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You are here: Home / Anderson On Health Insurance / Two health policy and politics things to note

Two health policy and politics things to note

by David Anderson|  March 15, 20178:55 am| 51 Comments

This post is in: Anderson On Health Insurance, All we want is life beyond the thunderdome

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I just want to put a placeholder up for two Republican Senators who could have a very busy summer if the House bill goes pear shape quickly.

First Senator Collins (R-ME)

Susan Collins responds to CBO score pic.twitter.com/naFdvIKZft

— Ben Jacobs (@Bencjacobs) March 13, 2017

And now Senator Cassidy (R-LA)

Three myths about replacing ObamaCare must be dispelled or replacement will fail. The first myth is that replacing ObamaCare creates a “new” entitlement to universal healthcare or health insurance that did not previously exist. The second myth—cutting funding for coverage means that society saves money. The third—Republican politics demand a paltry replacement or none at all….

The fact is that it is better to pay for the care that someone is going to receive no matter what, so as to maximize an American’s potential to contribute to society, than to instead pay for expensive, inefficient, episodic care which watches a patient decline and burdens families and society. We should maximize potential. It is good policy. It is good politics….

I think Cassidy-Collins can be a framework of a deal. It needs a lot of work (very smart people who are very good at what they do have told me that as currently written C-C is an ERISA mess) but this is where a plausible deal for 65 Senators could come from.

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51Comments

  1. 1.

    Elizabelle

    March 15, 2017 at 9:01 am

    I will be loaded for bear if ObamaCare gets renamed Cassidy-Collins, over people who could not do the right thing the first time. Just always give President Obama and the Democrats credit for getting the Affordable Care Act off the ground in the first place.

    It’s good the neanderthal congressweasels are feeling the heat.

    It is sinful that well off people with GREAT government-provided healthcare and benefits are in charge of this overhaul.

  2. 2.

    Napoleon

    March 15, 2017 at 9:05 am

    Personally I would be surprised if under best so circumstances they can peal off more then a couple of Dems in the Senate, but even if they get several, would such a plan ever pass the House (where I suspect no or nearly no Dems will vote for it)?

  3. 3.

    cosima

    March 15, 2017 at 9:06 am

    I had a conversation with my mother last night along these lines. Specifically, that a civilised society understand that ensuring a citizen’s ability to contribute positively to society and the greater good requires access to both health care & education. And the US has an enormous number of people who just do not understand that, and until the balance tips toward having a greater (rather than lesser) number who do, the US is doomed. Ill &/or uneducated person have no options, they are desperate, crime increases, drug abuse, alcoholism, etc etc.

    Further, even white middle-class people like my family are not immune from the disaster that can follow from one adverse medical situation without proper insurance. Everything gone in a moment. There is only a very small percentage that will be insulated from the disaster that is Trumpcare.

    I don’t hold out much hope for the Collins-Cassidy deal, but if it generates productive discussion it’s a good place to start.

  4. 4.

    rikyrah

    March 15, 2017 at 9:09 am

    you do understand that there are a lot of us who don’t trust Collins as far as they could throw her.

  5. 5.

    David Anderson

    March 15, 2017 at 9:13 am

    @rikyrah: Agreed, but we fight with the possible allies that could exist not the ones that we want to exist

  6. 6.

    ?eric

    March 15, 2017 at 9:19 am

    I cannot see how anything that gets democratic votes in the Senate gets the members of the House Freedom Caucus and/or the Republican Study Committee to vote “aye.” I dont see it. Especially, since those same members dont (generally) see the current House bill as draconian enough. I will worry about C-C the same way I worry about cleaning up Unicorn poop in my living room.

  7. 7.

    sdhays

    March 15, 2017 at 9:24 am

    I don’t really understand how Cassidy-Collins gets 65 votes in the Senate unless 48 of them are Democrats. If the majority of votes are provided by Democrats, then it’s not really “Obamacare repeal and replace”, so where do the 17 Republican votes that aren’t afraid of a primary challenge come from? And how does this pass the House?

