Right now, the current Republican plan is Repeal and Delay as the NY Times reports:
Republicans in Congress plan to move almost immediately next month to repeal the Affordable Care Act, as President-elect Donald J. Trump promised. But they also are likely to delay the effective date so that they have several years to phase out President Obama’s signature achievement.
This emerging “repeal and delay” strategy, which Speaker Paul D. Ryan discussed this week with Vice President-elect Mike Pence, underscores a growing recognition that replacing the health care law will be technically complicated and could be politically explosive.
The mechanics of the repeal bill are fairly straightforward. A reconciliation bill would be written to sunset subsidies and Medicaid Expansion money after two (or three) years while a Replace bill is cobbled together. The individual mandate tax would be dropped to zero even if it was not technically repealed and all of the taxes that fund the ACA would be dropped immediately. This blows up the insurance market fast. There are discussions and rumblings that some Republican wonks are trying to make this point to Republican leaders. Someway of shoveling a massive amount of cash to insurers would be needed that would perform the same function as risk corridors and reinsurance but called something else is the most likely response.
And then there would be some type of Replace bill that would offer skimpier subsidies and much higher cost sharing than current law.
That Replace bill will cost money. It won’t cost as much money as the ACA but it will cost money.
That is a major problem as the major funding streams from the ACA (Cadillac Tax and high income tax surcharges) are gone. Nicholas Bagley at the Incidental Economist flagged this very early on:
You’ve got to bear in mind that passing the reconciliation bill would represent an immediate $346 billion tax cut over ten years to the wealthy—$123 billion from the Medicare tax surcharge and $223 billion from the tax on investment income. All of that money—every dime—will go to people making more than $200,000 a year.
The other major source of funding for the ACA is the Cadillac tax in the out years and Medicare Advantage payment equalization. The Cadillac tax is popular with health economists who, when they concentrate for an annual convention, might have sufficient political power to elect a county commissioner in an NFL market and no one else. The Republican Replace plans use modified Cadillac plans that usually apply regular income tax rates to health insurance benefits at far lower thresholds than the Cadillac tax. But I digress.
The Replace plan will cost money. And here is where we run into the Norquist problem. It is Republican orthodoxy that once a tax cut is passed it can never be re-enacted. The Replace Bill would not be signed for at least six months (absurdly optimistic case scenario) after the Repeal bill that wiped out the high income taxes that fund the ACA. The Congressional Budget Office (CBO) would score Replace based on current law which means no high income surcharges as offsets. Republicans can’t vote for higher taxes per Norquist even if those are taxes that just got cut.
Assuming Norquist is still a major political enforcer of Republican orthodoxy, my best bet is that any Replace Bill will be like the 2003 Medicare Modernization Act (MMA) in that it is almost completely deficit financed.
Baud
Didn’t they have the tax problem in Jindal’s Louisiana and they invented some accounting trick to get around it.
danielx
@Baud:
If so it wasn’t a very good trick, considering that Jindal left the Gret Stet’s finances in smoking ruins.
Baud
@danielx: It satisfied Norquist, which was the only important thing to them.
I wonder if the GOP will name the repeal the “I Blame Obama Act of 2017.”
germy
Paul Ryan and Ayn Rand both collected social security benefits. Isn’t SS next in the crosshairs, after the ACA, Medicare and Medicaid?
Baud
I have a feeling the “offficial” deficit will go down because things will be taken off-budget. That was a Bush-era trick that Obama reversed and, of course, got blamed for.
azlib
If you nuke the funding immediately doesn’t that destroy the individual markets since premiums will go up drastically for most people in the individual market? Sounds like delaying the replace part is just a smokescreen since the individual markets will be a smoking hole by that time. These people are really heartless bastards.
Peale
I think the end game is 25% uninsured, your children and your children’s children forced to work to pay the hospital since bankruptcy is no longer an option, and a return of the very ineffective healthcare bills of rights.
Botsplainer
If somebody clubbed Norquist to death with a baseball bat, then he wouldn’t be in a position to advocate this anymore.
Problem solved.
Corday
Given this, what should be our strategy to oppose? Keep the pressure on the Senate? I’m meeting with some local Dems this week. Our rep is in the Freedom Caucus-a lost cause. But I think we should host a public forum. But this is so sneaky, quick, and complicated. I’m trying to work out what the message should be. Also, has Ryan dropped the plan to take out Medicare and ACA in one shot?
Peale
@azlib: you see, those people were never “really” insured. Just like government workers don’t have real jobs, only manufacturing jobs are real, and there are no really poor people in this country-only black people who democrats try to gotv with food stamps. So all of those people who claim to be losing their coverage are false. They never had real coverage to begin with because it wasn’t supplied by an employer. No one will miss that not real coverage because things that aren’t real can just disappear without effecting human beings.
