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Obamacare Could Die

Obamacare Could Die

We are at this very odd moment now.  We thought ACA was saved by a narrow vote some months ago, when John McCain joined Susan Collins and Lisa Murkowski to block the last version of Trumpcare.  Whew!  No need to worry about millions of people having their health insurance taken away!  Time to start pushing for single payer, Medicare for all, hah hah!  But, ooops!

So here we are with only 12 days to go before the window in which the US Senate can pass a repeal and replace of ACA using budget resolution, and thus with only a majority vote.  But, hey, here we have Cassidy-Graham, which would turn the whole thing into block grants to the states, allowing them to allow insurance companies to charge more for preexisting conditions and pretty much get rid of all those things people have liked about ACA once they began to realize that it might disappear.  But now hardly anybody is aware of what is going down at all, with near zero media attention, since we all moved on to Korea and DACA and whatever..   But this stealth Cassidy-Graham bill could very well pass.

It looks like Collinis and Murkowski will again vote no, realizing that it slashes the Medicaid expansion, among other things, and would kill insurance for many people in their states who currently have health insurance thanks to ACA.  But one of the co-sponsors, Lindsey Graham of SC, is John McCain’s closest ally and friend in the Senate, maybe in all of Washington now.  Reports have it that McCain is in fact thinking seriously of voting for this bill, which most reports say is actually worse than what got shot down previously by McCain’s swing vote.  The only other reported possible negative vote is  Rand Paul, who is claiming this bill still contains too  much of ACA, but he voted for the “slim repeal” after  similar complaining last time.  He could easily vote for this.

The hard bottom line is that we could wake up in a week or so with this awful bill passed, ready to whiz through the House for Trump to sign, and Obamacare dead after all, with millions set to lose their insurance, with barely anybody even knowing what is up.  This is a seriously bad business.

Barkley Rosser

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Does Single Payer Pay for Itself?

by ProGrowthLiberal (originally published at Econospeak)

Does Single Payer Pay for Itself?

Was this the message of the title of the latest from Dean Baker:

The economies of a single system can be viewed as analogous to the Social Security system, which has administrative costs that are less than 1/20th as much as privatized systems in places like Chile and the United Kingdom. The analogous institution in the health-care sector is of course Medicare, which has administrative costs of less than 2 percent of benefits in the traditional fee-for-service portion of the program, roughly a tenth the cost for private insurers.

I will agree that the 20% gross margins received by the health insurance companies are obscene. This margin breaks down into a 14% operating expense to premium revenue ratio and a 6% operating margin. I would imagine competition could cut the former in half and the latter by a factor of two-thirds. I’m suggesting a 2% operating margin is reasonable as the reserve to premium revenue ratio is close to 25% for health insurance and an 8% cost of capital is more than reasonable. But Dean is arguing that we can live on a 1% gross margin, which seems to be very ambitious. OK- governments might be able to lower the cost of capital but nearly eliminating administrative costs sounds incredible. But what do I know – so I did a Google search and came across this interesting discussion:

The correct way to estimate administrative savings is to use actual data from real world experience with single-payer systems such as that in Canada or Scotland, rather than using projections of costs in Vermont’s non-single-payer plan. In our study published in the New England Journal of Medicine we found that the administrative costs of insurers and providers accounted for 16.7 percent of total health care expenditures in Canada, versus. 31.0 percent in the U.S. – a difference of 14.3 percent. In subsequent studies, we have found that U.S. hospital administrative costs have continued to rise, while Canada’s have not. Moreover, hospital administrative costs in Scotland’s single-payer system were virtually identical those in Canada.

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Trump Cutting Deals with Democrats

In Cutting Deals With Trump, Are Democrats Walking Into a Trap?

Over the weekend the mainstream press published a flurry of articles about Donald Trump, the pragmatic independent outsider who has no loyalty to any party and will work with anyone to Get Things Done. This excited reaction was in response to the president’s agreement to raise the debt ceiling and fund disaster relief with the help of Democrats. But that’s nothing compared to the delirium that broke out after he had dinner with Nancy Pelosi and Chuck Schumer on Wednesday night and the Democrats announced that they had reached agreement to legalize the Dreamers without funding his Big Beautiful Wall.

That would be a big win for the good guys, to be sure. Of course, when it comes to Trump, trusting him on a handshake has rarely turned out to be a wise decision for anyone, so we’ll have to see. Heather Digby Parton

Dan, picked this up on Truthout and sent it to me. Guess I am not the only one who likes to check-out the horse’s mouth for the truth.