    The central problem for the Republican Party is that they are completely invested in destroying Obamacare and cutting taxes for the wealthy, but actually destroying Obamacare would probably cause a backlash that could have serious consequences for the permanent Republican majority. They have no interest in tweaking Obamacare in non-destructive ways, but they also have little interest in governing in constructive ways. So pressure for doing nothing is very strong.

    Josh Marshall has a post up on how the pressure to defeat the AHCA is working and that it will be a disaster for the Republicans in 2018. Defeating attacks on the ACA is worth it in itself, but I don’t really believe that if the Republicans fail to do anything much to Obamacare this year or next that they will pay a political price. The problem has always been that our side easily gets discouraged or distracted while their side never does – they always turn out no matter how disgusted they are with their own.

    On top of that, I also think it’s a mistake to take grassroots Republicans seriously that their anger is animated by Obamacare instead of thirst for dominance. I don’t think that they actually give a shit about Obamacare or the mandate any more than any other perceived slight – they really only care about kicking liberals and “those people”. Never underestimate the Base’s ability to completely forget what they were upset about for the last 8 years. Repeal and replace’s failure will confer loser-stink to Trump and the Republicans, but that won’t endanger the House majority; at best, it will be a small boost to something else.

  8. 8.

    Elizabelle

    March 15, 2017 at 9:24 am

    @rikyrah: Yes. She is made of industrial grade slippery and slithery substance. She is good at soaking up credit when she actually could have done much better. (See “Betsy DeVos”. Brave Susan Collins voted against DeVos in the full Senate after Career Republican Susan Collins passed the nomination through committee — the only real chance of stopping DeVos, and one Brave Susan Collins did not take.)

    She’s still heads above most of the GOP Senators, but that is faint praise indeed.

  9. 9.

    Aimai

    March 15, 2017 at 9:25 am

    @David Anderson: there should never be a compromise that relies on democratic votes and renames Obamacare–collins should switch to being a democrat or commit seppuku for very shame first.

  10. 10.

    prob50

    March 15, 2017 at 9:27 am

    The bill deserves at least a thorough read and analysis from knowledgeable experts (and a full CBO assessment, of course).

    If it is harmful and sucks (a highly probable condition) then push for rejection.

  11. 11.

    PaulW

    March 15, 2017 at 9:30 am

    As long as Republicans as a party are obsessed with their tax cuts, I can’t see any GOP-based healthcare plan working.

    Like it or not, something of this scale requires funding, and to make it affordable to the majority – if not entirety – of Americans it’s going to have to come in the form of taxes.

    And REPUBLICANS HATE TAXES (on the rich).

  12. 12.

    MomSense

    March 15, 2017 at 9:34 am

    I’ve been calling Collins just about every day. Hard to get more than a voicemail option.

  13. 13.

    Barbara

    March 15, 2017 at 9:36 am

    There are 48 Democratic senators. I don’t see where 10 additional Republican senators supporting this legislation are going to come from to create a filibuster proof majority, let alone 16 to create a veto proof majority. However, even if they could get the minimum, if I were Schumer, my message to Susie C. would be that at a minimum a majority of Republican senators (27) have to vote in favor or there is no deal. Remember the bail out vote in which Pelosi refused to let the measure pass based solely on Democratic votes? That should be the minimum demand Democrats make of Republicans seeking bipartisan solutions for health care. Every issue presents its own calculus of risks and benefits, but it is outrageous that elected representatives from red states “blame” Democrats for programs that disproportionately help their own constituents. If they want to pass health care reform then they have to demonstrate the willingness to bear political risk in making it happen.

    ETA: That is assuming that it would be worth any Democrat supporting. I am skeptical that at the end of the day this bill will look anything like what its proponents first cobbled together.

  14. 14.

    ArchTeryx

    March 15, 2017 at 9:39 am

    From thread downstairs:

    I know one thing for certain: If a SNAP-like work requirement was instituted for Medicaid, I’d die waiting for the paperwork to clear.

    For SNAP, if you’re classed able-bodied, you have to do one of two things: Travel (up to 50 miles each way) to a job search center and search for work at least 30 hours a work, or prove you work at least 30 hours making minimum wage. For a self-employed person like myself, it completely hoses me; my income is not 30/minwage stable, and as long as I am doing any sort of self-employment, they won’t classify me as ‘disabled’ because I’m working! If I stop working and file for disability, it can take years to clear through the state system. And if you DO meet their requirements, they slash or eliminate your benefits because you’re making too much! Nice Catch-22 the Republicans of the 90s set up.