Amir Khalid
Here’s what I don’t get: If Obamacare is so popular, why do Republicans want to abolish it at all? Do they really want to hand the Democratic party a talking point? Are they that spiteful?
Schlemazel
@danielx:
When have the modern Republicans ever considered that a negative?
JPL
@Botsplainer: Norquist’s wife is Muslim, and he supports the guy who wants to ban Muslims from our country. Who would have thought that the party is made up of hypocrites.
mai naem mobile
Well,Norquist is married to a Muslim woman. Take a page from the Republicans and smear Norwuist as a terrahrist sympathizer and ask every GOPr why they are following Sharia law.
Schlemazel
@Amir Khalid:
Easy, they will blame the Dems for it “the thing was so untenable we had to kill it!”
Hal
Question: I work in a cancer hospital with patients who have exchange plans or are covered under medicaid expansion. If someone is a brand new patient let’s say this January, what are their options?
And for people who have already started treatment and are looking at the next two to three years with regular visits, with the possibility they may need more chemotherapy and or radiation etc during that time, what should they do?
Poopyman
@Botsplainer: Alas! His ideas have been around so long that I’m afraid they’ve taken on a life of their own.
Not that I don’t see an upside to your solution, though.
Baud
@Corday: I still like, “You were conned.” Obviously, Dems need to not support any bill that does this. I hope Pelosi and Schumer can hold the caucus together.
Shalimar
@germy: If Paul Ryan gets his way, next generation’s Paul Ryan won’t have the money to go to college and follow in his footsteps. I’m guessing the sociopathic asshole sees that as a positive. They should overcome the obstacles he places in their way if they want to be a true Randian hero.
Botsplainer
@Poopyman:
“Pour encouragement les autres” could well work to dampen the frantic advocacy of (bowel) movement conservatives.
If they understood that at some point there is a price to their conduct…
Juice Box
@Amir Khalid: Obamacare isn’t popular. People hate it. However, they like all of Obamacare’s provisions except the individual mandate. Hence my suggestion; rename the plan Reagancare and rename the individual mandate “the American Eagle”.
hedgehog mobile
@Amir Khalid: Yes.
germy
@Shalimar:
Unless the next generation Ryan is from a wealthy family of lawyers.
Meanwhile, while we worry….
the new administration is partying. I saw photos of a “Heroes and Villains” costume party they had. Conway was dressed as Supergirl.
Bob Schooley tweeted “Who has costume parties in December?” He compared it to the “Eyes Wide Shut” film.
Schlemazel
@Hal:
They really can’t kill it for 2017 as that is already a done deal. After that it is anybodies guess. If the GOP does its worst I could see many desperate people trying to rush treatment while they still have coverage
Shalimar
@Amir Khalid: Republicans only care about Republican voters, and Obamacare is extremely unpopular with them. Even the ones who benefit from it and don’t call it Obamacare anymore because that is an evil word.
Yes, they know it might hurt them politically to eliminate it, but A) as Mayhew points out, repeal is a big tax break for rich people, and B) they have been promising their supporters for 7 years that they would repeal obamacare, so there will be a huge backlash for breaking that promise.
Their extreme rhetoric while out of power has left them no option now that won’t be unpopular with large numbers of people.
Shalimar
@germy: the Mercers, Conway’s billionaire masters, do whatever they want whenever they want. They even let Donald Trump come as Lex Luthor with wig.
Это курам на смех
@Hal:
Die quickly?
Sorry I don’t mean to be cynical about this. Perhaps they will have no options.
greennotGreen
John Q x 10000. My sister is white(r) with rage at Trump voters precisely (or at least mainly) because of the threat Trump poses to her son’s health insurance. He has cystic fibrosis. So, the same party that would now insist that a precious CF fetus not be aborted wants to assure he can die early anyway after bankrupting the family.
I hate them too. For my nephew and, as a cancer patient, for me.
PR
@germy:
It’s all goin’ down, baby. President Ryan will make sure of it.
Don’t bitch about your lost entitlements. SS has a lousy rate of return anyway (seriously even savings accounts aren’t much worse).
Be a capitalist. Get in the stock market now! Deregulation , tax cuts and debt financed infrastructure spending are gonna make the markets go fuckin bananas for the next four years!
It will be the 1920s all over again! Boom baby, boom!
germy
@PR: “Boom” is right.
Brachiator
Of course, Republicans will argue that the wealthy should never have had these extra taxes imposed upon them in the first place, while Democrats will mumble something about “fair share.”
But it makes sense that the GOP might kill ACA by killing it’s funding, even if they run it at a deficit for a while. And killing the Individual Mandate will give middle income taxpayers an immediate cash boost when they do their taxes.
I imagine that Trump and the GOP Congress could keep the insurance companies from squeaking too much, or could simply blame any subsequent problems on Obama.
