More Byrd droppings

Following on on Betty’s post this morning, keep on calling.

Senator Sanders in his role as the ranking member of the Senate Budget Committee has had his staff arguing hard to the parliamentarian over the past few weeks. They are arguing over every point in the Senate bill(s) that are still be scrawled on napkins in the Senate dining room on whether or not provisions are directly budget related and therefore only need a 50 vote threshold or are primarily policy and need a 60 vote threshold. They’ve won some big fights. It looks like they won an even bigger one this morning.

What that means is the waiver provisions need 60 votes. This is important from a policy perspective as the current waiver system in the ACA allows states to experiment if they can insure as many people, at the same or better actuarial value while protecting the most vulnerable and costing the federal government no more money. The provision that is now subject to a 60 vote threshold would allow the state to do whatever it wanted just as long as it cost the federal government no more money.

Politically this is important because the Senate leadership, Secretary of Health and Human Services Price and CMS Administrator Verma have been promising Republican senators that they’ll issue magical waivers that will give enough flexibility to states to keep everyone or at least enough people whole despite pulling out $750 billion dollars in Medicaid funding and several hundred billion net dollars from the individual market. That is a fantasy of the least interesting tripe but it waivers of unimaginable power are being pushed behind the scene. Those waivers can’t be part of the bill.

And if they are part of the bill, that means the legislative filibuster is dead which should help when we have to clean up this mess.








It’s Baaaaacccckkkk (Sort Of, Maybe)

It is impossible to overstate the Republican commitment to ripping health care from millions, while taking a chainsaw to our medical system.

Rand Paul has just announced that he will vote “Yes” on the Trumpcare motion to proceed as long as he is given a clean vote on his amendment, which would simply repeal the ACA (which, given the CBO evaluation of a similar proposal, would lead to something on the order of 17 million without health care next year, and 32 million Americans left in the cold by 2026).

That’s still not enough to get Trumpcare to the floor if the other declared “Noes” hold out, but each senator McConnell can peel away significantly increases the pressure on those who remain opposed.  And certainly, Paul’s cave reminds us that counting on any Republican to maintain a party-base-unpopular position as a matter of principle is a mug’s game.

This won’t be over until the GOP loses its majority in one house or the other.

Image: Workshop of Lucas Cranach the Elder, Massacre of the Innocents, c. 1515








ACHA review

Here are a few lowlights of the AHCA Congressional Budget Office score. I’ll try to keep this non-technical.

  • Medicaid is still getting changed from an entitlement that is responsive to changing needs to a block grant
  • 23 million people will lose coverage compared to current law projections
  • The MacArthur/Upton waivers are expected to destroy the individual markets that cover 15% of the country
  • Most of the premium decreases are due to older and sicker people being priced out of the market
    • Real easy to have low premiums when you don’t cover anyone who is likely to need services
  • Pre-existing condition protection is effectively destroyed by splitting the risk pool.

Relevant tweets below the fold:
Read more








Medicaid in the President’s budget request

The Department of Health and Human Services accidentally leaked their own budget this evening. Bob Herman at Axios saved a copy. The biggest aspect of the budget is it laid out another $600 billion dollars in cuts to Medicaid and CHIP over ten years in addition to the $820 billion in Medicaid cuts in the AHCA.

Between these two documents Medicaid would lose 47% of its federal funding over a decade.

Loren Adler at Brookings thinks the cuts would be to tie the AHCA block grants to no more than inflation rate growth without regard to population or case mixture. As the Baby Boomers retire, more of them will require nursing home care that is currently paid for by Medicaid but there would be no federal money.

This is a budget wishlist that pits old people versus kids, the disabled against the pregnant and state budgets against upper income tax cuts in the federal budget.

Call Congress and give them an earful.








Call and visit Congress today

The vote for the AHCA in the House is scheduled for sometime around 1:00pm today.

Call your Congressional office today.

If you are in the DC Area there is a protest at the Hill at noon time.

If you are out and about, see if you can visit your Congressional district office to let them know that a vote for the AHCA will result in their names added to an Arya Starkesque mantra.