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TrumpCare is a Human Rights Catastrophe Being Advanced Through an Undemocratic Process

[ 77 ] June 22, 2017 |

The Senate version of the AHCA is here, and it’s morally repugnant.

It will probably pass although it has virtually no public constituency, and as Beutler says this will happen in part because the undemocratic process McConnell used played the media like a fiddle:

For the reasons spelled out above, I think this misdiagnoses the source of the challenge and the solution to it. Senate Majority Leader Mitch McConnell didn’t lock down the bill-writing process in order to block liberals from going over the bill with a fine-tooth comb. His chief insight was in recognizing a bias—not among liberals, but within the news industry—toward what you might call “new news.” Things we didn’t know before, but do know now. It is that bias, more than anything else, that has brought us to the brink of living under a law that almost nobody on the planet has seen but that will uninsure millions to pay for millionaire tax cuts.

And it’s not just the quantity of coverage, either. The Times did run an A1 story on the AHCA, and the results were surely pleasing to the people looking to take insurance away from 23 million people to pay for an upper-class tax cut:

President Trump had urged Republican senators to write a more generous bill than a House version that he first heralded and then called “mean,” but Republican leaders on Tuesday appeared to be drafting legislation that would do even more to slow the growth of Medicaid toward the end of the coming decade.

This is not a neutral way of describing upwards of a trillion dollars and Medicaid cuts. This is just pure, undiluted Republican spin. Holding a vote two days after the release of the CBO score will help obscure the truth, but the media shouldn’t need a new score to tell the public the truth.

I have to say, it sure is weird how much federal spending for the poor and federal consumer regulation you eliminate when you repeal a neoliberal bailout of the health insurance industry.

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  • And I’m quite sure that now matter how vile this is, Trump’s base will stick with him no matter what.

    • Denverite

      The really funny — and by “funny,” I mean suicidally depressing — part is how Trump is going to run against the then-impending cuts to Medicaid in 2020, and no one in the media is going to point out that he signed the bill implementing those cuts in the first place.

      • Of course, because by then it will all be the fault of the Democrats.

      • FlipYrWhig

        He will stretch out his little hands and say, “Folks, I didn’t want it. I didn’t want it. And we’re going to fix it, believe me. This is what I do, fix things.” And all his idiot legions will cheer, at least those of them that can still express a voice between their hacking coughs.

        • Denverite

          “Obamacare was broken. Kaput. We had to get it off the books. And yeah, the replacement — which otherwise was a really wonderful bill — had to make some cuts according to the Senate rules because the Democrats were being obstructionists, but instead of blaming each other for those cuts, the important thing is that we elect someone who can fix them. And Pottymouth Kirsten isn’t that candidate!”

          • Jonny Scrum-half

            Your Trump quote is so believable that it’s not even parody.

            • CaptainBringdown

              The only thing missing is “I alone can fix it.”

              • Domino

                Throw in a couple of “Folks”, and then have him repeat everything he said in that a paragraph later, and you’ve got him down to a T.

    • aab84

      People keep saying this, even as his approval rating keeps falling, and even as his “strong approval” rating falls even faster. If by “base” you mean “27% rule,” I’m sure you’re right. But I don’t see how that’s particularly meaningful either.

      • It doesn’t matter what his approval ratings are. Republicans vote Republican, no matter what.

        • aab84

          Right, but Republicans aren’t anywhere close to a majority of the voting populace. Democrats vote Democrat too, except former Solid South Democrats who haven’t been actual Democrats since Reagan. Doesn’t stop them from losing elections.

          If Trump and Congressional Republicans only hold onto hard-core Republican voters, they’re going to be facing 2006/2008 all over again. And that’s before we even get into motivation and turnout.

          • Davis X. Machina

            Gonna need a war. Iran, anyone?

            • rea

              Or Qatar . . .

          • Yes, but also with a lot more gerrymandering and voter suppression. Which is not to say that people should give up. But 2018 is not going to be the wave a lot of people think it will be.

            • aab84

              We’ve seen major swings toward Democrats in every single special election held since November, and in basically every state-level race as well. Troublingly for Republicans, we’ve seen bigger swings in lower-profile races like Kansas and South Carolina than in over-saturated races like GA-06. That suggests a major enthusiasm gap, one that is far more likely to be replicated in the midterms — where each race is just one of 470 — than in the most expensive special election ever. On current trajectory, a lot of Trump voters may just stay home, especially since he’s not on the ballot.

