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- 05/04/17--07:21: _The GOP healthcare ...
- 05/04/17--11:18: _HOUSE PASSES HEALTH...
- 05/04/17--12:31: _Trump takes victory...
- 05/04/17--12:35: _Former Obama Admini...
- 05/04/17--12:43: _Watch as Democrats ...
- 05/04/17--18:16: _Trump praised Austr...
- 05/04/17--19:33: _'GRIN REAPER': New ...
- 05/04/17--21:37: _How did health insu...
- 05/05/17--05:26: _Here's why Congress...
- 05/05/17--07:46: _There's a good reas...
- 05/05/17--08:28: _A bunch of House Re...
- 05/05/17--09:09: _How Kentucky, one o...
- 05/05/17--09:35: _Democratic groups r...
- 05/06/17--12:07: _Obamacare isn't dea...
- 05/06/17--13:21: _BUFFETT ON REPUBLIC...
- 05/07/17--06:33: _One state shows the...
- 05/07/17--09:30: _Democrats’ reaction...
- 05/08/17--06:25: _Obama urges Congres...
- 05/08/17--08:23: _John Oliver takes a...
- 05/08/17--09:28: _'I don't understand...
- 05/04/17--11:18: HOUSE PASSES HEALTHCARE BILL AS TRUMP GETS MAJOR WIN
- 05/04/17--12:43: Watch as Democrats break out in song as the AHCA passes the House
- 05/04/17--19:33: 'GRIN REAPER': New York Daily News rips Trump over Obamacare repeal
- 05/04/17--21:37: How did health insurance get so complicated? Here are some answers
- 05/05/17--05:26: Here's why Congress exempted itself from the new healthcare bill
- Michael R. Turner (Ohio, 10th district) R+4
- David Joyce (Ohio, 14th district) R+5
- Andy Biggs (Arizona, 5th district) R+15
- Mike Coffman (Colorado, 6th district) D+2
- Ileana Ros-Lehtinen (Florida, 27th district) D+5
- Thomas Massie (Kentucky, 4th district) R+18
- Walter B. Jones (North Carolina, 3rd district) R+12
- Frank A. LoBiondo (New Jersey, 2nd district) R+1
- Christopher H. Smith (New Jersey, 4th district) R+8
- Leonard Lance (New Jersey, 7th district) R+3
- Dan Donovan (New York, 11th district) R+3
- John Katko (New York, 24th district) D+3
- Ryan Costello (Pennsylvania, 6th district) R+2
- Patrick Meehan (Pennsylvania, 7th district) R+1
- Brian Fitzpatrick (Pennsylvania, 8th district) R+2
- Charlie Dent (Pennsylvania, 15th district) R+4
- Will Hurd (Texas, 23rd district) R+1
- Barbara Comstock (Virginia, 10th district) D+1
- Jaime Hererra Beutler (Washington, 3rd district) R+4
- Dave Reichert (Washington, 8th district) Even
- 05/06/17--12:07: Obamacare isn't dead yet
- 05/07/17--09:30: Democrats’ reaction to the Trumpcare vote was tone-deaf and gross
- 05/08/17--06:25: Obama urges Congress not to repeal Obamacare
Last-minute changes to the proposed Republican overhaul of the US healthcare system may not be limited to the individual insurance market, according to a new report.
An analysis from The Wall Street Journal's Stephanie Armour and Michelle Hackman found that a provision in a recent amendment of the American Health Care Act could allow employers to gut some of Obamacare's biggest health-insurance protections for their employees.
The amendment would allow states to apply for waivers to rescind two major regulations of Obamacare, if the state can prove that healthcare costs would decrease as a result. That has led to concerns about its potential effects on the individual insurance market, but it could also change insurance for people that get coverage through their employers.
One of those Affordable Care Act-implemented protections — called essential health benefits (EHB) — requires insurers to cover a baseline of 10 health procedures and items including emergency-room visits, prenatal care, mental-health care, and some prescriptions.
Under Obamacare, employer plans could not place a lifetime limit on the amount that the plans pay out on EHBs, and required plans to limit the amount of out-of-pocket costs an employee had to pay annually, according to The Journal. That made plans more costly for employers but also provided better coverage for employees.
In 2011, The Journal says, the Obama administration said that companies could select whichever state's regulations they wanted for their insurance plans. But that had little practical effect because EHBs were mandated nationwide.
Yet the AHCA could allow a firm to drop these protections for employees by choosing regulations from a state-granted waiver.
Here's an example:
A company could have operations in South Carolina and Vermont. If South Carolina is granted a waiver and drops the lifetime limit on maternity care for insurance plans, the company could use that baseline to put a lifetime cap on maternity care for employees in Vermont as well.
Roughly half of all Americans get their insurance through their workplace, so any weakening of those protections could be wide ranging.
It remains to be seen if employers would be willing to drop the protections. Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonpartisan health-policy think tank, told The Journal that many employers might continue to provide these protections to be competitive in attracting talent.
The American Health Care Act passed in the House of Representatives on Thursday in a major win for President Donald Trump and House Speaker Paul Ryan after a series of fits and starts for the bill.
The legislation to overhaul the US healthcare system passed 217 to 213, with 20 Republicans and all Democrats voting against it.
The lead-up and the vote were contentious. After the vote, Democratic representatives chanted, "Na na na na, na na na na, hey hey hey, goodbye," apparently suggesting to their Republican counterparts that their votes would cost them control of the chamber.
GOP representatives also walked out of the Capitol after the vote to chants of"Shame!"
Republican leaders celebrated as they left the House floor.
"As difficult as it was, we never gave up," Rep. Steve Scalise said. "It sets us up to do even bigger things in the future."
Right before the vote, Trump said GOP representatives would come to the White House for a celebration if the bill passed. The president delayed his trip to New York City on Thursday.
