The House Freedom Caucus (HFC) is the reactionary Republican sub-caucus. It easily controls the marginal vote to get a party-line majority so it controls the most likely route to 218 in the House on any ACA repeal bill. And last night they came out with the second most important piece of news for the day (the National Security Advisor resigning as he had been compromised by the Russians is, of course, the most important)
The House Freedom Caucus and a number of Republican Study Committee members this week will urge Speaker Paul Ryan (R-Wis.) and his lieutenants to forego their plan to add replacement provisions to a repeal bill, dubbed “repeal-plus.” Instead, they want to approve the same standalone repeal bill that Congress sent to President Barack Obama in 2016.
The major elements of that bill would shut down the exchanges and subsidies after a short transition, shut down Medicaid Expansion and defund Planned Parenthood.
I’m moving my pessimism index from 80% to 70%. I’m also moving my Cassidy-Collins as a plausible skeleton index from 15% to 25%.
Why is this important?
The major difference is that the 2016 bill was a messaging and prevent the base from primarying incumbents bill. Everyone who voted for the bill knew that. The Yes votes could be broken down as a combination of people who voted yes and wanted no veto and those who voted yes and wanted a veto.
The bet is that there is a majority blocking coalition in at least the Senate of Democrats plus those Senators who voted yes and hoped for a veto. That seems to be a sure thing as Collins and Murkowski have both indicated that defunding Planned Parenthood is a deal breaker. Far more importantly, there are a large number of Republican Senators whose states have expanded Medicaid and they know that they will be blamed for causing chaos. I’m thinking that the obvious peel-able votes are from Pennsylvania, West Virginia, Louisiana, Ohio, Indiana, Wisconsin, Montana, North Dakota and Arizona. That is a blocking coalition to prevent 50 much less 60.
And if Ryan advances a bill that does not conform to HFC demands, the only way he gets to 218 in the House is if he Boehners himself. Any health policy that is more than renaming Obamacare to the Affordable Care Act will involve Ryan Boehnering himself but I don’t think he wants to do that. Nor do I think Democrats in the House would be inclined to supply 100 votes for a very long time.
PaulW
I do hope this causes a legitimate split in the Republican House caucus. I doubt it, because those bastards remain united even as the wingnuts drive the nation’s bus over the cliff, but wouldn’t it be pretty to think so that enough sane main-street Republicans scream “enough” and jump off before the whole thing crashes?
Baud
Good news. If it doesn’t halt repeal efforts altogether, it will hopefully delay things and distract from other from other things. Time is our friend.
Kropadope
@PaulW: But how does the bus get stopped?
Frankensteinbeck
Minor objection: Boehnoring himself should not be used for failing to pass a bill through only Republican votes. What made Boehner weird and unique (and a reactionary asshole) was requiring that shutout of Democrats. Don’t let him get away with blaming the Tea Party for what nobody did before him.
‘Hastert Rule’ my ass. It’s the Boehner Rule.
Kay
In a way, they’re right. Medicaid expansion was always the most liberal part of Obamacare. If you talk to people who went from no health insurance to Medicaid – which for people on that income level means no health care – it’s a life-transforming change. Opposing “Obamacare” but supporting Medicaid expansion never really made any sense if you’re genuinely “conservative”.
I would have happily supported Obamacare for the Medicaid expansion alone. It’s a shame that it didn’t pay any political dividends for Democrats, but I think they knew it wouldn’t and did it anyway which is genuinely admirable.
Baud
@Kay:
This nation’s epitaph.
Kay
Too, as someone who used to see the judgments for unpaid hospital bills in rural areas, I bet rural providers are pretty thrilled about getting paid. Maybe they don’t like the rates they’re paid but “some” is better than “none” and these people have no money and no assets- you can get all the judgments you want- they can’t pay these bills. Asking them to pay 10,000 might as well be ten million. It’s a fantasy. They won’t have that much extra money, ever. Often they can’t even garnish- their wages are too low.
Frankensteinbeck
@Kay:
Being rescued by a black man pissed 50% of whites off to the point of insanity. Sad, but the evidence is clear.