Everyday which goes by secures healthcare in the US even though Trump and Repubs have threatened the CSRs and had previously blocked the Risk Corridor Program causing premiums to increase, insurance companies to leave the exchanges, and Coops to go bankrupt. Their actions confuses people as they see premiums increase and believe it is because of the ACA. The increase is still compensated for by an increased subsidy to cover the premium increase. This part is not mentioned and people blame the ACA, which is the objective of Republicans and Trump. Even so and at particular cost risk is the individuals market with those making >400% FPL who are not covered by any subsidy.

A flurry of activity by Republicans could still endanger The ACA using Reconciliation requiring 51 votes. McCain is in on the Graham – Cassidy bill.

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Republicans Think They Can Pull It Off with the ACA and the Budget

On September 7, I pointed out Republicans are preparing Another Assault on the PPACA/ACA in 2017. Republican senators Lindsey Graham S.C. and Bill Cassidy LA are making a last stand in an effort to repeal and replace the ACA by “proposing legislation doing away with many of the subsidies and mandates of the 2010 law. Instead, the Graham – Cassidy Bill would provide block grants to the states to help individuals pay for health coverage.

Graham taking it out of context what Obama said on keeping company healthcare insurance, rolls out his own version of the same except it is mocking Obama. “You can keep the ACA;” however, Republican legislation would make it virtually impossible for dozens of states to continue operating Obamacare without large amounts of state funding. In the short term, the law is designed to penalize states who embraced the ACA and reward states not expanding Medicaid. The legislation stops all of the ACA by repealing the subsidies and substituting their own budgetary subsidies as required under Reconciliation. As Slate’s Jordan Weissmann says, “it’s a bit like walking into somebody’s house, lighting the whole ground floor on fire and telling them, Hey, you can keep living here — if you like it.” It is political revenge being vent on constituents the same as Republicans blocking the Risk Corridor Programs and Trump’s threats to block CSR subsidies applied to premiums by healthcare insurance companies. Some detail on the Republican plan and the impact:

• The new plan favors poorer, older, and less populated parts of the country utilizing its own formula for block grants instead of using the ACA formula to fund the grants. The Graham – Cassidy plan shifts spending to the large states which expanded Medicaid (California and New York) to less populated states refusing to expand Medicaid (Mississippi and Alabama). Some non-expansion states like North Carolina and Florida would also will see less funding as much of the population benefited from premium subsidies. As a whole, the Republican Graham-Cassidy plan punishes states getting more of their residents insured through the ACA.

• The 2% inflation planned increases of block grants would be far less than the inflationary cost of healthcare or insurance. The impact either leaves states to back fill or constituents to make up the difference. The Center on Budget and Policy Priorities states the block grants would result in a 34 percent spending cut in comparison to the ACA by 2026. Nine states; California, Connecticut, Delaware, Florida, Massachusetts, New Jersey, New York, North Carolina, and Virginia would see their federal health-care funding cut in half under the block grant system when compared to the funding received from Obamacare’s Medicaid expansion and increased subsidy spending.

• Graham – Cassidy also implements a capita cap which cuts Medicaid expansion state funding by $180 billion over 10 years. The resulting cuts would increase each year reaching $41 billion annually by 2026. A 9 percent cut to total federal Medicaid spending for seniors, people with disabilities, families with children, and other adults (outside of the ACA’s Medicaid expansion) comes into play by 2026. The per capita spending cuts are expected to grow from a 26% cut to Medicaid funding in 2026 to 35% in 2036 according to CBO calculations.

• States will may also be able to eliminate such benefits as maternity and mental healthcare from their plans, impose annual and lifetime limits, and dramatically raise deductibles and other out-of-pocket costs. According to the CBO, states having approximately 50% of the population would take up these damaging waivers. As if this is not enough, Graham and Cassidy are also considering the “Cruz amendment,” which allows insurers to sharply increase premiums to people with pre-existing conditions or deny them coverage altogether. Now whether or not these addition benefit eliminations are budget related and qualify under Reconciliation is something I would wonder about as they do not appear to be budget related.

There is enough time for Republicans to change the ACA and also achieve a new budget going in 2018 (October 1) with Reconciliation instructions for Tax Reform. The Republicans might burn some midnight oil and have short weekends; but, it can be done if they wish to further deny President Obama a legacy and support Trump’s skewed views on race and Obama.