    They do the same to Medicaid, it will be like demographc exclusions on steroids: A way to make sure that very few people actually can get into the program. They’ll pair it with very rigid income and asset tests, I guarantee that, so that nobody working anything more then 10 hours a week can qualify, and nobody working UNDER 10 hours a week can qualify, either.

  15. 15.

    OzarkHillbilly

    March 15, 2017 at 9:40 am

    @Aimai: For all I care they can call it “The Grand Golden Trump Healthcare Act for The Ages” ™, and if it actually provides healthcare to every American when they need it, as they need it, as they can best afford it, I really don’t care. We will all know who is really responsible for making that very idea acceptable to America, and those who don’t know, don’t want to know..

  16. 16.

    Barbara

    March 15, 2017 at 9:41 am

    @Aimai: Yes, let Collins switch to the Democratic party. That would be a bigger threat if Dems had just one more seat in the Senate.

  17. 17.

    comrade scotts agenda of rage

    March 15, 2017 at 9:44 am

    Meh, this is Collins pulling her usual schtick. Note the wording of the sentence:

    “…which would expand access to health care coverage…”

    Emphasis mine.

    All the Repubs yammer about is increasing “access”, not increasing those covered or reducing costs, etc. She’s not saying anything different than the rest of them. She’s just couching it in her usual way so as to dupe the easily duped Villagers into screaming “MODERATE REPUBLICANS HAVE A PLAN! THE ONLY THING STOPPING US FROM PEAK BRODERISM ARE STUBBORN DEMOCRATS!!!!!!”

    Again, get back to be when Collins does something truly outside the tribe.

  18. 18.

    D58826

    March 15, 2017 at 9:47 am

    In a sane society, Congress would just patch the holes in Obamacare. Would probably take a week or two on the legislative calendar.

  19. 19.

    OzarkHillbilly

    March 15, 2017 at 9:47 am

    @PaulW:

    And REPUBLICANS HATE TAXES (on the rich).

    Yes, the qualifier is all important. They just love sin taxes.

  20. 20.

    Kropadope

    March 15, 2017 at 9:49 am

    The second myth—cutting funding for coverage means that society saves money.

    I bet he was even hitting this point real hard when a Democrat was still president.

  21. 21.

    Aimai

    March 15, 2017 at 9:51 am

    @OzarkHillbilly: no–the right thing for democrats to do is introduce the Campaign Trump Health Care Act which would give absolutely free coverage to everyone and suggest paying for it be deferred to two second phases.

  22. 22.

    JMG

    March 15, 2017 at 9:54 am

    @Aimai:
    Outstanding idea!

  23. 23.

    schrodingers_cat

    March 15, 2017 at 9:56 am

    @rikyrah: She is a P-H-O-N-Y. I used to live in Maine. Her reputation as a moderate is undeserved. She knows how to preen for cameras in her whiny voice.

    ETA: Olympia Snowe and William Cohen are better examples of moderate Maine Republicans.

  24. 24.

    artem1s

    March 15, 2017 at 9:56 am

    @sdhays:

    I don’t really understand how Cassidy-Collins gets 65 votes in the Senate unless 48 of them are Democrats. If the majority of votes are provided by Democrats, then it’s not really “Obamacare repeal and replace”, so where do the 17 Republican votes that aren’t afraid of a primary challenge come from? And how does this pass the House?

    and if they need 48 dems to get this passed, why not use that as leverage to just expand ACA the way dems always planned to expand it. Use C-C as a platform to introduce the stuff we know the WWC idiots don’t want to lose. Who cares if it’s a poison pill to the bill. It keeps the discussion alive and in the media. It means every GOP lackey has to face angry town halls screeching about why aren’t they producing the unicorn the WWC was promised. It is plain that Ryan needs Dems to get this done. Make the asshole pay for it. Make him beg and then tell him ‘you get nothing’.