The final reckoning will be a mess, but the suckers who voted for Trump will convince themselves that they got exactly what they wanted.
PR
@germy:
Dow 42,000. Watch out!
greennotGreen
@Shalimar: Yes, but Republican voters largely base their policy preferences on a very poor understanding of what those policies actually are. If repealing Obamacare blows up the insurance market and that, in turn, affects their family, that family may become former Republican voters. If, on the other hand, the individual mandate is dropped so that there’s no penalty for not having insurance, that’s great for them! Until Bubba wrecks his four wheeler and spends ten days in the hospital on everyone else’s dime. So, still great!
Hal
@Это курам на смех: That’s my big fear.
Sigh. Just think, if Hillary Clinton had won we would be debating the potential for public options and expanding health care. Good job Trumpsters.
Kathleen
@Amir Khalid: Yes, they are that spiteful, hateful and mean.
Brachiator
@germy:
Evidently, this party is a regular thing put on by the wealthy Mercer family, big Trump supporters.
And “Eyes Wide Shut” aptly describes Trump voters.
germy
@Brachiator: Doesn’t seem wholesome to me, to quote Marge Simpson.
RealityBites
Time to educate the public. Ideally by getting lots of people to tell their health care stories. Get news coverage locally and in Washington. Interviews, YouTube, all forms of social media. Protests. Maybe the protest theme should be: “won’t lie down and die”. Get the stories of people who WILL die without the ACA. Have huge displays of their “death” certificates. Turn up the political heat for no repeal until a “better” replacement is ready. Act out “arrests” of people like Ryan for “attempted murder”. Introduce bills for the government to pay funeral expenses for anyone who dies after loosing coverage. Have experts testify about how many people will die in each state, or will no longer be able to get continuing treatment for cancer, diabetes, high blood pressure, etc. Put a human face on all of this. Get the stories on local and national television.
There are 20 million people being helped by the ACA. Start with the people who will die without it, then find the people who used it so they could leave their old jobs and care for sick children or parents.
Make the Republicans own their evil. Point out that they have had six years to come up with a plan and didn’t do it. They can’t be trusted or believed.
Point out the how the ACA has helped rural areas keep their hospitals and health care providers in business to provide care for EVERYONE in the area. Ask the rethugs how that money and the economic activity that goes with it will be replaced. Get as many charities and nonprofits as possible on board.
Ksmiami has suggested a health care education PAC. There are lots of good ideas and things to do. And it will help us prepare for the many more fights to come.
The main problem is how and who can ORGANIZE plan this attack. Stronger together.
Jinchi
@Baud: Republicans only care about the deficit when Democrats are in power. My guess is we don’t hear another word about the deficit until after tax cuts are passed and they need an excuse to gut Social Security.
Shalimar
@greennotGreen: Admittedly, Republicans have yet to destroy a program that has a substantial personal impact on people’s lives like Medicare or Social Security. Based on what we have seen so far in the last few decades though, Republican voters are like cult members and I doubt seeing Republican policies directly lead to grandpa Bill’s death is going to change many of their voting habits. They hate who they are told to hate and don’t seem to have the capacity for logic.
Brachiator
A significant number of people hate the Individual Mandate. They reject the idea that they should be forced to get insurance if they don’t want it or when they don’t feel they need it.
During a tax law seminar I spoke at, a couple of CPAs asked if a person with two dependents could not claim them so that they would not be hit with the Individual Mandate for them. The parents would still be hit with a payment and a hypothetical couple might lose some credits and deductions for the dependent kids, but the weird workaround gives some idea about how much the ACA is hated by some people.
Brachiator
@germy:
Oh, it was quite a bash.
More here
https://www.google.com/amp/abcnews.go.com/amp/Politics/donald-trump-kellyanne-conway-stephen-bannon-attend-lavish/story%3fid=43958443
Adam L Silverman
@germy: And Hayek had to be formally guaranteed by the Kochs that he would be able to access Medicare before he’d leave Germany and his state funded through taxes health insurance before he’d come to the US and become a distinguished senior fellow at their think tank. The road to serfdom indeed.
gene108
@RealityBites:
Great idea, but who has the money to put together this sort of thing?
There are probably enough capable documentary film makers, who could make these stories come to light, but who is going to pay them and support their work and provide coordination, so it becomes an organized effort?
That’s a problem conservatives do not have to grapple with, because there are always billionaires with bags full of cash willing to fund anything.