As far as McCain? “Sen. John McCain told the Hill on September 6th, he would support a plan offered by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) to repeal the Affordable Care Act. And McCain later released a statement clarifying his support for the bill in concept, but hasn’t seen a final product.

“While I support the concept of the Graham-Cassidy proposal, I want to see the final legislation and understand its impact on the state of Arizona before taking a position,”

As far as Pelosi and Schumer offering up a solution to the national debt and making it easy for Trump to offer hurricane Harvey Relief. The Democrat relief gesture was humane; however, McConnell says he has a counter measure to the maneuver by Democrats to renegotiate the National Debt in December. Republicans are planning to stick it to Democrats and “all” constituents with a repeal of the ACA and by killing a large percentage of the subsidies. In the end if the repeal does happen, Pelosi and Schumer’s kind hearted display of bi-partisanship will be recognized as the dumbest move Democrats have ever made. They should have waited a week or so to extend the help.

Dan’s comment in an email: “We will see soon enough…I hope you are not prescient.” I hope I am wrong. It is too close to call.

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Another Assault on the PPACA/ACA Coming in 2017

The Present

If you thought it was over, it is not. Now that Schumer/Pelosi have removed the debt limit issue in front of Republicans with a Trump agreement, one more impediment to assaulting healthcare has been cleared away. John, I have cancer and have healthcare, McCain has come out to support a bill proposed by Senators Lindsay Graham and Bill Cassidy to repeal Obamacare. Maybe Trump knew and maybe he did not know; but, he did a nice pivot with Schumer and Pelosi with Ryan and McConnell shocked by his abandonment of Republican partisan values. A good friend of Graham, John McCain, who has a guarantee of healthcare anyway he wants it through federal government insurance or the VA, has thrown his support to Graham on healthcare.

The Graham-Cassidy legislation would essentially dismantle much of Obamacare’s federal infrastructure, turning over federal dollars to the states to do with what they wish, though that flexibility at the state level would come at a sharp cost. Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities, told Politico on August 1 that she estimated it would result in 16 percent less federal spending in 2020 versus the Obamacare status quo’s spending on Medicaid expansion and market subsidies.

The Recent Heroics

Who can forget the noble, cancerous Senator from Arizona with a scar above his left eye marching into the Senate to make a deciding vote? Such bravado . . . Unfortunately, it was all about getting even with Trump and supposedly Senate Order for McCain.

“We don’t answer to Trump no matter how much he stomps his foot. We answer to the American people regardless of how much our decisions will impact them. We must be diligent in discharging our responsibility to serve as a check on his power and screw them in our own way. And we should value our identity as members of Congress more than our partisan affiliation.”

That last sentence is priceless. Value your identity as a senator, a step above the citizenry so we do not engage in partisan affiliation. The Republican persona has been about party affiliation “uber alles.” Amongst themselves the Republicans are split along partisan lines and no longer represent the citizenry they lay claim too. McCain is about using a proper order in screwing the constituents in favor of partisanship.

Some History and Procedure

It was Aaron Burr in 1806 who recommended “the Previous Question” Motion (call for a vote or end debate) be discontinued as senators were gentlemen and knew when to end debate and when to move on to the next question. The motion was rarely used. Of course, that was then and today is today. So what happened? The “Previous Question” motion was eliminated and being gentlemen in the Senate without party affiliation died with it as the age of the filibuster came to be. This is want McCain alludes to in his Senate Order comment. It is so far in the Senate past an few senators would understand Aaron Burr’s comment.

Under today’s rule, the Republicans will have to repeal portions of the ACA using Reconciliation; which requires a majority of 51 votes, can only impact budgeting, and not create a deficit 10 years out (think the sunset of the 2001/2003 tax breaks). Unless there is a special session called by Ryan, the House is in session for 12 days in September and this year’s budget ends this month. There can only be one Reconciliation per budget year.

Pessimism

Trump seized the moment to solve the potential debt limit crisis approaching EOM September. It also appears he has resolved some other issues politically with the support of the Democrats and has moved one step closer to his goals of killing the ACA and Tax Reform. The issues remaining on the table are:

1. Revising the ACA in 2017 before EOM September using Reconciliation.
2. Create a 2018 Budget with Reconciliation Rules for Tax Reform.
3. 12 congressional days to accomplish these two tasks.