"If victorious, Republicans will be having a big press conference at the beautiful Rose Garden of the White House immediately after vote!"Trump tweeted.
The AHCA succeeded after a last-minute amendment on Wednesday night won over some moderate holdouts who had expressed concerns about changes to the bill that experts said would undermine protections for Americans with preexisting conditions.
The House Republicans' victory comes over a month after the original version of the AHCA was yanked from the House floor before a vote after a cohort of moderates and conservatives said they would oppose it.
It now heads to the Senate.
President Donald Trump on Thursday cheered the passage of the American Health Care Act in the House at a ceremony at the White House with Republican lawmakers.
He said the bill's passage meant an end was in sight for the Affordable Care Act, the healthcare law better known as Obamacare.
"It's dead. It's essentially dead. Unless we pay a lot of ransom money to the insurance companies," Trump said in the Rose Garden. "What we have is something that is very, very, incredibly well-crafted."
Trump also thanked the House GOP leadership, specifically House Speaker Paul Ryan, for getting the bill through the House.
"For the last week I've been hearing, 'Paul Ryan doesn't have it,' 'It's not working out with Paul Ryan, 'He's going to get rid of Paul Ryan,'" Trump said. "But then today I heard, 'Paul Ryan is a genius.'"
The president also promised to get it through the Senate.
"It's going to be an unbelievable victory when we get it through the Senate, and there's so much spirit there," Trump said.
Trump delayed a trip to New York City to meet with Australian Prime Minister Malcolm Turnbull until after the vote.
Vice President Mike Pence, who spearheaded the White House effort to swing representatives' votes, also celebrated the bill's passage.
"Thanks to the leadership of President Donald Trump, welcome to the beginning of the end of Obamacare," Pence said.
The AHCA succeeded after a last-minute amendment on Wednesday night won over some moderate holdouts who had expressed concerns about changes to the bill that experts said would undermine protections for Americans with preexisting conditions.
The House Republicans' victory comes over a month after the original version of the AHCA was yanked from the House floor before a vote after a cohort of moderates and conservatives said they would oppose it.
The American Health Care Act just passed the House of Representatives in a close vote on Tuesday.
The bill is the latest iteration of congressional Republicans' attempts to repeal and replace the Affordable Care Act, also known as Obamacare.
After the vote, members of the Obama Administration, which was responsible for the passage of the Affordable Care Act in 2009, blasted the vote's outcome.
Sylvia Burwell, who served as secretary of the Department of Health and Human Servies under President Barack Obama from 2014-2017, said in a statement (emphasis ours):
"Today’s House vote is a setback for our nation’s health system. An estimated 24 million Americans would lose coverage. Premiums and out-of-pocket costs would increase, especially for low-income, older, and rural Americans. Millions of Americans would be segregated into high-risk pools and charged more for the misfortune of being sick. This bill does not protect people with pre-existing conditions, and it would block women from accessing basic preventive care. And it does not improve the quality of care. In fact, it takes us backwards on making prescription drugs affordable and addressing the opioid epidemic. The Senate should abandon this harmful, partisan bill and work on constructive, bipartisan improvements to our health system. This is what the American people want and what they deserve."
Andy Slavitt, the former head of Medicare and Medicaid under the Obama administration, wrote a sequence of tweets, calling this "their easiest round," and offering up an apology.
If you are in fear or pain, I want to personally say I'm sorry for not doing enough. But I (and many others) are as energized as hell. 5— Andy Slavitt (@ASlavitt) May 4, 2017
Organizing for America, Obama's super PAC, called the 217 representatives who voted for the bill "nothing more than rubber stamps."
Obama himself, who did tweet about Jimmy Kimmel's monologue about his son's open-heart surgery, did not immediately comment on the vote.
The American Health Care Act passed in the House of Representatives on Thursday in a major win for President Donald Trump and House Speaker Paul Ryan after a series of fits and starts for the bill. The legislation to overhaul the US healthcare system passed by a 217-213 margin, with every Democrats and 20 Republicans voting against it. As Republicans left the floor, Democrats broke out in song, singing "Na-na-na-na, goodbye."
During a press conference with Australian Prime Minister Malcolm Turnbull in New York on Thursday, US President Donald Trump voiced his optimism about the American Health Care Act.
"It's a very good bill right now," Trump said of the GOP plan to overhaul the US healthcare system. "The premiums are going to come down very substantially. The deductibles are going to come down. It's going to be fantastic healthcare. Right now, Obamacare is failing."
The next comment Trump made, however, amused Sen. Bernie Sanders of Vermont during an interview on MSNBC's "All in with Chris Hayes."
"I shouldn't say this to our great gentleman and my friend from Australia," Trump said, "because you have better healthcare than we do."
The federal government administers Australia's universal healthcare system.
"Wait a minute," Sanders said as he erupted in laughter. "The president has just said it."
He continued: "Let's take a look at the Australian healthcare system. And let's move — maybe he wants to take a look at the Canadian healthcare system or systems throughout Europe. Thank you, Mr. President. Let us move to a Medicare-for-all system that does what every other major country on earth does: guarantee healthcare to all people at a fraction of the cost per capita that we spend.
"Thank you, Mr. President," Sanders said. "We'll quote you on the floor of the Senate."
The AHCA barely passed through the House, 217 to 213, on Thursday. It's widely expected to be overhauled in the Senate.
Watch the clip:
The New York Daily News torched the Republican Party's passage of the American Health Care Act, the bill intended to start the process of repealing Obamacare.
The publication released a preview of its Friday cover, which features a smiling President Donald Trump and the headline, GRIN REAPER — a reference to the deeply unpopular legislation.
The bill is expected to go through an overhaul process in the Senate.
With the passage of the Republicans’ health care act, the House of Representatives seems to be saying that coming up with a plan to insure Americans really wasn’t all that hard after all.