Another Scott
@Amir Khalid: GOP orthodoxy is that the government providing a public good though taxes is bad for them as a party because:
1) It shows that government can work. That destroys a bedrock principle that “government is the problem”
2) Actually paying for things with taxes means that deficits actually do matter (to some extent). Taxes actually do good, rather than just being a black hole slush fund for “those people”. We can actually run a budget and include everything and not pretend that “tax cuts pay for themselves” or “deficits don’t matter when the GOP is in power”, etc. It shows that there actually is a choice between saying the richest country in the world can’t afford to do anything and actually raising money to do something
3) It shows that they aren’t the party of “fiscal responsibility” and that Democrats actually do know how the world works while the GOP doesn’t. Democratic policies actually can make things better. Democrats can never be allowed to get credit for anything good.
Norquist or someone said in 2009 that the ACA had to be opposed tooth-and-nail because if it passed it would be almost impossible to get rid of…
Cheers,
Scott.
gene108
@Another Scott:
The Republicans went out of their way to kill the Clintons healthcare plan, in 1993, because it might start convincing people government can work for their benefit.
They would rather see people suffer and die, than admit their philosophy is wrong.
And half the country supports them in this, which is sadder.
D58826
As one of his final environmental acts, Pres. Obama is adding the famous ‘gop deficit hawk’ to the endangered species list. They have not been seen in the wild for several decades and the only known representatives reside at the Capitol Hill annex of the Washington DC Zoo. Biologists are still trying to determine if there is proof of life :-)
D58826
Since I don’t have kids, when can I get my rebate for all of the taxes paid to educate other people’s kids???? (snark/sarcasm)
fuckwit
kill the poor. and the sick.
hitler tried to do it too overtly. wasn’t abstract enough.
this is the more american way to do genocide: let the free market do it!
D58826
@Brachiator: And that doesn’t include whatever tax cuts they get from changes to the tax code.
What I still do not understand is these folks, right now, have more money then they and their spawn can spend in several times. I saw somewhere they could burn a 1k bill every second of the day until the universe ends and still not touch the principal. They could just use the interest. SO other than pure greed why the obsession to hoover up every last dime?
Lurking Canadian
I think the Democrats need a punchy slogan. Resurrecting “If you get sick, die quickly” might work. As I said the other day on LGM, I think they should refer to repeal as “Ryan’s plan to kill 100,000 Americans”, based on pre-ACA estimates of 30,000 deaths per year suffered by people for lack of health coverage.
Whatever they choose as a slogan, it should make clear that this is malice on the part of the Republicans. People dying isn’t just going to happen. People going bankrupt isn’t just going to happen. It’s something Paul Ryan is going to do to them because he enjoys their suffering .
they should repeat it over and over. Yes, Wolf Blitzer and David Brooks will clutch their pearls and say, “How dare you suggest that Speaker Ryan isn’t motivated by high-minded principle”. The Dems need to fight through that shit.
Remember, they made the absurdity that was “death panels” stick. This plan could work the same way, and has the benefit of being true.
Corday
@Lurking Canadian: Good idea. A quick google search found this: http://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/
and RealityBites has good ideas too. Like I said, I’m working locally. Finding those stories in the county and pitching them to the local papers/TV news might work.
Another Scott
@D58826: The rich want more and more because they’re always making comparisons to their peers. “I’m better, smarter, more talented, etc., than the head of XYZ Corp., I should be making more than he does.” It’s not about what they can do with the fortune they have, it’s about being ranked higher than their peers.
Business Insider:
IOW, those guys make a boat load of money, I should too! Pay me!!1
:-/
Cheers,
Scott.
J R in WV
@PR:
Dow 42,000, gas at $40/gallon. In constant dollars, that’s a Dow of 3800, which is more likely given Trump’s ignorance. In other words, a catastrophe~!
I don’t know what to do with my retirement savings… bonds? Stocks? Gold in a bank vault in the Caymans?
At least no one paying attention will be bored. Maybe we should do a pool, bet which new member of the nuclear club comes first, bet on the first nation to set off a nuke in anger, bet on their target, the casualty count, declared vrs undeclared war…. etc.
There are so many interesting things to bet on!
Back on topic, they may just tinker a little with Obamacare, declare it repealed and replaced, rename it Trumpcare.
David S
Private insurance for everyone and get Mexico to pay for it……. :(
The Very Reverend Crimson Fire of Compassion
@Amir Khalid: Yes. This has been an installment in the series, SATSQ.
VFX Lurker
@J R in WV:
I hear ya. I have 20-30 years to go before retirement, so I’m going to leave my IRA in Vanguard’s Lifestrategy Moderate Growth fund until then. It spreads my meager savings across ~10,000 stocks and bonds around the globe, for a rock-bottom cost. Best part: it auto-rebalances, so I don’t have to look at it until I retire.
One thing I wonder about: the US Treasury has never defaulted on its debt. Ever. Right now, Treasuries are the safest thing one could own. If that changes in the next four years, it will shock every endowment and pension fund. As far as catastrophes go, it’s relatively small potatoes compared to the other kinds of damage that Trump can do.
I dread the next four years.