Let’s rewind history.
The Trump Administration in 2017 worked their asses off to repeal the ACA and dramatically reduce the Medicaid program by converting it into a block grant structure where federal funding would shrink as a percentage of spending over time.
Let’s look at the legislative history in 2017:
We had ACHA V1 that never came to a vote in the House in March 2017.
We had ACHA and the MacArthur amendments that were a fig leaf of a high cost risk pool pass the House in May 2017.
We had the CBO say that bill would cause tens of millions of people to lose coverage.
We had a bunch of competing bills ping-ponging in the Senate for the first half of the summer.
The Cruz Amendment of parallel risk pools and authorizing cocaine and hookers via a waiver process becomes the blue print for conservative health policy since then.
Vote-a-rama happens in the Senate.
- Strict repeal fails
- ACHA fails
- BCRA fails
- Murkowski and Collins are joined by McCain’s thumb down with unaminous Democratic support to sink Skinny Repeal
Cassidy-Graham-Heller try to block grant the ACA to states with lots of money going to states that chose not to expand Medicaid (IE the 25 governor/50 Senator plan) That never comes up for a vote
2017 Tax cut bill eliminates the penalty for failure to have creditable coverage effective 1/1/19.
Now let’s look at the regulatory side:
The first executive order from the Trump Administration was on the ACA. It directed the federal government to find every way possible to not spend money on the ACA. This resulted in television advertising being immediately shut off in the last few days of the open enrollment period. This led to an immediate 30% decline in enrollment applications relative to the same week in the prior year.
Open enrollment periods were reduced.
Navigator funding was slashed to eventually 10% of pre-Trump levels.
Massive political uncertainty likely drove out some insurers in 2017 and 2018 (some were leaving anyways).
I can say that the Trump administration did three intentional things that were ACA supportive. They did one thing that pragmatically was supportive although they intended the action to blow up the market.
First, they pushed for rapid deployment of Enhanced Direct Enrollment to Healthcare.gov which makes the task to enroll people a lot easier for brokers.
Second, they created regulations for Individual Contribution Health Reimbursement Accounts as a way to chip away at the employer sponsored market and bring new folks into the individual market.
Third, they approve a lot of reinsurance waivers which are good at reducing premiums for upper middle class folks.
The biggest support policy for the ACA from the Trump Administration was an accident. In October 2017, direct reimbursement for Cost Sharing Reduction (CSR) subsidies was stopped. The administration intended to make the market roil as insurers would be required to offer a benefit without a source of cash to pay for it, thus leading to a lot of mid-year exit and chaos. OOPS!
Insurers and states responded with Silverloading that made subsidized insurance a lot cheaper for ACA enrollees with incomes under 400% FPL.
Baud
They’ll take credit for it, however. But thanks for bringing receipts.
Starfish
I am going to ask you random stuff that you may or may not be following. What do you think of the investigation of Steward Healthy Care?
What do you think about the lawsuit against the pharmacy benefits managers?
Mowgli
Wait, wait. Are you saying Vance may not have accurately summarized the history during the debate last night?
say it ain’t’ so.
Another Scott
But their asses are still there, so something doesn’t add up!!
;-)
Something something old age and treachery something something.
People who know what they’re doing can still defeat the new monsters if they put in the work.
Seriously – Ouch. That must have been painful to go through again.
It’s important to document the atrocities, but it’ll hurt your head if you over-do it.
Thanks.
Cheers,
Scott.
David Anderson
@Starfish: Interesting but outside the realm of my expertise.
Starfish
@David Anderson: You always blog as if we are not all experts on hurricanes, middle eastern politics, and whether or not we should wear pants.
catclub
Was there any truth in the statements Vance made about prescription prices?
I think there was something recently where Trump claimed credit for the insulin price control and the Democrats show Biden signing a bill.
David Anderson
@Starfish: Pants are up for discussion.
David Anderson
@catclub: Minimal — there was a voluntary demonstration project to get insulin to a $35 copay in Medicare Part D
https://www.kff.org/policy-watch/the-facts-about-the-35-insulin-copay-cap-in-medicare/
The big action was legislation under Biden.
Pragmatically, the co-pay cap is mainly an outlier trimmer of the worst behaviors of insurers and does not bite for many people.
catclub
@David Anderson: Thanks!
ArchTeryx
One thing worth mentioning is tht both the ACHA and “Skinny Repeal” completely did away with the Medicaid Expansion. That was where most of those 10 million were going to lose coverage. And that wasn’t enough for those monsters; turning Medicaid into a block grant program (and instituting unlimited waivers) was their way of indirectly killing Medicaid altogether. Even states that were extremely Medicaid-friendly like New York State were looking at drastic cuts to Medicaid just to stay fiscally afloat. And that’s where I came in, because at the time, stripping my Medicaid was as good as killing me. And I was HARDLY the only one. Millions were expected to die if Skinny Repeal passed.
And the fuckers in the House threw a kegger after ACHA passed. They were celebrating those deaths openly and on camera.
Now think of what would have happened if they’d killed Medicaid right before the COVID pandemic. We lost a million people to that. If Medicaid were gone and most states blocked poor people from any medical care, what would COVID had done to us then?
Anonymous At Work
This is flipped:
It wasn’t that Murkowski and Collins joined McCain. It was that McCain voted LAST and SWITCHED his position by surprise (he was less a ‘maverick’ than mythologized) after the GOP Whips thought he was in the bag. I guarantee that, had McCain voted first, Suzy Collins would have found some reason to be “concerned” about ACA and voted to repeal it in favor of a “bipartisan compromise”.
Anonymous At Work
@David Anderson: Florida made capped insulin prices mandatory at $40 under DeSantis during COVID, I remember. It was a big deal for those without. I think either they or BCBS started allowing prescriptions for longer than a month as well to cut down on required trips. Big change for those on a sliding scale but probably only barely detectable by specialists at a macro level.
Frankensteinbeck
Removed – wrong thread! Ha!
Frankensteinbeck
@ArchTeryx:
McConnell’s absolute determination to gut Medicaid doomed his repeal of the ACA. He’s such an evil fuck that he couldn’t resist poison pilling the legislation his caucus wanted to pass most.
ArchTeryx
@Frankensteinbeck: It didn’t doom it. What doomed it was McCain wanting to spite McConnell virtually from the grave, by throwing his Precious right into Mount Doom. It shocked everyone, me included; conventional wisdom of the time was if the House passed it, it was a done deal in the Senate. And only pure spite from a dying Senator saved what could have been 10 million deaths. What a country.
The only even blackly humorous thing to come out of that near-humanitan catastrophe was seeing the Gravedigger of Democracy caught utterly, totally flat-footed. I guess when people are near death, they think about their legacy much harder than they normally would, and McCain didn’t want to go down in history as a mass murderer.
ArchTeryx
@Anonymous At Work: This is exactly right. Suzy Q was always there when you never needed her. When it came to her vote actually deciding the issue she voted with the Republicans 100% of the time.
eclare
A friend and I, both of us covered under the ACA, stayed up to around 2:30 AM, when we watched McCain give the thumbs down.
We were so relieved. Yet another example of Republicans trying to kill their fellow citizens.
eclare
@ArchTeryx:
I remember your comments from back then.
eclare
@ArchTeryx:
I also think McCain loathed TCFG. Why wouldn’t he?
David Anderson
@eclare: Yep, and once I figured out what I had just seen, I cracked open a bottle of 15 year Scotch
ArchTeryx
@eclare: I was the human face around here (or at least a human face) of what millions of deaths by deliberate, malignant neglect was going to look like. And now we may face it all over again. That’s what keeps me awake at night.