  25. 25.

    liberal

    March 15, 2017 at 9:57 am

    I’m pretty sure that by the time Nelson (NE) retired, Collins was to the right of every single Democrat in the Senate.

  26. 26.

    Another Scott

    March 15, 2017 at 9:59 am

    Like other commenters above, I don’t see a productive result of this exercise.

    But I was surprised by Tim Kaine saying on NPR this morning that he has all kinds of amendments he wants to propose in committee to fix whatever bill the House passes, if they pass anything. Maybe it’s “please don’t throw me in that briar patch” 11-dimensional chess stuff, but it seems to me that if the GOP wants to destroy Obamacare, then they alone must own it. We shouldn’t be helping them “fix” what they’re joyously breaking when they have the votes to do it on their own.

    Collins has a long history of tut-tutting and then voting however McConnell wants.

    We’ll see, I guess.

    Cheers,
    Scott.

  27. 27.

    schrodingers_cat

    March 15, 2017 at 10:00 am

    @David Anderson: She is not an ally you can trust.

  28. 28.

    The Moar You Know

    March 15, 2017 at 10:02 am

    I think Cassidy-Collins can be a framework of a deal.

    Two words: “Freedom Caucus”

    This will never happen. At least, not unless the Dems are so utterly stupid as to help; and they very much need to not participate at all.

  29. 29.

    MomSense

    March 15, 2017 at 10:03 am

    @rikyrah: @David Anderson: @schrodingers_cat:

    Never trust Collins.

  30. 30.

    The Moar You Know

    March 15, 2017 at 10:05 am

    The bill deserves at least a thorough read and analysis from knowledgeable experts (and a full CBO assessment, of course).

    @prob50: It sure does, and if the Republican party deems it good then they can pass it. Without one single Democratic vote.

  31. 31.

    schrodingers_cat

    March 15, 2017 at 10:09 am

    @MomSense: But she keeps getting reelected.

  32. 32.

    prob50

    March 15, 2017 at 10:10 am

    @OzarkHillbilly:

    For all I care they can call it “The Grand Golden Trump Healthcare Act for The Ages” ™, and if it actually provides healthcare to every American when they need it, as they need it, as they can best afford it, I really don’t care. We will all know who is really responsible for making that very idea acceptable to America, and those who don’t know, don’t want to know..

    Right on!

  33. 33.

    ThresherK

    March 15, 2017 at 10:11 am

    @MomSense: She’s the Senate version of Invisible Boy, a superhero who remains invisible unless someone is looking at her (i.e. her vote would make a difference).

  34. 34.

    MomSense

    March 15, 2017 at 10:24 am

    @schrodingers_cat:

    It drives me crazy. So many democratic women vote for her and I try to explain why she’s a problem but they are so programmed by NPR to believe she is a moderate who is sooo civil and works with everyone.

    @ThresherK:

    Perfect description. One of the most quotable movies of all time, BTW. It’s a family favorite.

  35. 35.

    Major Major Major Major

    March 15, 2017 at 10:26 am

    I’m pretty sure the original plan was to use the “tea party” “uprising” to put a bunch of standard, fool-the-plebes republicans in charge who would then pass Ryancare and call it a day, not letting the lunatics run the asylum via the Freedom Caucus. It’s very karmic, unfortunately we bear the brunt of the cost.

    I hate Susan Collins as much as the next person but if this is a bill that can get past the senate (which means it would require Dem cooperation, so it would have to earn it–more on that), and the House which would require Ryan telling the Freedumb Caucus to pound sand, and it would shut everybody the fuck up about destroying Obamacare, then it’s better than anything Ryan is going to produce and it’s better than Trump faithlessly executing the ACA so that it falls apart. At the very least it’s worth reading and scoring. And in that scenario it’s worth Dems considering support.

  36. 36.

    prob50

    March 15, 2017 at 10:26 am

    @The Moar You Know:

    It sure does, and if the Republican party deems it good then they can pass it. Without one single Democratic vote.

    Well, look, I recognize the likelihood of the proposal being crap and if is then we should blast away at it. But if there is anything actually useful and humane in it those ideas could be incorporated later on in possible amendments to fix flaws that currently exist in the ACA. It appears you’re telling me you couldn’t support such ideas if they came from that side of the aisle.