Kay
@Baud:
Schumer said it once. I laughed because it was so honest and so true. Everyone else was dancing around it and he was like “this won’t pay in votes” but was cheerfully willing to take the loss on the political ledger, in that rat-a-tat way he has. I appreciate that. It’s true and no one else would come out and say it. They took a hit w/no payback and they knew they would.
Kay
@Frankensteinbeck:
It was hard for me on so many levels. Kasich was unbearable. He decided to adopt this suffering religious martyr pose- he hated this rampant liberalism but Jesus said!
He didn’t mention all those rural providers who weren’t getting paid and now are. It was all about “the poor“
Baud
@Kay: I like Schumer. He’s not been too popular here, but I think he’s been doing a decent job.
Jeffro
Go for it, Republicans! You have the wind at your backs! The country is with you!!
(I think the non-political version of this story goes something like, “Oh please don’t throw me in that briar patch…” =)
Patricia Kayden
Still sounds like they’re determined to destroy the ACA. Heartless bastards all.
Cermet
Look for this to drag out and paper cut’s will be liberally applied by the new Health Secretary to undermine the act. Maybe some band-aids by congress but only if they get to act as if this is part of a temporary fix before repeal. But the ACA will not be allowed to continue by the Kock sucker bothers and they will lobby hard; here is hoping the thugs cave to the healthcare industry and don’t repeal.
Baud
@Patricia Kayden: No question. The only issue is whether they get to a position where they feel they can get away with it.
Frankensteinbeck
@Cermet:
If they don’t repeal, the messaging strategy will be that they did repeal and it was never Obamacare helping whites in the first place. The base will believe that the same way they believe Obamacare and the ACA are different – and for the same reason.
alce_ e_ ardilla
@Kropadope: Time. Time is not Ryan’s friend here. He has a very narrow window to pass any legislation before 1.) Trump self-immolates, or 2.) the nations senior’s wake up to what is happening. Right now they are way behind schedule, and have no concrete plan for replacement. If we can rope-a-dope into fall without repeal then I think we will be in good shape, because Ryan will not want to put repeal in the 2018 election mix.
ItinerantPedant
@Baud: Regarding Schumer. Is he perfect? Fuck and no.
But! I find this comment at LGM regarding Dr. Anti-Vax pertinent about many Capital P Progressives: “The thing about purity ponies is that they care more about being pure or being seen as pure than any sort of practical advancement of goals. Would America become a refugee paradise under HRC*? Probably not but Trump’s EO would not have been put in place either. But the purity pony is seemingly someone who likes to live under the opposition because it provides countless opportunities to prove their moral righteousness. Living under Clinton would require admissions of political limits and moral ambiguity.”
Baud
@ItinerantPedant: The Republicans won’t give me everything I want. The Democrats won’t give me everything I want. Both sides are the same.
Frankensteinbeck
@Baud:
They go whole hog on that. I’m still hearing that Hillary would have been just as bad.
Honus
@Kay: after those non-union coal jobs come back there will be plenty of money and health benefits to pay those hospital bills.
Baud
@Frankensteinbeck: Just as long as we recognize that they are not our allies.
low-tech cyclist
@Kay:
Also Tom Perriello of Virginia, who’d narrowly won a GOP-leaning district in 2008. He was open about the likelihood that supporting the ACA might cost him his seat in 2010 (it did), but his attitude was basically, ‘if we don’t do stuff like this while we’re here, then what are we here for?’
gvg
I still don’t understand why it didn’t pay in support. It should have. I thought a bunch of GOP opposition is that they thought it would too. This blog assumed it would get later support mostly. Evidently some congress people knew differently which is why they are elected and I’m not, but for the life of me I can’t understand the stupid.
Baud
@gvg: I for one underestimated the extent to which people’s self-worth depended on their ability to look down on Democrats.
David in NY
We have a Congressman, John Faso NY-19(R), who opposes defunding PP and who wants to continue medicaid expansion. That would put him voting against the Freedom Caucus proposal. We’d like to get him committed to some other facet of current ACA structure that would keep him from voting for such a proposal if the PP and medicaid expansion portions were miraculously stripped out. So far, looks like he’s buying into high-risk pools and maybe continuing coverage. Any helpful suggestions on which particular way to push him would be welcome. Also, would like to know if Faso is alone or if other Reps share his position. All help appreciated.