It just took a bit more of a subsidy – US$8 billion to be precise – for really sick people to make Congress comfortable with the alternative to the Affordable Care Act.
But from being a professor of health finance and a former insurance CEO, I know that it is really much more difficult than this to keep all the insurers competing aggressively in the market, all the providers focused on high quality and all the patients choosing wisely among their options for coverage and care.
One of the biggest underlying problems is confusion over what we are buying here and what incentives are necessary to get everyone to behave.
What are we buying anyway?
The first confusion is over the very nature of health insurance. The discussion often reveals an assumption that we are just buying a service and paying for it much as we finance a new car. So why should I pay more in financing costs than I actually get? If I want a VW, why should I pay for a BMW? I don’t need maternity services or mental health, but they are part of the standard package of essential benefits that I have to buy. And this drives up my premium.
But health insurance is not car financing. By its very nature, it is the strangest of products, one that I hope I will not have to use but is there when I need it. I am not buying specific services but access to potential services, the particulars of which are unknowable in advance. This ticket to ride is very valuable, but pricing it is devilishly difficult.
To make this work, I have to share my potential need with a large group of like-minded consumers who also hope they won’t have to use the ticket. But unlike the lottery, where I want to win and get all that money for the $2 ticket I bought, I am unhappy if I “win” with my health insurance and get back more than I paid when I have a serious illness. It is this confusing nature of the product that leads to bad policy and bad purchasing decisions.
Proposed patch will wear thin
The patch proposed by the AHCA is to pull out of the insurance pool more of those who are likely to need services, leaving the rest with a premium that is closer to what they actually are likely to need on a one-to-one basis.
Loosening up the requirements on pricing to let insurers charge more for people with varying conditions moves us even closer to this image. Why shouldn’t the sick pay more since they use more services? The apparent hope is to come closer to the implicit assumption of health care as car financing – I get what I pay for.
Unfortunately for all of us, this is a losing proposition. There will always be more at the margin who would qualify for coverage under the high-risk pools, driving the cost of these beyond any arbitrary funding, be it $8 billion or $800 billion.
Our experience in many states in the past is that these pools are inevitably underfunded, leaving those who would qualify the butt of a cruel joke – they can’t get conventional health insurance, but the cost of even the high-risk pool is excessive due to underfunding.
This is the real concern over high-risk pools as an alternative to offering coverage to all, regardless of pre-existing conditions. While economists suggest that this excess demand is the patient’s fault (the so-called “moral hazard” of excess demand when something is covered), no one chooses to have a heart condition, diabetes or a birth defect.
Payment shapes decisions and incentives
Another problem comes from, again, the misconception of health insurance as the financing of a known product. Besides just paying for services when needed, we also want to create incentives for prevention and high quality and lowest cost settings to provide them when they are needed.
The Affordable Care Act has moved health care far down this path through value-based payment, which rewards providers for higher quality and lower total cost over the whole spectrum of care, not just for a single service.
But while providers have received the message loud and clear and reacted with major advances on quality and cost, we have far to go in creating similar incentives for the patient. This is where the “skin in the game” argument, as a way to make individuals more responsible for their own care, has some credibility.
But AHCA supporters went further. Under their replacement bill, it is OK to penalize people for being sick, even if it is not their “fault,” and regardless of their wealth or income.
The new legislation’s subsidies depend on age, not income, and entirely remove the cost-sharing reductions that make high-deductible plans on the Obamacare exchanges feasible for the working poor just above the poverty level.
With these changes, clearly health insurance is no longer affordable for those who were the main target of the ACA.
Admittedly, premiums for those other than the near poor are higher under the ACA, even if health care inflation in general has been largely tamed. Those who support the lower-premium, stripped-down plans of the AHCA replacement bill focus on the concerns of those who now must buy more expensive policies that cover everything they might need – but without the subsidies the poor receive.
So if I think I can predict what I will need and want a plan that will finance this like my new car, then I probably don’t need insurance at all.
And, if I do want coverage and can afford to pay for it, the replacement legislation will do just fine. Because I have the money, I can buy a BMW policy, if I choose.
However, if I am poor – or if I care about a stable insurance market – this is a jalopy with recycled tires, a torn leather seat and an engine about to blow.
Last week, Vox dug into the Republican healthcare bill and found a provision that would exempt Congress and its staff from many of the bill's effects.
This provision was bad "optics," as they say in Washington.
But instead of taking it out — like you would usually do with a provision you aren't wedded to and can't defend politically — the House passed the American Health Care Act with the exemption intact after first passing a separate bill that would repeal the exemption that would be created by the AHCA if both bills became law.
There's a reason for this mess, and it's not about Republicans in Congress not wanting to be subject to their law.
It's about Senate procedure.
Republicans are attempting to pass the AHCA through a process called reconciliation. This process, created by the Congressional Budget and Impoundment Control Act of 1974, allows the Senate to pass certain bills relating to the federal budget with just a simple majority. There is no need to get 60 votes — and, in this case, some Democratic support — as there is for other legislation.
A variety of complex rules govern what matters may and may not be considered through reconciliation.
One of those is that reconciliation must be conducted pursuant to reconciliation instructions passed by both chambers of Congress. That happened earlier this year — Congress sent reconciliation instructions to two Senate committees (finance; and health, education, labor, and pensions) that were designed to allow those committees to write bills making changes to healthcare policy.
The problem, as the Committee for a Responsible Federal Budget explains, is that Congress' healthcare is governed by the Senate Homeland Security and Governmental Affairs Committee, and that committee was not sent any reconciliation instructions.
Therefore, if a reconciliation bill makes changes to the way Congress gets its healthcare, it might become subject to a 60-vote threshold because it addresses a matter that is supposed to be the purview of a committee that doesn't get to participate in reconciliation this year.
Why would the AHCA need to touch Congress' healthcare in the first place? Because Obamacare included, at Republican urging, a provision requiring members of Congress and their staffs to buy insurance through the Obamacare exchanges.