Democrats gave up an impediment to Republicans, the passage of the debt limit, too early in the remainder of the 2017 budget year. McCain is on board for revising the ACA, the ultra conservatives will support it as it has block grants to states, and it will create the budget surpluses needed to do tax reform. To get Tax Reform in 2018, they need surpluses, which the revision of the ACA will provide and a new budget with Reconciliation Rules.

Can Republicans get both of these tems accomplished in 12 days? I am sure McConnell and Ryan will increase the rowing tempo of the drum this close to the goal. If Republicans pull it off, Democrats are going to look mighty dumb in helping them along.

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Reports of Obamacare’s death are greatly exaggerated: All counties to be covered for 2018

Reports of Obamacare’s death are greatly exaggerated: All counties to be covered for 2018

Obamacare has now obtained an insurer for every county in the country, defying Republican claims that the program is collapsing. As reported by The Hill, “At one point or another over the past year, more than 80 counties have been at risk of having no ObamaCare insurer on the exchanges in 2018.” On Thursday (Aug. 24), the last “bare” county, in Ohio, was covered by insurer CareSource. Insurance companies have until September 27 to sign contracts, so it is not yet guaranteed there will be no bare counties for 2018.

As you no doubt remember, Chicken Little Republicans have proclaimed the sky to be falling ever since the Patient Protection and Affordable Care Act was passed in 2010. We were subject to ridiculous predictions about “death panels,” skyrocketing premiums, predictions of no fall in the uninsured, horror stories that weren’t, and of course the ever-popular “job killing” meme.

Instead, three years of the ACA (Q4 2013 to Q4 2016) brought the uninsured rate for adults 18-64 down from 20.8% to 13.1% (but an increase to 14.2% in Q2 2017) while unemployment fell from 6.7% in December 2013 to 4.7% in December 2016 (and 4.3% in July 2017). In addition, personal bankruptcies fell from 1.5 million in 2010 to just 771,000 in 2016, according to Consumer Reports.

As the recent increase in the uninsured rate shows, the ACA is still vulnerable to sabotage by the Republicans. Given that the increase occurred disproportionately among younger adults, Gallup speculates that uncertainty about the consequences for disregarding the individual mandate may explain a large amount of the change. There remain several routes for sabotage to take place. At the same time, there is a bipartisan effort in the Senate to stabilize the individual marketplace, potentially with explicit funding for individual subsidies.

Constant vigilance!

h/t David Ayon

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Extreme Contempt

Extreme Contempt

Donald Trump has engaged in so many outrageous statements and conduct that it has become very difficult to remember which of  those were really the most outrageous, the most morally contemptible, the ones that should have led his supporters to have abandoned but they did not, the ones that merited above all others the most Extreme Contempt.

The events of the last 24 hours have clarified for me what was the moment in 2016 when Trump crossed the line, when he committed an act of Extreme Contempt that should have lad to every Republican worth anything above a sewer of morally contemptible and disgusting garbage to have rejected this worst of all people to have occupied the White House.  That moment was when he dissed John McCain as a loser for having been captured by the North Vietnamese during the Vietnam War.  I think the only way fervent Trump supporters can justify their existence on this planet after that particular outburst is to simply ignore it and forget about it, which is what I am sure the vast majority of them have done,  But the events of the last 24 hours have brought this matter back into focus, and while I really do not know, I think that it is quite likely that when we get to the bottom line, and we are indeed now at a very serious bottom line, Donald Trump’s ultimate desecration of any moral  consciousness when he dissed McCain for becoming a deeply tortured POW has come back to haunt him and defeat his pathetic and incoherent effort to overturn the Obama health care legacy.

Let me be clear that I have many disagreements with McCain, and many things he has done personally.  But the man’s days are now shorter than most of ours.  Yeah, maybe it will all go away and he will still be a Senator a decade from now.  But more likely he will follow the late Ted Kennedy, who apparently had the same sort of “aggressive” brain cancer he has, and, well…

So, let me confess that I know John McCain.  About a decade ago I sat next to him on a long airplane flight and we discussed climate change.  He had a reasonable view in my mind, and indeed when he ran against Obama, his position was only marginally less progressive/reasonable than Obama’s.  I actually gave him my card offering to give advice, although I never heard from him later.  Of course he has gone silent on this issue more recently as his party has gone off the deep end on denying the very existence of global warming, on the  list of many others where, well, tsk tsk.