              Meanwhile, Reps like Barbara Comstock and Leonard Lance are acting like they’re terrified, and Republicans are having trouble recruiting challengers even in seats like Jon Tester’s. We’re miles away from the midterms and a million things can happen, but right now, pretty much all the signs are looking very wave-ish.

              Also, gerrymandering actually makes huge waves more likely, not less, given the nature of the process. For the most part, Gerrymandering works by creating a bunch of 55-45 districts, spreading your voters out in the most efficient way. That’s great until a wave hits. Then all those 55-45s can go down at once.

        • Jon_H11

          In GA-6 2016 Trump got 48% of the vote to Hillary’s 47%, Price got 62%. Handel got 52%, Ossoff got 48%.

          That’s a 20 point swing that an non-Trump Republican took because of Trump. That’s a significant number of Republican or Republican leaning independents (same thing basically) not voting Republican*–just because of Trump.

          *Or every single person that voted for the D in the house race 2016 voted in the special election. And if there’s that kind of turnout advantage the midterms will be a bigger wave than 2006 or 2010.

          • Bufflars

            Yeah, I believe the stats were showing equal turnout for Dems from 2016 – which is almost unbelievable. To get presidential-election turnout in a special election in JUNE is amazing. The Republicans were down 30% participation from 2016. As you say, if Dems can produce presidential style turnout for off year elections there will absolutely be a wave.

    • twbb

      Healthcare is different. He may keep the 25% that never abandoned GWB, but if this goes through it will wreak havoc on the GOP in 2018 and 2020. Even if it DOESN’T go through they are going to pay a price for it.

      • Denverite

        Most people have employer-provided insurance (which will be affected by this, but only indirectly, and not until after 2020) or Medicare. You underestimate the power of “I got mine, now go fuck off” in the American populace.

        • NonyNony

          OTOH – everything about my employer provided insurance for the past 8 years has been blamed on Obamacare (the legislation so powerful it reached back in time and affected insurance rates before it was even a law – just the thought of Obamacare apparently caused rate increases!). There’s a good chance that this will carry over onto Trumpcare as well – especially if the folks in HR continue to act like HR and look for an easy scapegoat to blame changes on.

          • farin

            Trumpcare, though, per insurance companies’ own statements, has already raised rates.

            • Alex.S

              Nah, that’s the government (led by Trump) threatening to cut off the incentives to insurance companies that were encouraging them to participate in markets. That encouragement was needed to convince them to offer plans in low-population areas that might not have a good mix of healthy/unhealthy people to offer plans to.

            • guthrie

              Nobody reads them; Obamacare will be blamed for a while longer.

  • Denverite

    This is not a neutral way of describing upwards of a trillion dollars and Medicaid cuts. This is just pure, undiluted Republican spin.

    I mean, negative numbers do exist, so something that “slows” the growth of Medicaid to -47% is a *kind* of true statement.

    CHECKMATE LIBTARDS

    • Joe_JP

      Per your past comments, various things in the bill are put off to the future.

      • Denverite

        Yup. Best case, I guess.

        • rm

          The putting-off-until-the-next-president, cynical ploy though it is, is the only hopeful thing about this, but it’s like they want to take off the parking brake and let the bus start rolling down the slippery slope, and we are hoping that a better driver will stop the bus before it hits the cliff. It’s still a bus rolling downhill toward disaster.

  • Joe_JP

    You know, the Republicans — helped by a flawed system — gained control. So, they get to block justice nominations (Garland) and pass craptacular legislation. But, basic democratic (small ‘d’ but also big “D” these days) rules of how things are done means you do it in a certain way. The alternative is possible as a matter of raw power, but it isn’t legitimate as a matter of just government.

    • Whirrlaway

      Arrow theorem! , that is, if Republicans didn’t exist, the system (any such system) would invent them. And if Trump didn’t exist, Republicans would invent _him_. It’s mathematically inevitable. Strange words you use, “legitimate”, “just”. (Google “group selection”)

      Good news: “democratic” (or “Democratic”) isn’t the same as “structured”. Just gonna take a change of the human heart, is all.