That Republicans are in this position at all reflects how rushed and ad hoc their healthcare policymaking has been. They set about passing reconciliation instructions right after taking office because they hoped to repeal Obamacare very quickly. Since they didn't know what their repeal strategy would be, they didn't know which committees would ultimately need reconciliation instructions, and now it's too late for them to change which ones have them.
Now their hope is to enact the AHCA and the companion bill that would undo the congressional exemption created by the AHCA. That companion passed the House on Thursday unanimously with Democratic and Republican votes.
In the Senate, that bill would need 60 votes to pass because it's not a reconciliation matter.
Democrats clearly like the talking point that Republicans exempted Congress from the AHCA — and if the AHCA were enacted, Democrats would have the power to filibuster the companion bill and make it a matter of law. But politically, I'm not sure how it would land, as Republicans could say they are trying to apply the AHCA to Congress and it's Democrats who are blocking that simple bill from becoming law.
Of course, in all likelihood, the Senate will pass a healthcare bill that differs extensively from the AHCA, which might make moot the whole matter of needing to change the rules about Congress' healthcare.
The American Health Care Act squeaked by the House on Thursday, passing with a vote of 217 to 213.
The unanimous opposition by Democrats made up most of the "no" votes, but 20 Republicans also voted against their party's bid to overhaul the US healthcare system.
While there may be policy reasons for these members to vote against the bill — concerns over preexisting conditions or the bill not going far enough in repealing Obamacare — there's also a compelling political reason.
The Cook Partisan Voting Index, which takes the average margin of victory in a district over the past two election cycles and calculates the partisan lean of that area, shows that many of the "no" votes by Republicans came from representatives in vulnerable seats.
The average Cook PVI for the 20 Republicans against the AHCA was 3.6 points toward Republicans. But when you remove the districts of conservative Reps. Thomas Massie, Walter Jones, and Andy Biggs (who voted against the AHCA because they didn't think it went far enough in repealing Obamacare), the score drops to 1.6 points toward the GOP. In fact, four members that voted against the AHCA are in districts that, based on Cook's score, lean Democratic.
Here's a full list of Republicans who voted against the bill:
On March 7, the day after the original version of the American Health Care Act was unveiled, House Speaker Paul Ryan told Americans where they could read the bill.
"I encourage all Americans to read this bill online at readthebill.gop,"Ryan said.
By Friday, the day after the legislation sailed through the House, it became apparent many of Ryan's colleagues didn't heed his advice.
Several Republican representatives have said they did not read the bill, instead relying on staff or the media to understand its potential effects.
Rep. Chris Collins of New York told CNN's Wolf Blitzer on Thursday that he did not read the entire bill.
"I will fully admit, Wolf, I did not," Collins said. "But I can also assure you my staff did. We have to rely on our staff."
Collins also had to ask a reporter from The Buffalo News to explain to him a provision of the AHCA that would cut $3 billion in funding to help low- and middle-income New Yorkers pay for healthcare.
Rep. Mark Sanford of South Carolina, who flipped his voted to a "yes" on the AHCA days before its passage, told CNN that he looked at the bill but did not absorb all of it.
"I turned through every page," Sanford said. "As to whether or not I got through some of the details in some of the pages, no. But yes, I attempted to read the entire bill."
Sanford said he thoroughly read the amendments to the bill.
On Thursday, before the vote, Rep. Thomas Garrett of Virginia told MSNBC he also did not read the bill.
"Oh, gosh. Let's put it this way: People in my office have read all the parts of the bill," Garrett said. "I don't think any individual has read the whole bill, but that's why we have staff."
Republican leaders long criticized Democrats for supposedly not reading the Affordable Care Act, the healthcare law better known as Obamacare, before passing that bill.
The 126-page AHCA had two amendments totaling 11 pages, making the full bill 137 pages. The Affordable Care Act and a reconciliation bill attached to it comprised 974 pages.
Ryan wasn't the only Republican leader to boast about how short and easy to read the bill was. White House press secretary Sean Spicer during a press briefing in March even held up the ACA to compare its length with the AHCA's.
"For all the people who have concerns about this, especially on the right," Spicer said, "look at the size."
FRANKFORT, Ky./SAN FRANCISCO (Reuters) - For nearly three years, Democrats and former President Barack Obama pointed to Kentucky as one of the Affordable Care Act’s biggest success stories.
A poor, rural state that straddles the North and South, Kentucky was an early adopter of the healthcare law commonly known as Obamacare and saw one of the country’s largest drops in the uninsured rate.
Now Kentucky is poised for a new distinction: to be the first state to save money by reducing the number of people on Medicaid, the government health insurance program for the poor and disabled and a central tenet of Obamacare.
If successful, Kentucky would provide a roadmap for other states who are worried about paying an increasing share for people on Medicaid.
A new Republican health law that passed the U.S. House of Representatives on Thursday, along with state initiatives like Kentucky's, would dramatically change the national healthcare system and cut more than $800 billion from Medicaid over the next 10 years.
The Republican bill still faces a long road ahead in the U.S. Senate and its final passage is far from assured, making initiatives like Kentucky's all the more important.
Kentucky has proposed to lessen its financial burden before it grows by reducing the number of residents on Medicaid by nearly 86,000 within five years, saving more than $330 million in the process. (For a graphic click http://tmsnrt.rs/2on0HVK)
Kentucky's plan also calls for new work requirements for able-bodied adults to get insurance. Plus, it would establish new fees for all members based on income and lock out some people who miss a payment or fail to re-enroll.
By following these proposed rules, Kentucky believes Medicaid enrollees will over time graduate from Medicaid to private and employer insurance plans.
“One of the most remarkable lies that has perpetrated in recent years in the healthcare community in America is that expanded Medicaid was working well in Kentucky,” Republican Governor Matt Bevin, who is leading the state effort, told Reuters from the governor’s mansion in Frankfort, Kentucky.