Buskertype
Re. The senate blockage:
My GOP senator, Capito, says that she will not vote for a repeal without a replacement. I have called her offices and pressed on this point multiple times and I keep getting the same response :)
glasnost
@davidandersen @richardmayhew – Don’t know which is right – if this is true, why is your pessimism index still as high as 70%? The Senate won’t pass this and the House won’t pass anything else, so the repeal of Obamacare is toast, right?
JGabriel
Frankensteinbeck:
Maybe, but I still prefer calling it the Hastert Rule. I think there’s political value in keeping the public reminded that Republicans put a child molester in charge of the House and third in line to the Presidency.
David in NY
@Buskertype:
I’d say you gotta move on and ask her what her replacement would be.
Another Scott
@glasnost: They don’t have to “repeal” it to destroy it. They can do lots and lots of damage in their mania to convince their primary voters that they really are getting rid of the “job killing Obamacare”…
We have to keep an eye on them and fight them every day.
Thanks Richard/David.
Cheers,
Scott.
JGabriel
I can’t speak for David, but I’d guess it’s probably because Donald Trump won the White House – proof that Republicans can’t be guaranteed not to immolate the country and their political careers.
David Anderson
@David in NY: Right now keep the pressure on Faso for Planned Parenthood and Medicaid. If the pool of money is big enough for the Exchanges the mechanics can be flexible as fuck. Medicaid is the key — hell see if he would support Medicaid expansion to 150% or 175% and shift some of the incremental savings to either presumptive eligibility or higher subsidies or a higher Federal match rate AND MAGIC DEFICIT SAVINGS!
There are enough Republicans who represent Dem leaning districts to form a secondary, House based blocking coalition.
David Anderson
@David in NY: She is a co-sponsor on Cassidy-Collins (this is why I think this is the only thing left standing that can get 60 has Cassidy-Collins as a framework)
David Anderson
@glasnost: On November 9th I was at 97% pessimism that something ACA -like could survive. I am intentionally trying to be pessimistic so that any surprise is a happy surprise.
Basically, it is far easier to break shit than either build or tweak shit. The ACA can be broken with either executive action or Congressional inaction. It can not be systemically tweaked even in a conservative preferred policy direction without a bipartian coalition. And if we model the House into three factions — House Democrats, not batshit but scared shitless Republicans and the House Freedom Caucus reactionaries/known nothings, the natural alliance structure is Not Batshit but scared Shitless Republicans + HFC and the unnantural alliance is House Democrats +Not Batshit but Scared Shitless Republicans.
Breaking things is still the easiest path forward.
Percysowner
@gvg: Honestly, I think that a lot of people would rather drown than be saved by the black guy. Now, we’ll see what happens if all the help gets taken away. The best chance will be if Trump or his successor loses the next election and we get a nice, white, male President who will reinstate the ACA.
Fake Irishman
@gvg: Mark Schafer took the same tack in Michigans seventh district, never wavering on the ACA or anything else. He lost in 2010. I got the chance to speak with him briefly after a panel in 2012 and thanked him for taking the tough votes. He told me “I sleep soundly at night.”
David in NY
@David Anderson: Thanks. At this point, we’re just trying to make him realize that existing Republican plans — continuing coverage + high-risk pools, e.g. — will not be popular here. And then if we get more Democrats in the House or Senate it will be possible to dream.
glasnost
@DavidAnderson : So if you’re at 75% pessimism in the broad category, what’s your pessimism index that ACA will be broken through afffirmative acts of legislation?
Because both exec action and Congress inaction seem overturnable pretty fast post-2020. Or 2018.
Edit: also, thanks.
Barbara
@ItinerantPedant: You can sort of divide people into the categories of evangelizers (I love it and you will too!) and separaters (I am better because I love it and you are an idiot because you can’t). The latter basically live for the opportunity to compare themselves favorably to others. Whether it’s radical Christians railing against the sinful urbanites or the perfect mother railing against the ordinary working moms who sometimes stoop to junk food or the Bay Area Foodophiles who need to move on from raw kale salad now that the rest of the world has found it — their mission is, basically, self-aggrandizing. This is especially pernicious, I think, when you see liberals who use the goal of inclusiveness as a cudgel against practical realists like Clinton, and in so doing end up making themselves and the country as a whole basically exclusionary. A little introspection and self-examination among this group would be highly welcome.
oldster
Here’s a comforting story–probably not true, but comforting.