      • Joe_JP

        I don’t know what the Google search is supposed to tell me.

        Don’t find my usage strange. There are basic rules that in my opinion are involved in just government and such principles guided the move honored here in the U.S. in a couple weeks.

        The two parties existed in the past but Republicans are acting in a particularly blatant way in recent years. I don’t find this as compelled. But, I admit not to be as familiar as some about the theorem that sounds like that of a superhero.

        Changing the human heart is fairly hard.

  • Denverite

    One pleasant — and by “pleasant,” I mean that feeling you get when the doctor tells you that it has spread — surprise in the Senate version is that the premium assistance tax credits aren’t paid up front to the insurance company. You fork over the full $1800 a month or whatever for your family, and then maybe you’ll get some of that back next year when you file your taxes, depending on how much you owe and how many taxes you paid. Or not.

    • rm

      This is truly wonderful, because I have that extra cash sitting around and I am excellent at bookkeeping. Medical bills and records are so crystal clear, and I never have trouble figuring out what numbers go where in my tax forms. I welcome the extra expense and complication.

      • CaptainBringdown

        I welcome the extra expense and complication.

        Especially when I or one of my loved ones is seriously ill.

    • Jon_H11

      Seriously, without the up front tax credits you’re going to have $15 million people all of a sudden have to front thousands of dollars a month… Considering the fit that “not keeping your crap policy” caused, this is astounding.

  • Sebastian_h

    I understand the media criticism aspect, but the counter seems super obvious–Democratic senators need to have high profile press conferences every day. They need to say things like: while the Repblicans are hiding the bill from public scrutiny, we’ve heard… and then spin any probable Republican scary outcome you want to talk about. It’s the perfect opportunity because Republicans can’t easily counter without talking specifics.

    If you want to be a real ass, specifically call out the ‘moderates’ by name to push toward the outcomes you want. I’ve heard: that so and so is willing to slash premium support and hide behind not implementing it until after the election…

    I’ve heard, that they don’t guarantee predicting conditions.

    • McAllen

      The problem is that Democrats can’t make their press conferences high-profile. Whether their press conferences are high-profile or not depends on whether the media covers them.

      • MyNameIsZweig

        And certainly, if they have press conferences every day, they won’t be high profile for very long. Then they’ll just be oh ho hum, another press conference, just like yesterday. I can afford to skip this one.

    • cleek

      Democratic senators need to have high profile press conferences every day

      for example:

      Three Democrats tried to make a point by live streaming a visit to the Congressional Budget Office, where they failed to get a copy of the GOP plan.

      “Do not let this go by without your voice!” Sen. Cory Booker, D-N.J., said.

      “Republicans are shutting us and the American public out of this process,” Sen. Chris Murphy, D-Conn., said.

      Republican leaders are trying to come up with a bill that marks a clean break with Obamacare, but does not resemble the House GOP bill, which the president described as “mean.”

      “How will your bill have more ‘heart,’ as the president puts it, than the House version?” Cordes asked Senate Majority Leader Mitch McConnell.

    • Murc

      I understand the media criticism aspect, but the counter seems super obvious–Democratic senators need to have high profile press conferences every day.

      Democratic Senators do not have the power to unilaterally do this.

      • efgoldman

        Democratic Senators do not have the power to unilaterally do this.

        Ask John Lewis and Kate Clark. They got plenty of attention in the house last year. Made Granny Starver turn out the lights and lock the chamber, you’ll remember.

        Oh, wait. “Senate decorum, norms, and tradition”, right?
        Fuck that.

    • rm

      When Democrats are in power, Republicans get on the news because they are the opposition; it’s only fair. When Republicans are in charge, Republicans get on the news because they are in charge, so they are newsmakers.

      I do share your frustration, and wish they’d have the imagination to dream up some more extreme, really entertaining theater. How boring is visiting the CBO office? Let’s think, like, dumping truckloads of elephant shit on the Capitol steps or something. Circus type stuff. That is how Trump campaigned, after all.

    • Scott Mc

      I agree. The dem senators could create these high profile daily press briefings by simply trotting out their pony unicorns. But they don’t. even. try.