That view is in line with President Donald Trump’s administration, which has criticizedObamacare’s Medicaid expansion and urged states to pursue similar Medicaid reforms to what Kentucky is now attempting.
"If Kentucky is successful, you’ll see this spread through the more conservative-leaning states. It’s possible even a Democratic blue state could do it,” said George Huang, director and senior municipal healthcare research analyst at Wells Fargo Securities. “It’s the flexibility that some states are seeking.”
Insuring the poor at a price
Kentucky, a state Trump won handily last November, has been devastated by the loss of coal mining jobs and an opioid epidemic. The state sits near the bottom of health rankings for smoking rates, cancer deaths and diabetes.
“To me, morally, it was the right thing to expand Medicaid, but I had a responsibility to not to do something that would bankrupt the state,” said former Governor Steve Beshear, a Democrat, referring to the increased costs of caring for a larger population with Medicaid insurance.
More than 30 states, about a dozen of which are led by Republican governors, expanded Medicaid under Obamacare. In Kentucky, more than 400,000 people gained health insurance through the program, the highest growth rate of Medicaid coverage of any state.
Beshear commissioned independent studies by PricewaterhouseCoopers and Deloitte on the financial and health impacts of expanding Medicaid. Both studies found health and economic gains. Deloitte reported that 90,000 newly covered residents received cholesterol screening and 80,000 got preventative dental care within a year. It estimated Kentucky would see an economic boost of $30 billion and 40,000 new jobs by 2021.
Beshear’s successor, Republican Governor Bevin, was elected in 2015 on a promise to repeal and replace the healthcare law on the view that thousands of Kentuckians had unaffordable premiums and only one health insurer to choose from.
He dismissed the projections in the Beshear-commissioned studies as “preposterous,” and says the state’s share of expanded Medicaid - $74 million in 2017 and totaling $1.2 billion over five years - was too expensive and unsustainable.
“We want this to be a helping hand for people at a time when they need it, but then be able to return to the commercial marketplace,” Bevin said.
Last year, Bevin submitted the waiver to restrict Medicaid eligibility by requiring enrollees to work or volunteer at least 20 hours per week and to pay monthly premiums based on income. He's still awaiting approval.
Bevin said he has spoken with several governors about the waiver and has had extensive conversations with Health and Human Services Secretary Tom Price about fast-tracking the approval process in order for other states to quickly adopt similar programs. Such conversations are occurring across the country in response to encouragement from the new administration to reform state Medicaid programs, said Alleigh Marre, a Health and Human Services spokeswoman.
Louisiana and Wisconsin are considering work requirements for Medicaid enrollees. The Obama administration rejected previous attempts by other states, including Ohio and Arizona, to require work programs and monthly premiums for Medicaid, historically a free program for those eligible.
"Every state is watching this to see what happens,” said Bevin of Kentucky’s waiver. “It’s the first one in the queue.”
Signs point to 'yes' for Kentucky waiver
The odds look good for Kentucky to get the waiver in the coming months, based on the track records of health officials that Trump named after his inauguration.
Seema Verma, the new head of the Centers for Medicare and Medicaid Services, which approves Medicaid waivers, said during congressional testimony that the agency will usher in “a new era of state flexibility and leadership.”
Verma helped craft Kentucky’s waiver, but said she will recuse herself from the approval process to avoid conflicts of interest.
She and Tom Price wrote a letter to governors in March encouraging Medicaid reforms that more closely resemble commercial insurance plans. In the letter, they suggested features such as premium fees, health savings accounts, and emergency room co-payments that encourage the use of primary care.
CMS declined to comment on Kentucky’s waiver and said it does not speculate on the process while ongoing.
Under federal law, waivers must promote Medicaid’s objective of delivering healthcare services to vulnerable populations who cannot otherwise afford them.
“Waivers have never been used to cut people from the rolls,” said Emily Parento, associate professor at the University of the Pacific’s law school and the former executive director of Kentucky’s Office of Health Policy.
But Verma’s office is encouraging changes to Medicaid that make the government program look more like private insurance policies - goals that are similar to Bevin’s in Kentucky.
“I think what will happen is that other states will look at it and go, ‘We want everything they got,’” Bevin said.
(This story has been refiled to fix spelling in paragraph 3.)
(Reporting by Yasmeen Abutaleb in Kentucky and Robin Respaut in San Francisco; Editing by Caroline Humer and Edward Tobin)
Following the passage of the American Healthcare Act on Thursday, Democrats expressed outrage at House Republicans — online, in person, and at the bank.
In a joint statement released Friday, Democratic fundraising groups Daily Kos, Swing Left, and ActBlue reported that they raised a combined $2 million Thursday following the passage of the bill that would roll back President Barack Obama's signature healthcare law.
"Americans are horrified that congressional Republicans just voted to take away their health care, and that's kindled real anger—anger that the Daily Kos community is channeling with record-breaking donations at unheard-of speed," Daily Kos Political Director David Nir said in a statement.
ActBlue, a service used by Democratic candidates and political action committees to streamline online fundraising, told Business Insider the organization raised over $4 million on Thursday, including $300,000 through a page specifically targeting Republicans who voted in support of the bill. (As of noon on Friday, the number had grown to over $400,000.)
Swing Left, a small grassroots organization founded after President Donald Trump's election, reported that it raised more than $150,000 in the hour after the healthcare bill and more than $800,000 on Thursday.
"Across America, grassroots Democrats are drawing a line in the sand on healthcare today and making their voices heard," ActBlue Executive Director Erin Hill said in a statement. "They're flooding their elected officials inboxes and voicemails, organizing protests and direct actions, and talking to their neighbors about what's at stake."
Official Democratic groups were more cagey about releasing fundraising totals.