The House Freedom Caucus saw that the public is stepping up to defend Obamacare, and that repeal is no longer politically possible. Their own Republican colleagues, their own Republican constituents, won’t let them do it.
So with that objective off the table, they decided to do the next best thing: posturing about how they are the Only True Conservatives.
The ACA can be their Roe v. Wade for decades now–they can rail against it and beat their chests about how pure they are, secure in the knowledge that it won’t be changed, because the vast majority of Americans don’t want it to be changed.
It gets them votes with their wing-nut base and gets them the support of their wing-nut patrons. So long as they have a permanent job claiming that they are just about to destroy the hated tyranny of Obamacare, they will never get primaried.
Like I said–it probably isn’t true. But it wouldn’t surprise me, either
Barbara
@gvg: One reason why it didn’t pay in support is because its benefits were too forward looking. What would have been better would have been immediate Medicaid expansion (some states like California expanded early via waiver — it was possible). When Congress passed the MMA (created Part D outpatient Rx benefits for Medicare) it didn’t really go into effect until 2006, but they phased in little goodies in advance of the major initiatives.
Barbara
@David in NY: High risk pools single out people for being sick. One argument I might try making is that when you have to pull out 25% of potential customers in order to have a prayer of making a market work, that’s kind of a clue that you can never have a truly free market. The question is, what is your “closest to free” market option. The ACA is it. It preserves individual choice and private insurance participation. High risk pools are simply a public program by another name — the equivalent of Medicaid eligibility based on health status instead of income. Plus, they are incredibly unstable and reward insurers by keeping out risks that many insurers are actually pretty good at managing.
rikyrah
When I read that…I went What Da Phuq?
Their sociopathy knows no bounds.
They literally are against the poorest among us having healthcare.
I’ll say it again: I loathe these people.
rikyrah
@Kay:
I just got tears in my eyes reading that..because, it’s true.
Which makes my loathing of those who want to take it away deepen.
rikyrah
@alce_ e_ ardilla:
Didn’t Mayhew tell us earlier in the month that we had 50 days?
If we can run out the clock, time is on our side.
Gelfling 545
@Baud: As a NY resident, I have been perfectly contant with Schumer. Sometimes I have disagreed certainly, but by and large he has done right by NY and the country.
Major Major Major Major
@rikyrah: end of Q1 was an important deadline IIRC.
Thru the Looking Glass...
@ItinerantPedant:
In other worlds… the real world… which is still vastly preferable to the ‘the black is white’, ‘night is day’, self serving fantasyland Republicans want us to put up w/…
artem1s
@low-tech cyclist:
If the Dems need to recruit Rs to primary some of the more odious members of the Freedum Caucus, Perriello is exactly the sort of legislator I can see reaching out to. If there is one, there are more who will be willing to take a couple of years out of their lives to do the right thing, even if it means getting primaried themselves in the next election. If there are still idjit enablers in the DNC who think that coddling the WWC is going to save the Dems, let them work on recruiting guys like Perriello and send them into those border red districts to run messaging campaigns. Even if they lose, the protesters who are showing up at these town halls will have someone to fight for as well as someone to fight against.
I think the Dems need to steal more of the GOP playbook when it comes to disrupting ‘safe’ elections in red districts. Right now I’m ready to send money to the most frothing at the mouth wingnut who runs in the Georgia special election to replace Price. It’s a runoff format. and if the 5-6 GOP candidates have to publicly denounce or support Twitler and spend all their time on the disaster in the WH, bonus. If the indivisible groups show up to every rally and demand they answer questions about ACA or Flynn, bonus. that might actually help the Dem candidate get over the 50% mark. I really hope the DNC is really ready to get down and dirty and use every possible advantage in the next two years.