  • Aaron Morrow

    This is not a neutral way of describing upwards of a trillion dollars and Medicaid cuts.

    Refusing to use constant FY dollars makes it a fuckin’ lie.

  • LeeEsq

    I was going to attempt sarcasm but I’m too angry about it. Tens of millions of people are going to suffer because of the nihilistic cynicism of the Republicans and their donor base.

    • searcher

      Hey now, don’t sell the rampant racism and misogyny of GOP voters short.

  • Davis X. Machina

    I just reminded Collins’ people that 66,000 of us just put Medicaid expansion on the ballot — Governor Ragey McAsshole vetoed it six times when it came out of the State House — and that’s a lot of voters to piss off if you’re running for governor in 2018.

  • Denverite
    • Denverite
    • mongolia

      it’s a shame he wasn’t doing this earlier – out of their 3 most prominent people (him, matt, and sarah kliff) only matt had really been sounding the alarm during election season on how the gop’s plans were literally only about destroying services and regulations to give wealthy people tax cuts. the others would after treating the proposals by gop “thought leaders” with a modicum of seriousness, but it should have been obvious years ago to not treat anything by these guys seriously, and that anyone looking at these health care plans seriously should have been stating clearly that this has been the gop *stated* agenda since romney/ryan

  • Denverite

    On the plus side, it looks like the private insurance industry isn’t going to be around much longer, because the bill doesn’t change the ban on excluding preexisting conditions. Combine that with no mandate, no penalty, and much higher out-of-pocket insurance costs (less subsidy and less coverage), that virtually insures that most people just aren’t going to get insurance unless and until they get sick.

    That means: More medical bankruptcies as emergency hospitalizations for uninsureds skyrocket, and widespread insurer failures as the only people who buy insurance now are people with massive expected health care costs! It’s a win-win for evil!

    (Seriously, there is a nonzero chance that this is a poison pill put in by someone. There’s no way that this can get out of Congress. It would be apocalyptic for the insurance and health care industries.)

    • Jon_H11

      Above you said that the tax credits won’t be advanced. If that’s true that alone blows up the entire market.

      • Denverite

        Probably not on its own. There are still some middle- and upper-middle-class people who buy individual market insurance without any subsidies. But now they’ll just wait until they get cancer or whatnot.

    • Murc

      On the plus side, it looks like the private insurance industry isn’t going to be around much longer, because the bill doesn’t change the ban on excluding preexisting conditions.

      My understanding, which may be faulty (this blog needs its own Richard Mayhew) is that it doesn’t have to because of the state opt-outs.

      That is, the AHCA formally keeps a lot of the ACA regs around, but also allows states to opt-out of them. Which means that they don’t actually exist in a meaningful way, because insurers can then simply tell states “opt-out of these regs or we’ll completely bail from your market.” I think only California is big and powerful enough to resist that by itself; even New York probably couldn’t do it.

      We’re also only talking about the individual market, correct? Most people still get their insurance through their employers, and the insurance industry can continue to happily operate in that market, profitably, for a long time.

      • Denverite

        That is, the AHCA formally keeps a lot of the ACA regs around, but also allows states to opt-out of them. Which means that they don’t actually exist in a meaningful way, because insurers can then simply tell states “opt-out of these regs or we’ll completely bail from your market.” I think only California is big and powerful enough to resist that by itself; even New York probably couldn’t do it.

        I’m pretty sure the amended waiver provision doesn’t include the preexisting condition ban. It’s limited in scope.

        ETA: Here’s the waiver statute. https://www.law.cornell.edu/uscode/text/42/18052 The scope is defined by (a)(2)(A)-(D). You can doublecheck that none of those include the preexisting condition exclusion ban.

        We’re also only talking about the individual market, correct? Most people still get their insurance through their employers, and the insurance industry can continue to happily operate in that market, profitably, for a long time.

        This is correct. Sloppy language on my part.

        • Murc

          I stand corrected, then!

      • Hogan

        My understanding, which may be faulty (this blog needs its own Richard Mayhew) is that it doesn’t have to because of the state opt-outs.

        We know that’s in the House bill. Do we know it’s in the Senate bill?

    • JKTH

      I was thinking that too. Ironically, the ways that the Senate bill tries to appeal to the less sociopathic GOPers over the House bill could very well cause a death spiral.