A Democratic National Committee aide told Business Insider that the organization saw a "significant uptick in online donations" on Thursday, while Vice reported that the DNC had its strongest month of fundraising in over a month. The Democratic Congressional Campaign Committee, the party's official congressional campaign arm, flooded subscribers' inboxes with fundraising emails immediately following the vote but did not immediately disclose its fundraising totals.
While many Democrats condemned the bill's potential effects, like the Congressional Budget Office's estimate that millions more people would be uninsured over the next decade, some saw the move as a political benefit for Democrats hoping to retake the House of Representatives in 2018.
Following the passage of the bill, Democrats on the House floor chanted: "Na na na na, na na na na, hey hey hey, goodbye," implying unpopular provisions in the bill would handicap Republicans seeking reelection next year.
When the House passed the American Health Care Act by a slim margin on Thursday, Republican lawmakers made their way to the White House for a celebration.
President Donald Trump joked with House Speaker Paul Ryan, mocking pundits who said the speaker didn't "have it." Ryan hailed the passage of the legislation he spearheaded successfully — finally, after three tries.
"We've got a lot of work to do, but one thing is now clear: Republicans are committed to keeping our promise to lift the burden of Obamacare from the American people and put in place a better, more patient-centered system," Ryan said.
The celebration might have been premature.
The bill has a long way to go to reach Trump's desk — starting with the Senate, which could present an even more difficult process than the fits and starts the AHCA faced in the House.
A mix of politics and arcane Senate procedure could sink the AHCA — or totally alter what it looks like.
'Viewed with caution'
The AHCA went through multiple different versions before Republican leaders found a coalition of enough moderate and conservative members to join together to pass the bill. But despite amendments offered to the AHCA by the House Republicans to get enough members on board, Republican senators have expressed serious doubts regarding the bill.
Sen. Lindsay Graham, who had been against the original version of the AHCA, conveyed reservation about the final edition, too. Graham tweeted on Wednesday that the bill "should be viewed with caution."
"My primary duty and job is to ensure this bill – if it were to become law – would be beneficial to the people of South Carolina," Graham said in a statement after its passage. "Only after a careful review of the legislation, as well as discussions with the interested stakeholders across South Carolina, will I know the answer to that question. I do know the revised bill is an improvement over the first attempt."
Some rising-star GOP senators, including Ted Cruz of Texas, Rand Paul of Kentucky, and Tom Cotton of Arkansas, all expressed misgivings about the bill during its consideration in the House.
In fact, the Senate appears ready to scrap the AHCA altogether and pass their own version of a healthcare bill. A group of 12 GOP senators, including Majority Leader Mitch McConnell, have begun to work together on separate legislation.
"It was kind of a moot issue if the House wasn't going to be able to pass a bill and now they have, and I'm proud of them for doing it," Senate Majority Whip John Cornyn said. "Now it's up to us to pass a bill 51 senators can agree to."
'They better not change it'
If the Republican senators are able to come up with a way to get a bill past the Senate, that would open up another can of worms. After the House passed its version of the legislation, House members signaled they wouldn't accept many alterations in the Senate — even as Republican senators said they were preparing their own bill.
Rep. David Brat, a member of the conservative House Freedom Caucus who refrained from supporting the AHCA until amendments were added, told USA Today's Eliza Collins he wants to see the AHCA as it stands now to get to Trump's desk.
"None, not at all," Brat said when asked how much change he would accept to the AHCA in the Senate. "It's about time [the Senate] get a dose of medicine. ... They change it one iota ... they better not change it."
Those types of comments, and fundamental disagreements about some of the provisions of the law, don't seem to bode well for its future. If the Senate passes a different bill, House and Senate members will need to form a conference committee to iron out the differences.
"Assuming the conference committee can produce an agreement, would the full House and Senate then agree to their product?" Greg Valliere, chief investment strategist and long-time political analyst at Horizon Investments, wrote in a note to clients Friday. "Not out of the question, but unlikely. The most probable scenario is that a relatively moderate conference committee bill would be unacceptable to the House Freedom Caucus, sending this maddening process back to the drawing board late this year."
Republicans in the Senate could run into another problem — their chamber's rules.
In order to avoid a Democratic filibuster, the GOP has been using the budget reconciliation process to pass the healthcare bill. That means it would only take a simply majority in the Senate to pass, but it also means it would be subject to a different set of rules.
Among those: the Byrd rule, which requires that all provisions in a bill that goes through the reconciliation process has to deal with the federal budget.
That means various parts of the AHCA, like gutting Obamacare regulations on insurers, could fail to qualify in the Senate.
"The House has an untenable task of trying to craft a bill that will fit through the matrix of the Byrd rule," Republican Rep. Trent Franks said in March, when the original version of the AHCA was released. "It's essentially like trying to force a giraffe through a keyhole. If you get the job done, he looks a little differently on the other side."
Warren Buffett thinks that the US healthcare system is broken.
The legendary investor said costs for healthcare have exploded in the US and are holding back business growth.
Buffett pointed out corporate tax payments as a percentage of GDP have shrunk from 4% in 1960 to just 2% now. On the other hand, medical costs have ballooned from 5% of GDP to 17% of GDP currently.
"Medical costs are the tapeworm of American economic competitiveness," Buffett said.
Buffett said that the lower rate of healthcare spending in other countries is one of the biggest disadvantages for US businesses.
The Berkshire Hathaway CEO also said that for his own business, "the tax system is not crippling our business around the world," but the burden of healthcare costs make it more difficult to do business.
Additionally, in regards to the American Health Care Act — the bill passed by the House on Thursday to repeal and replace Obamacare — Buffett did not offer a forward prediction on how it would impact people's healthcare but he did say it had one direct impact on him.
"The net effect of that act is that my federal income taxes would have gone down, down 17%, last year," Buffett said.
"It's a huge tax cut for guys like me."