Aaron Peterson
My daughter and I are on expanded medicaid in Arizona (I earn too much to ever qualify for traditional medicaid). Before I got health insurance I was undiagnosed diabetic with pressure ulcers. The ACA literally saved my limbs and saved me from bankruptcy. Amazingly, I owe this result to ex-Governor Jan (Mexicans are coming to chop your heads off) Brewer. She forced the expansion through an overwhelming republican anti-expansion Legislature. She was a shortlist VP candidate or potential legit Pres candidate before that. How many people in non expansion states are unnecessarily dead, maimed and/or bankrupt? And the scariest truth is I really believe Kasich would be president if he hadn’t had to deal with his expansion decision in a republican primary. If the ACA survives it will be because of expansion red state senators and reps. A nod and thank you to otherwise reprehensible republican governors who (this one time) cared more about good policy than maintaining street cred with their crazy base.
UofAZGrad
My daughter and I are on expanded medicaid in Arizona (I earn too much to ever qualify for traditional medicaid). Before I got health insurance I was undiagnosed diabetic with pressure ulcers. The ACA literally saved my limbs and saved me from bankruptcy. Amazingly, I owe this result to ex-Governor Jan (Mexicans are coming to chop your heads off) Brewer. She forced the expansion through an overwhelming republican anti-expansion Legislature. She was a shortlist VP candidate or potential legit Pres candidate before that. How many people in non expansion states are unnecessarily dead, maimed and/or bankrupt? And the scariest truth is I really believe Kasich would be president if he hadn’t had to deal with his expansion decision in a republican primary. If the ACA survives it will be because of expansion red state senators and reps. A nod and thank you to otherwise reprehensible republican governors who (this one time) cared more about good policy than maintaining street cred with their crazy base.
David Anderson
@Aaron Peterson: Agreed!
David Anderson
@glasnost: Around 75% as well… I am wrapping up intentional sabotage into the general pessimism index.
The key thing that I am flagging that has me here is that CSR payments have not been stopped. That would kill the Exchanges in no more than 30 days.
The downside sabotage risks are actuaries being told to assume that there is no mandate enforcement. That will produce a major off-Exchange non-subsidized price spike and horrendous headlines from May 15 to October 31 until people realize that the subsidized population is protected.
Everything else is a pound of flesh that is not fatal (most notably contraception). But thinking in terms of structure, it is the money that matters most.
David Anderson
@rikyrah: We have 50 days or so before the insurers start panicking as they need information for what the fuck to submit for approval for 2018 by May 3rd which means they need to have their actuarial assumptions in play by early April at the absolute latest (and lots of coffee). Ideally the insurers want their actuarial assumptions in play in January BUT…..
1,000 Flouncing Lurkers (was fidelioscabinet)
I remember when the late Ned Ray McWherter* introduced TennCare over the prostrate, kicking, screaming bodies of the state legislature in the late 1980s. There were sudden improvements in health metrics across the state, and doctors in a lot of places suddenly went from patients they saw a few times a year, in crisis, if they didn’t just see them in the emergency room, to being able to sit down with people and address health issues with a consistent plan that they could follow through on. It was amazing, and as someone who works in the disability field, the results for people with chronic, potentially disabling problems was wonderful. I knew the ACA would work, because of what I’ve seen with TennCare, especially in its early stages, and also that the GOP would hate it, because it would change lives and their names weren’t on it,
*He had a few points he wanted to see accomplished as governor that he’d been pushing, with only limited success in his years as Speaker of the TN House–roads, vocational training (community colleges/technology “institutes”/whatever), and healthcare. We are still seeing the benefits, despite the best efforts of Republican legislators and governors to tear these down, in the interests of becoming more like Kansas, AKA, a place no business would relocate to.
Bob Hertz
Dave, I also used to work for an insurance company, so your perspective is valuable.
When an actuary looks at the individual market today, he sees:
a. no mandate — this takes out some healthy people who only got insurance to avoid the mandate.
b. Age based tax credits rather than income based — this takes out the people down around 200% of poverty who were getting very large subsidies. A family of four with lower income has been getting a $20,000 annual-premium plan for about $4,000 a year of their own money. With tax credits only, their cost would go to $13,000.
c. Those who are currently in treatment for cancer, et al — they of course will stay around, whatever it takes financially.
As you have said, a responsible actuary will come back with a huge price increase. That is a way to ease out of the market and make a little bit of money on the way.