    • Alex.S

      Briefly–

      SUNSET OF ESSENTIAL HEALTH BENEFITS REQUIREMENT. — Section 1937(b)(5) of the Social Security Act (42 U.S.C. 1396u–7(b)(5)) is amended by adding at the end the following: “This paragraph shall not apply after December 31, 2019.”.

      — This is in the proposed bill.

      (5) Minimum standards.—Effective January 1, 2014, any benchmark benefit package under paragraph (1) or benchmark equivalent coverage under paragraph (2) must provide at least essential health benefits as described in section 1302(b) of the Patient Protection and Affordable Care Act.

      — This is the part being amended.

      (b) ESSENTIAL HEALTH BENEFITS.—
      (1) IN GENERAL.—Subject to paragraph (2), the Secretary shall define the essential health benefits, except that such benefits shall include at least the following general categories and the items and services covered within the categories:
      (A) Ambulatory patient services.
      (B) Emergency services.
      (C) Hospitalization.
      (D) Maternity and newborn care.
      (E) Mental health and substance use disorder services, including behavioral health treatment.
      (F) Prescription drugs.
      (G) Rehabilitative and habilitative services and devices.
      (H) Laboratory services.
      (I) Preventive and wellness services and chronic disease management.
      (J) Pediatric services, including oral and vision care.

      — This is the definition of what is being amended

      ————–

      So, I think “pre-existing conditions” are untouched, but the insurance companies get to race to the bottom by simply not providing insurance.

      • JKTH

        AFAICT that’s just in Medicaid. I don’t think there’s anything about EHBs elsewhere.

      • Denverite

        This is how I read it too.

        • Denverite

          Grrr, I’ll expand my analysis. Here’s the current waiver statute:

          https://www.law.cornell.edu/uscode/text/42/18052

          The proposed amendment basically guts subsection (b). It allows any state waiver otherwise authorized by 42 USC 18052 that doesn’t increase the federal deficit. But the waiver still has to be authorized under 42 18052.

          For that, you turn to subsection (a)(2)(A)-(D). This essentially permits states to seek a waiver for five different requirements of the ACA. The are: EHB, establishing an exchange, providing premium support, providing premium support through refundable credits, the individual mandate, and the employer mandate.

          Basically, the current ACA says that states can seek a waiver from those five requirements of the ACA, provided (and I’m paraphrasing) they can accomplish the same goals in a different/just-as-good way. The Senate bill cuts the “provided that” part. Now they can just seek a waiver full stop.

    • efgoldman

      there is a nonzero chance that this is a poison pill put in by someone. There’s no way that this can get out of Congress. It would be apocalyptic for the insurance and health care industries.

      As recently as a couple of years ago. I’d have expected their lobbyists and executives to run screaming to Capitol Hill, and to the big rainmaker fundraising bundlers. But what Pierce calls the prion disease has taken over the RWNJ klowns. Either they have other funding sources or they somehow don’t give a flying fuck.

  • D.N. Nation

    And because this turd sundae needed a cherry, US Capitol goons roughed up some disabled protesters outside of Yertle the Turtle’s office because of course they did. In a sane world, those are some lousy optics; in ours, however, McConnell will sneer some nonsense about civility and the Beltway Boyz will nod in agreement.

    • mds

      In a sane world, those are some lousy optics; in ours, however, McConnell will sneer some nonsense about civility and the Beltway Boyz will nod in agreement.

      Indeed, already today McConnell has (1) tut-tutted about how Democrats were unwilling to work with them on a bill that was kept away from debate, committees, and most Republican senators, let alone Democrats; and (2) berated Senator Schumer for scaremongering about a bill that Schumer hasn’t even seen. I mean, literally in subsequent statements from the floor of the Senate. In a sane world, the obvious and immediate contradiction would invite a great deal of public scorn and invective. And it’s just business as usual now. So yeah, if he even bothers to acknowledge the protestors’ existence at all, it will be to blame them for protesting.

  • Terok Nor

    There’s one sense in which this is a reform. The ACA’s most obvious failure is that the death panels aren’t functioning at all. This bill could go a long way to remedy that.

