesday’s bill would reimburse doctors at current Medicare rates, which would save the government money but would surely arouse opposition from hospitals and some physician groups. The fact that Medicare for all is still controversial was probably best illustrated by the fact that one of the Senate’s most reliably progressive members, Ohio’s Sherrod Brown, declined to co-sponsor it. It’s not much of a mystery why: He’s running for re-election next year in a state Donald Trump won by eight points and that has largely elected Republicans to statewide office in recent years.

But Brown’s hesitation is a sign of the challenge single-payer supporters face. If the left wants to remake the entire U.S. health insurance system from the ground up, it will need the support of purple- and red-state Democrats. And as of now, it can’t even get a died-in-the-wool, labor-loving progressive to support a fantasy bill that shunts inevitable tax hikes into a companion document. Medicare for all might be mainstream. But it’s got a long, long way to go before it becomes consensus.

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