    For the record, I hate what the Repubs are doing about as much as anyone here, and I fervently hope they lose their legislative majorities in ’18.

  37. 37.

    Kropadope

    March 15, 2017 at 10:28 am

    @The Moar You Know:

    This will never happen. At least, not unless the Dems are so utterly stupid as to help; and they very much need to not participate at all.

    I don’t know, in the off chance that they can assemble a coalition to pass reforms that legitimately improve the state of healthcare, I say go for it.

  38. 38.

    Major Major Major Major

    March 15, 2017 at 10:33 am

    @Kropadope: Right now, I’ll settle for “shuts everybody the fuck up about destroying the safety net with only minor damage.”

  39. 39.

    Kropadope

    March 15, 2017 at 10:40 am

    @Major Major Major Major: We don’t need no stinkin’ safety net. Don’t you know that’s just an incentive for people to fall?

  40. 40.

    Barbara

    March 15, 2017 at 10:47 am

    @prob50: I read it when it came out, but I do think that the yardstick should be what we have now. If it is better than that or improves the status quo then I would be for it. If it is simply a less awful compromise than the outrage being considered by the house, then I don’t see the point. The prospect that it will be a compromise between what the house passes and what the Senate can “live with” means that it is unlikely to be better than the status quo. Democrats will not get dinged if they don’t vote for something that proves to be popular, but they will get tarred ever which way if they give bipartisan cover to something that is worse. That’s the way it works.

  41. 41.

    amk

    March 15, 2017 at 10:54 am

    @Barbara:

    Even if one dem cong critter votes for it, the rethugs and their msm minions will claim the bill passed with a yyyuuuge bipartisanship and will stick all the failures to the dems. They nailed Hillary for one Iraq vote and all the rethug war criminals have gotten away scotfree.

  42. 42.

    Another Scott

    March 15, 2017 at 10:54 am

    @Barbara: Bingo.

    As Nancy said when she was asked about her alternative to W’s privatization of Social Security, this time “Our plan is to protect the ACA” is a good mantra. Genuine improvements are fine. Compromise for the sake of passing something to help the GOP keep their promise to repeal Obamacare, isn’t.

    People don’t want to destroy their heathcare system and their access to that system in exchange for giving millionaires tax cuts. If they insist on doing that, we should say No. This shouldn’t be controversial.

    Cheers,
    Scott.

  43. 43.

    schrodingers_cat

    March 15, 2017 at 10:55 am

    How many times do the Democrats need a knife in their back to know never to give an inch to the Republicans. They want kill us and you want to compromise with them? WTF is wrong with you? Even my cats have a better instinct for self-preservation.

  44. 44.

    Major Major Major Major

    March 15, 2017 at 10:57 am

    @Another Scott: unlike with social security, though, Trump can half-trash the ACA just fine by himself without any legislation.

  45. 45.

    prob50

    March 15, 2017 at 11:02 am

    @Barbara: I wouldn’t be in favor of any bill that makes things worse, but I would like Dems to support something that makes things work better, especially if it needed their votes to pass.

    And yes, a Republican sponsored bill that make things work better is probably not a likely scenario. It is kind of hard to conceive of, barring some sort of typesetting error in printing the bill’s final language.

    Perhaps “better” and “Republican” are too much of an abstract combination to actually be considered plausible.
    Still, if it happened I would be in favor of support.

  46. 46.

    Another Scott

    March 15, 2017 at 11:10 am

    @Major Major Major Major: Indeed.

    The GOP has the majority. They can pass what they like. That’s what having the majority means – they get the glory, and also get the blame.

    Unfortunately, until Congress (and the White House (and the Courts)) change, there’s little that we can do as the minority. But we can finally refuse to play into the “both parties are the same” meme that has killed our chances with so many voters. As Barbara said, making this fiasco “bipartisan” will not help make it better in the long run. We have to do everything we can to maximize our chances in the states this fall, and in states and the Congress next year.

    I understand the risk to real people in us just saying “No”. But I don’t see how helping them gut the ACA helps the electoral prospects of Democrats. And that is the way to actually make things better for real – throw out the Teabaggers and elect Democrats, and that means having an absolutely clear choice for the voters. No “both sides” – not this time.