Buffett went on to say that the AHCA will lower taxes significantly for people making over $250,000 that have large investment income.
"That means one of two things, either the deficit goes up, or someone else's taxes do," Buffett said.
Charlie Munger, Buffett's partner, also decried incentives for healthcare providers to charge ever higher costs for procedures with questionable impact, saying there is "too much chemotherapy on people that are basically dead."
"A lot of it is greatly immoral," Munger said. "You have a lot of doctors and hospitals that are feasting on a dying person like jackals on a carcass."
While Munger and Buffett did not offer particular policy solutions, they did say that the issue is being dealt with poorly by politicians on both sides of the aisle.
"Both parties hate each other so much that neither one of them can think rationally," Munger said.
SEE ALSO: Obamacare isn't dead yet
Republicans passed their plan to repeal and replace Obamacare through the House this week, but the Affordable Care Act remains the law of the land.
That means that the ACA's individual insurance markets are still up and running. But under the Trump administration, they haven't been running very well.
Maryland, which has a state-run exchange instead of using the federal Healthcare.gov platform, released requested premium increases from the five insurers in its market on Thursday.
The proposed increases are quite stunning.
Of the five insurers, the Kaiser Foundation Health Plan of the Mid-Atlantic States had the lowest average requested increase for their plans, at 18.08%. The highest was CareFirst of Maryland, with an average increase request of 58.80%, which would bring the baseline monthly premium payment for the plans up to $714.95.
The maximum requested premium increases were similarly striking. The biggest proposed jump came from Cigna, which requested a 150.83% hike for a plan on the high end.
Maryland's insurance commissioner Al Redmer said in a statement that the proposed rates still have to go through a review process and could be adjusted before they are offered to consumers.
"It’s important to remember that these rates are what companies have requested, and not necessarily what will be approved," Redmer said. "There will be a thorough review of all the filings. As in years past, we may require changes."
Also at issue is the uncertainty of whether Obamacare's cost-sharing reduction (CSR) payments are ceased.
The payments, which help defray the cost of providing low-income Americans with cheaper health insurance plans, are seen as critical to ensure the stabilization of the ACA's individual insurance markets.
Currently, the payments are appropriated by the White House rather than Congress, and President Donald Trump has threatened to end the payments. The payments are also subject to an ongoing lawsuit between the House and executive branch questioning the legality of their funding without a congressional appropriation. While the Obama administration defended the case, Trump could drop an appeal of a ruling from 2016 in which a court sided with House Republicans.
The White House has said that it will continue funding for the CSR payments but have not guaranteed they will be in place for 2018.
The uncertainty led Maryland to tell insurers that they would be able to refile their requested increases if the payments are discontinued.
In fact, in California, the insurance commission told insurers that the companies could submit plans that assumed CSRs would be paid and a set of rates assuming they went unpaid.
"I have written President Trump asking that he and his Administration stop undermining the Affordable Care Act and health insurance markets," read a letter from Dave Jones, the California insurance commissioner, to insurers filing in the state. "Health insurers are legitimately concerned that the President's actions are undermining the ACA and health insurance markets."
Most other states have set deadlines for plan submissions in June.
In addition to the uncertainty regarding CSR payments, which some experts said insurers are already baking into the rate projections, Trump's administration has also issued a number of rules that could cause instability in the individual market.
A variety of insurers have already pulled out of various markets, like Aetna in Iowa and Virginia, in part due to the political uncertainty.
There’s principled opposition, and then there’s political gamesmanship, and today’s Democratic Party has a remarkable knack for choosing the wrong one at the wrong time.
In the moments after it became clear that House Republicans had passed the Trump-endorsed American Health Care Act, a handful of legislators began to sing. The voices rose up from the House floor: “Na na na na / hey he-hey / goodbye.”
I assumed at first—as did at least one CNN on-air analyst—that it was Republicans celebrating the demise of Obamacare. But no: According to multiple reporters present, the song came from a group of Democratic legislators. The implication: By voting to pass the unpopular bill, GOP lawmakers had ensured that they’d be voted out of office at the next opportunity.
Democrats didn’t just come up with this out of the blue. As Talking Points Memo’s Josh Marshall points out, it was a mocking callback to Republicans’ behavior after the Clinton tax hike of 1993:
This is both an homage and a literal repetition of what Republicans did when the Clinton tax bill passed in the House in 1993. Same singing, same song. The bill paved the way for budget balancing over the course of the decade and (more arguably) played a role in creating the prosperity of that decade. It also came little more than a year before Democratic majorities in both Houses were annihilated in the 1994 midterm.
Be that as it may: It’s disgusting. This was not an own goal at a soccer game. It was not a vote noteworthy solely for its long-term effects on the partisan balance of Congress. It was a vote for a bill that, if signed into law, would likely strip health coverage from millions of Americans while potentially threatening protections for many more. It was not an occasion for singing. And it sure as hell wasn’t an occasion for celebration by the party that failed to stop it—the party whose members purport to represent the interests of the vulnerable citizens whom Trumpcare would affect.
Lest anyone think these were the actions of a rogue few within the Democratic caucus, the sentiment echoed that of House Minority Leader Nancy Pelosi, who suggested earlier in the day that she welcomed the bill’s passage by the GOP-controlled House.
I get that Democrats are confident it won’t pass the Senate, where Republican legislators have already said they won’t work from the House’s bill but write their own. I get that the minority party is angry and lashing out from a position of political weakness. I get that they’re determined to make Republicans pay for the hypocrisy that characterized the process by which the bill was drafted, updated, and voted upon. And I get that they believe, perhaps rightly, that House Republicans will suffer at the polls for passing a broadly unpopular bill that appears to short-change their constituents.
But come on, Democrats. If you really believe that Republicans are voting to hurt vulnerable Americans—that this bill would cost people their lives if passed—then you can’t act like the joke’s on the GOP. And, as a rule, if your whole strategy is to take the high road, then you’d better not turn around and take a moral-victory lap on the low one.