    • farin

      Better still, it automates the death panels, saving even more taxpayer dollars!

    • D.N. Nation

      Solid name/comment synergy.

  • Michael Masinter

    Republicans are playing the long game. Once their bill is signed into law, it will take a democratic majority in the House, a filibuster proof democratic majority in the senate*, and a democrat in the white house to undo its effects. Their bet, stated simply, is that those circumstances will never come to pass again in their political lifetimes. So knowing that their bill will wreck havoc on all but the upper middle class and above is a feature, not a bug, and one the voters won’t be able to undo even if a so-called wave election takes place and throws one or both houses of congress into democratic control.

    *Reconciliation rules can’t be used to raise taxes and reinstate PPACA or any other legislation that restores medicaid cuts and makes health care available. In a perfect world, a hypothetical democratic senate majority could abolish the legislative filibuster to get a democratic house passed bill to a democratic president to sign, but we don’t live in that perfect world; see generally the last time the democrats controlled the senate and tried to pass PPACA.

    Give McConnell and Ryan credit; they are evil, but they are smart.

    • mds

      In a perfect world, a hypothetical democratic senate majority could abolish the legislative filibuster to get a democratic house passed bill to a democratic president to sign, but we don’t live in that perfect world;

      You really think that in this scenario, Democrats are going to retain the legislative filibuster, as if nothing whatsoever has changed since 2010? Seriously? Hell, the way McConnell is going, the only way we have a legislative filibuster when Democrats regain control is if they reinistate it, because it’s gone the moment it blocks McConnell from something he wants. The history of the filibuster on appointments should be instructive in that regard. It was Democrats who finally felt forced into scrapping it for non-SCOTUS appointments, and I’m guessing the current caucus aren’t particularly inclined to restore it for SCOTUS appointments.

      • Michael Masinter

        I do, because there are democrats currently serving in the senate who revere its traditions and norms and will always support reinstating them. Take Patrick Leahy as an example; when he chaired the judiciary committee he adhered to the blue slip custom even though Hatch had ignored it the last time he chaired the Judiciary Committee, and will surely ignore it again. Unless a democratic majority consists of at least 50 dyed in the wool liberals (and by most measures Leahy is pretty liberal), there will be resistance to eliminating the legislative filibuster. As for McConnell, he doesn’t need to eliminate it. Throughout its history the legislative filibuster has benefited conservatives and racists far more often than it has benefited liberals and progressives, so why would any conservative or racist playing the long game eliminate it? Liberals and progressives rely on legislative power to enact laws that benefit the common good; conservatives don’t; they rely on the courts they are busy stacking for a generation to come to block them.

    • mongolia

      legislative filibuster is gone the moment dems take both houses of congress and have a dem president. won’t particularly need it before then, and based on party compositions of the current seats that’s not a concern until 2021 anyways, but literally the only scenario i could see for it not being repealed in the scenario i outlined is if there are only 50 dem senators in 2020, a tiny house majority, and the dem pres only won the popular vote by 0.5% or so, which might make a dem or three that barely won a red state (heitkamp, donnelly, manchin types) hesistant on abolition.

    • Aaron Morrow

      Reconciliation rules can be used for a bill that counteracts everything the Senate bill does post-Byrd bath, raises taxes further taxes, and expands Medicaid more. Such a bill couldn’t fix everything that needs to be fixed in health care, but it could easily be introduced on Day 1.

  • wengler

    If anyone is looking for positives, let’s remember that this stinking piece of shit is going to be passed with all Republican votes, signed by a Republican President and it may be the most unpopular bill in my lifetime.

    It still kind of surprises me though, what a bunch of single-minded nihilists Republicans are. This bill will bankrupt hospitals, put healthcare providers out of business and kill people. But those first two, those are rich people. Those people tend to matter to Republicans.

    • LosGatosCA

      The calculus for insurers appears to be that lower taxes on a smaller insured base is better than higher taxes on a larger insured base. After tax margins go up with less investment required.

  • Mike G

    President Trump had urged Republican senators to write a more generous bill than a House version that he first heralded and then called “mean,”

    “I meant more generous with tax cuts. Sad! Unfair!”

  • XerMom

    The Better Care Reconciliation Act: in which Americans better reconcile themselves to never getting any care.