    Trump has shown every indication that he is going to run roughshod over the government no matter what the rules and norms are. It’s hard for me to see any bill passed by this Congress and signed by him as being any check on what he and Price end up doing to the health care system. In other words, what is the value of some moderate language that Collins or Kaine manages to get in the bill if Price and Trump ignore it, or don’t fully fund it, or if they have “other more important priorities” or if they make waivers and exceptions the normal course of business? We’re ~ 50 days in and they’re trying to destroy everything no matter what the existing laws and policies are.

    In normal times, yes, we compromise and try to get the best bill we can. These are not normal times.

    My $0.02.

    Cheers,
    Scott.

  47. 47.

    Kropadope

    March 15, 2017 at 11:33 am

    @Another Scott:

    No “both sides” – not this time.

    “Both sides” is an element of American folklore. It is endemic in the media and in casual conversation about government by people who don’t really pay attention to the government. You won’t get rid of “both sides,” but there are, as I can count, three ways the “both sides” narrative can play out here.

    I think “both sides are intransigent and can’t work together” is really dangerous for the Democrats. Polls show that Democrats like the idea of working together and compromise on the whole. Many wouldn’t like the idea that the Dems dug in to an across the board “no” position without fighting for something better. Plus, given how the Republicans treated Obama, this looks way too much like “both sides are the same.” My main concern here is that both sides narratives always cut against Dems in the media and the intransigence by the Dems angle would be played up over the fact that the repeal effort is truly just an extension of the Republicans’ last 8 years of intransigence.

    But worse still would be “both sides got together to gut the ACA.” This likewise has elements of both sides being the same, except would be a blatant betrayal of the voters by the Dems. Fortunately, though, I don’t think D pols are that stupid.

    That leaves us with the possibility that “both sides get together to fix what’s currently broken.” And we do know that the ACA did leave some aspects of healthcare delivery in a less-than-ideal state. The Dems would likely have to do the heavy lifting on this and they would have to do so with a plan to make sure Trump isn’t the one who winds up with the credit, cult of the Presidency and all. There would also be likely elements Dem voters don’t like, R majority and all. It’s far-fetched that a working Congressional majority can be formed around such a thing, but if Congress can somehow produce something that legitimately helps people, I don’t see why the Dems shouldn’t go for it. Besides which, if there is no buy-in from Rs, the best PR for the Ds would to be seen trying to help people (like constituents) and being rebuffed. It may even help push back against the “both sides” narrative, even though I maintain that particular zombie will never die.

  48. 48.

    prob50

    March 15, 2017 at 1:43 pm

    @Kropadope: Thread is probably dead, but I think this is the most cogent comment of all.

  49. 49.

    Another Scott

    March 15, 2017 at 3:12 pm

    @Kropadope: Good points.

    It’s hard to know how things will go. We need to make our opinions know and push the things we can. We’ve got no control over how the press and the political operatives spin things – we can only do what we can…

    Cheers,
    Scott.

  50. 50.

    Debbie1

    March 15, 2017 at 3:20 pm

    @schrodingers_cat: Her emails are in order.

  51. 51.

    dww44

    March 15, 2017 at 3:55 pm

    @cosima:

    Specifically, that a civilised society understand that ensuring a citizen’s ability to contribute positively to society and the greater good requires access to both health care & education. And the US has an enormous number of people who just do not understand that,

    I believe Americans used to understand this with no problem. But over the last 30 years (certainly since Reagan and 1980) a signification portion, maybe even at times a majority of us, has come to believe that a viable public education system and a health care system open to all is a luxury that the country cannot afford.

    As one who lives in a redstate where the white middle class has largely walked away from its public schools, the generations younger than me largely have no experience of a public education and don’t understand the equalizing and the lifting of all boats that results from a great public school system.

    As far as health care, the nursing home industry in this red state would die pdq if Medicaid funding is pulled. My Mom was in a nursing home with Alzheimers for almost 6 years prior to her death. We could not have provided her the necessary care otherwise.

    This needs to be shouted out long and loud every day from now till this proposed legislation gets voted on.

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