So, let us get to the really serious. McCain has been going back and forth on the heath care issue, a man about to die and having surgery on taxpayers money, a man who is by far the most serious Republican senator there is currently by several orders of magnitude, and not just because he is a former presidential candidate of the Republican Party in 2008.  No, he is serious beyond all of them for  his experience, much bragged about by his party in 2008, as a POW in Vietnam, where he experienced Extreme Torture, leading him to stand unequivocally and without a shred of doubt that torture is completely unacceptable, morally and practically.  I applaud his declaring and maintaining this position throughout the Bush admin when torture got approved during the Iraq War.  On this matter he has absolute and unassailable credibility beyond all critics, and I applaud him for this.  I shall add that this is a matter that is personal. My wife was tortured by the former Soviet government, and I have also been tortured in a distant land I shall not name and of which I shall not speak. Unsurprisingly, my wife and I have deep personal support for McCain’s unequivocal position on this matter to totally oppose torture in all circumstances everywhere period.

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Repeal ACA Rejected Again – Updated

July 25, 2017: There is a lot of bad dialogue going on in the news these days. In my last three posts, I have tried to point out what can be passed by Repubs with just 51 votes and what requires 60 votes. Much thought being given to defunding Planned Parenthood and the Mandate(s). If Repubs chose to follow Reconciliation and not nuke it and/or the supermajority vote, both of the defunding and the elimination of the Mandate(s) are not going to happen. The Parliamentarian decided on 60 votes for each to pass.

“The discussions came as the Senate rejected 45-55 a straight repeal of Obamacare with a two-year delay in implementation to allow Congress to work out a replacement. Seven Republicans opposed the measure.”

In the 2015 bill, Republicans had attempted to kill the mandate. The parliamentarian had ruled it could not be done in Reconciliation. “In 2015 the Senate revised the ACA repeal reconciliation bill passed by the House after the Parliamentarian ruled that it could not repeal the individual and employer mandates under the Byrd rule, amending the bill to repeal only the penalties imposed by the mandates.” This would require sixty votes to accomplish if not amended. The Senate could eliminate the monetary penalty.

July 26, 2017: Sens. Lamar Alexander, R-Tenn.; Shelley Moore Capito, R-W.Va.; Susan Collins, R-Maine; Dean Heller, R-Nev.; John McCain, R-Ariz.; Lisa Murkowski, R-Alaska; and Rob Portman, R-Ohio, joined all Democrats to defeat the amendment, which would have given Congress two years to devise a replacement to the 2010 Affordable Care Act.

July 27, 2017: Not going to raise the flag in honor of McCain voting “no” as he should have done this long ago. McCain’s reasoning for voting against the repeal and/or amend is false.

“McCain said that he’s repeated time and time again that one of the ‘major failures’ of Obamacare was that it was “rammed through Congress by Democrats on a strict-party line basis without a single Republican vote.’

‘We should not make the mistakes of the past that has led to Obamacare’s collapse, including in my home state of Arizona where premiums are skyrocketing and health care providers are fleeing the marketplace,’ McCain said.”

Republicans had every opportunity to participate in designing the ACA and refused to do so. That premiums are increasing have two reasons. The lack of control of the rising cost of the healthcare industrial complex and the blocking of the Risk Corridor Program by Sessions, Upton, and Kingston.

– People have been claiming McCain is a maverick and he bucks party lines. Not really as he goes with the flow 87% of the time. He just took an opportunity to stick it to Trump and some others. The real Maverick who voted “NO” was Susan Collins who votes the party line 60% of the time.

July 28, 2017: Now Trump again has threatened to kill the ACA by blocking the CSR subsidies to those between 100% and 250% FPL attacking the low income citizens.

– In passing the blame around for the Republican failure to repeal and amend the ACA; Congressional Idiot Louis Gohmert crawls out from under his rock. “I pray for Senator McCain, for his health, his full recovery from the cancer but it doesn’t give him the right to make people suffer more under the current ACA,”

– Always the positive aww shuck guy Paul Ryan: “‘We were sent to Washington to fulfill the pledges we made to our constituents. While the House delivered a bill to repeal and replace Obamacare, unfortunately the Senate was unable to reach a consensus,’ Ryan said in a statement Friday. ‘I am disappointed and frustrated, but we should not give up. I encourage the Senate to continue working toward a real solution that keeps our promise.'”

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First Vote to Amend and Repeal Rejected

The first vote in the Senate to amend the PPACA was rejected.

“Senators voted 57-43 late Tuesday to reject the plan in the first vote on an amendment to the bill. Those voting “no” included nine defecting Republicans. The vote underscored problems Republicans will have in winning enough votes to recast Obama’s statute.