President Obama urged Congress not to repeal The Affordable Care Act during a speech at the John F Kennedy Library. Obama received the Profile in Courage Award from members of the Kennedy family for his contributions to public life. Following is a transcript of the video.
And so by the time the vote came up to pass the Affordable Care Act, these freshmen congressmen and women knew that they had to make a choice. That they had a chance to insure millions and prevent untold worry and suffering and bankruptcy, and even death, but that this same vote would likely cost them their new seats, perhaps end their political careers.
And these men and women did the right thing. They did the hard thing. Theirs was a profile in courage. Because of that vote, 20 million people got health insurance who didn't have it before.
And most of them — and most of them did lose their seats, but they were true to what President Kennedy defined in his book as a congressional profile in courage: the desire to maintain a reputation for integrity that is stronger than the desire to maintain office.
And it is my fervent hope and the hope of millions that regardless of party, such courage is still possible, that today's members of Congress, regardless of party, are willing to look at the facts and speak the truth even when it contradicts party positions.
I hope that current members of Congress recall that it actually doesn't take a lot of courage to aid those who are already powerful, already comfortable, already influential. But it does require some courage to champion the vulnerable, and the sick, and the infirm, those who often have no access to the corridors of power.
I hope they understand that courage means not simply doing what is politically expedient but doing what they believe deep in their hearts is right.
As you’ve probably heard, the House of Representatives recently passed a bill to repeal and replace Obamacare (also known as the Affordable Care Act) with the American Health Care Act (AHCA).
The ACHA could take away protections that Obamacare had in place for Americans with preexisting conditions, which could make health care less affordable for those who need it most. On Sunday's "Last Week Tonight," host John Oliver had strong words about the bill.
"Yes, they took a bad thing, and managed to make it even worse," Oliver said on his HBO show. "It's like watching Mariah Carey’s ‘Glitter' and saying, 'You know what this needs? Jar Jar Binks.'"
The host also mocked one congressman who asked a reporter to explain part of the bill, which he had not read in full.
"Okay. I can explain that to you right now," Oliver said. "This bill could cause many of your constituents to get thrown into an individual marketplace they cannot afford, and when they realize that, they are going to be furious with you. Essentially: You f---ed up."
Oliver closed the segment by encouraging viewers to take action.
"It is dangerous to assume that this bill will die on its own. Your Senators are incredibly important right now and they're going to recess soon, so you need to let them know how you feel about this," he said. "Call your Senators. Call. Your. Senators."
You can watch the segment below:
CNN host Chris Cuomo questioned Republican Rep. Tom Reed of New York on his vote for the American Health Care Act following a contentious town hall in which Reed told a child that the Affordable Care Act's preexisting-conditions protections were also in the House GOP's replacement bill.
"It is going to continue — you will have access to health insurance just as you do today," Reed told the child.
Cuomo followed up with Reed on his remarks.
"How do you believe you are standing with individuals like that teenager if you remove the guarantee that preexisting conditions get covered?" he said.
Reed denied that the bill scrapped the preexisting-conditions mandate of the ACA, the healthcare law better known as Obamacare.
"That's the misinformation," Reed said. "When you read the bill like we have, and study the bill ... the preexisting-guaranteed issue is still cornerstone reform as we go forward. And with the waiver opportunity, that comes down — it only can get better as I read the bill and the text of it."
An amendment to the American Health Care Act, the House GOP's replacement for the ACA, would allow states to waive Obamacare's guarantee of coverage for preexisting conditions, but they could do so only if they provided some funding for people with preexisting conditions to get coverage, participate in "invisible high-risk pools" that would be established by the AHCA, or "provide incentives to appropriate entities" to "stabilize premiums."
Republicans have championed state high-risk pools as an option to bolster the ACA's preexisting-conditions protections. But their effectiveness has been sharply contested, with critics saying the sickest and oldest citizens would most likely see their healthcare costs skyrocket. Research has also disputed the effectiveness of high-risk pools when they have been implemented in the past.
Cuomo also grilled Reed about the GOP's decision to dismantle Obamacare instead of working to build on the existing law.
"Now, there is no question that there are problems with some of the individual marketplace venues," Cuomo said. "And there's a good argument to be made as to why your party refused to do anything to address any of those, waiting for an opportunity to kill the ACA instead of fixing it."
"But you know that many people don't maintain coverage ... that would make them vulnerable if a state took a waiver" to the preexisting conditions requirements, Cuomo added. "And we both know that companies, given an option, will not cover preexisting conditions if they're told they don't have to. Why ignore those possibilities?"
"Because we have to look over the horizon and provide for flexibility at the state level to come up with innovative ways that could improve upon it," Reed answered. He did not specifically address the possibility of healthcare lapses for some people with preexisting conditions.
Cuomo and Reed also went back and forth about the effectiveness of cutting $880 billion out of the healthcare system and how that might affect coverage.
"Pulling money out of the system has never been shown to be a way to improve coverage in terms of how many people will be getting care," Cuomo said. "You're pulling $880 billion out of it over about a decade period. How is that going to help?"
"That is one of the fundamental issues we have in the disagreement to the other side," Reed said in response. "The other side assumes putting money in the situation solves the problem. I believe in flexibility and innovation in the market. Allow people to provide them choices. That allows the dollars to be more efficient and provide access to care to millions that don't have it today."
But Cuomo said the GOP's healthcare bill didn't just cut funding from programs like Medicaid — which serves primarily low-income Americans — but also would give steep tax breaks to the country's wealthiest.
"I don't understand why the GOP doesn't just own it and say we will put less money in it," Cuomo said. "And say, 'Yes, we're going to put less money into it. Yes, some people may not get covered the same they are now. But we think it is worth it. It will help fund our tax cuts.'"