The rejected proposal included language by Senate Majority Leader Mitch McConnell erasing the Obama law’s tax penalties on people not buying insurance and cutting Medicaid.

Language by Texas Republican Sen. Ted Cruz would let insurers sell cut-rate policies with skimpy coverage. And there was an additional $100 billion to help states ease costs for people losing Medicaid sought by Midwestern.

By 57-43 — including nine GOP defectors — it blocked a wide-ranging proposal by McConnell to erase and replace much of the statute. It included language by Sen. Ted Cruz, R-Texas, letting insurers sell cut-rate policies with skimpy coverage, plus an additional $100 billion to help states ease out-of-pocket costs for people losing Medicaid sought by Midwestern moderates including Rob Portman, R-Ohio.”

Senate blocks proposal to repeal ‘Obamacare’

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What Will It Take for Republicans to Be Able to Revise the ACA

The first section of issues McConnell and Republicans must overcome requires 60 votes due to the Parliamentarian ruling the provisions of the BCHA violate the Byrd Rule; consequently, the Reconciliation procedure requiring only 51 votes can not be used to repeal the Affordable Care Act (ACA) or waive the Byrd rule. The second set of provisions ruled upon by the Parliamentarian only require 51 or a majority vote to pass these changes.

There is little McConnell and Republicans can do to get past a supermajority vote. McConnell appears to be confident and it may also be possible to kill the supermajority vote. It will be interesting to see what he is thinking. The vote will take place this week unless canceled or rescheduled.

The provisions that the Parliamentarian ruled may be stricken if raised by a point of order include (requires 60 votes to waive the Byrd rule)

• The provision defunding Planned Parenthood;
• The provisions prohibiting the use of small business tax credits and individual market premium tax credits to pay for health plans that cover abortions;
• The sunset of an essential health benefit coverage requirement for Medicaid plans;
• The section funding cost-sharing reductions (CSRs), which the Parliamentarian ruled was redundant of current law, which already funds them (this ruling seems contrary to the lower court’s ruling in House v. Price that money had not been appropriated for the CSRs, but is consistent with the belief that the CSRs are already built into the budget baseline, thus an appropriation does not affect the deficit. A bill to clarify the appropriation situation could, of course, be passed separately from the reconciliation act;
• The six-month waiting period for individuals who have not maintained continuous coverage;
• The provision sunsetting the federal medical loss ratio requirement and allowing states to set the medical loss ratio;
• A provision, that has been removed from the most recent version of the BCRA, that might have allowed states to rollover unused Medicaid block grant funds and possibly use them for other purposes;
• The “Buffalo Bailout” which would have limited the ability of New York State to require counties other than those in New York City to contribute funding to the state’s Medicaid program (the ruling on this provision should caution against including further state-specific provisions in future versions of the legislation);
• A provision grandfathering certain Medicaid waivers and prioritizing Medicaid Home and Community-Based Services Waivers;
• A provision requiring a report by the Department of Health and Human Services (HHS) to Congress regarding the preferability of adopting a different system for reporting Medicaid data; and,
• A section requiring HHS to consult with the states before finalizing Medicaid rules,
• The provision allowing age rating at a 1 to 5 rather than the current 1 to 3 ratio, increasing premiums for older people and decreasing them for younger; and
• The provisions allowing small business association health plans that would be regulated as large group health plans, largely free from state regulation.

The Parliamentarian upheld against a Byrd rule challenge (requires majority vote to pass):

• A provision allowing state the option of imposing work requirement on Medicaid enrollees who are not disabled, elderly, pregnant, or within 60 days of giving birth;
• A provision granting $10 billion to Medicaid non-expansion states;
• The state stability and innovation fund, which imposes abortion restrictions by funding the program through the Children’s Health Insurance Program, which already prohibits abortion funding;
• A provision adjusting per capita cap targets for low-spending and high-spending states to promote equity;
• The permanent repeal of the cost-sharing reduction program beginning in 2020; and,
• A provision requiring states to include information on per capita enrollment and expenditures, psychiatric hospital expenditures, and children with complex conditions in their Medicaid expenditure reports.

There are a few more issues the Parliamentarian still has to rule upon which I have not included; but, you can find them on the link I have provided. Senate Parliamentarian Rules on BCRA July 25, 2017

Senate GOP Wins Vote To Debate Health Care, Then Loses Vote On ACA Replacement Bill July 26, 2017, Tim Jost, Health Affairs Blog

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