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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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US Public Support for Medicaid

Prominent among the things that the out of touch elite knows about regular Americans in, say Kansas where something is the matter, is that those people oppose means tested programs almost as much as they support Social Security old age and survivor benefits and Medicare.

(Another used to be that the didn’t support higher taxes on high income people. One of my angrybear obsessions was noting the solid to overwhelming majorities in all polls dating back to 1992 who have told Gallup that “upper income people” pay less than their fair share of taxes (search for Gallup here). For roughly a decade, I have been a voice crying out in a crowded room as the fact has become too obvious to deny.)

Now Kate Zernike & Abby Goodnough at the New York Times have noted the overwhelming support for means tested Medicaid (both the ACA expansion and legacy Medicaid).
update: I should write that I think the article is excellent. I object to one clause in the article.
End update:

But even when reporting the fact, they repeat the old falsehood asserting “The shift in mood also reflects a strong increase in support for Medicaid, ”

Now the mood certainly includes overwhelming support for Medicaid. The claim that this is an increase from previous lower levels is not supported by evidence presented in the article. There is the problem that, in plain English, high and increased are used as synonyms (that is people are generally innumerate about levels and changes). But, I think, it is also true that a plain fact clearly demonstrated in poll after poll has been denied by members of the out of touch elite. Here I think highly educated urban liberals assume most of our countrymen are savage reactionaries. Also political reporters talk to Republican operatives a lot and Republican operatives both live in the conservabubble and lie shamelessly.

In any case, US public support for Medicaid has been overwhelming for many years (always click and search for Medicaid)

In 2012 the fraction who found Medicaid cuts acceptable was a Kung Fu Monkey + 1 28%

“In order to strike a budget deal that avoids the so-called fiscal cliff, would you accept cutting spending on Medicaid, which is the government health insurance program for the poor, or is this something you would find unacceptable?” 12/13-16/12

Accept 28%
Unacceptable 68 %
Unsure 3%

On the stronger position “favor” not just “accept” Bloomberg found that cuts to Medicaid crushed the Kung Fu Monkey Crazification limit

“Cut Medicaid, which is government help for medical care for low-income people”

12/7-10/12

Favor 22 %
Oppose 74 %
unsure 4 %

McClatchy Marist found an almost Kung Fu Monkey crazy 26% in favor

“Cut spending for Medicaid”

12/4-6/12

Favor 26
Oppose 70
Unsure 4

With middle choice cut some but not a lot United Technologies got 35% support.

All these polls address the fiscal cliff. They were taken roughly four and one half years ago. They show support for cutting Medicaid very similar to support for the AHCA and BCRA in recent polls.

Back when the ACA passed, support for Medicaid expansion wasn’t as overwhelming as opposition to Medicaid cuts (it was a polarized debate and it is true that it is easier to refrain from giving than to take back once given). Still there was always at least plurality support for Medicaid expansion (even in the context of Medicare cuts).

23% support for Medicaid cuts (34% for increases when discussed in the context of the budget).

In particular, the pattern makes it very cleat that hatred of “welfare” isn’t hatred of welfare as defined by economists. I don’t know of much polling, but I certainly don’t know of much public opposition to disability pensions.

There has been overwhelming opposition to Medicaid cuts for many years. Public support for Medicaid is slighly lower than public support for Medicare, but basically feelings about the two programs are similar. This fact doesn’t fit the narrative, so the fact was surpressed.

The hatred of “welfare” is based on racism and not on any particular program or belief about incentives or anything else. In context “welfare” means “Money for black people”. The pattern in public opinion polling makes this almost undeniable.

I’m going to try to avoid discussing the implications for the argument that social insurance is politically feasible while redistribution isn’t. I can’t help noting that I consider this hypothesis to have been rejected by the data.

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How Keynesian Policy Led Economic Growth In the New Deal Era: Three Simple Graphs

(Dan here…lifted and reposted)

by Mike Kimel

How Keynesian Policy Led Economic Growth In the New Deal Era: Three Simple Graphs

November 22, 2011

In this post, I will show that during the New Deal era, changes in the real economic growth rate can be explained almost entirely by the earlier changes in federal government’s non-defense spending. There are going to be a lot of words at first – but if you’re the impatient type, feel free to jump ahead to the graphs. There are three of them.

The story I’m going to tell is a very Keynesian story. In broad strokes, when the Great Depression began in 1929, aggregate demand dropped a lot. People stopped buying things leading companies to reduce production and stop hiring, which in turn reduced how much people could buy and so on and so forth in a vicious cycle. Keynes’ approach, and one that FDR bought into, was that somebody had to step in and start buying stuff, and if nobody else would do it, the government would.

So an increase in this federal government spending would lead to an increase in economic growth. Even a relatively small boost in government spending, in theory, could have a big consequences through the multiplier effect – the government hires some construction companies to build a road, those companies in turn purchase material from third parties and hire people, and in the end, if the government spent X, that could lead to an effect on the economy exceeding X.

This increased spending by the Federal government typically came in the form of roads and dams, the CCC and the WPA and the Tennessee Valley Authority, in the Bureau of Economic Analysis’ National Income and Product Accounts (NIPA) tables it falls under the category of nondefense federal spending.

Now, in a time and place like the US in the early 1930s, it could take a while for such nondefense spending by the federal government to work its way through the economy. Commerce moved more slowly back in the day. It was more difficult to spend money at the time than it is now, particularly if you were employed on building a road or a dam out in the boondocks. You might be able to spend some of your earnings at a company store, but presumably the bulk of what you made wouldn’t get spent until you get somewhere close to civilization again.

So let’s make a simple assumption – let’s say that according to this Keynesian theory we’re looking at, growth in any given year a function of nondefense spending in that year and the year before. Let’s keep it very simple and say the effect of nondefense spending in the current year is exactly twice the effect of nondefense spending in the previous year. Thus, restated,

(1) change in economic growth, t =
f[(2/3)*change in nondefense spending t,
(1/3)*change in nondefense spending t-1]

For the change in economic growth, we can simply use Growth Rate of Real GDP at time t less Growth Rate of Real GDP at time t-1. The growth rate of real GDP is provided by the BEA in an easy to use spreadsheet here.

Now, it would seem to make sense that nondefense spending could simply be adjusted for inflation as well. But it isn’t that simple. Our little Keynesian story assumes a multiplier, but we’re not going to estimate that multiplier or this is going to get too complicated very quickly, particularly given the large swing from deflation to inflation that occurred in the period. What we can say is that from the point of view of companies that have gotten a federal contract, or the point of view of people hired to work on that contract who saved what they didn’t spend in their workboots, or storekeepers serving those people, they would have spent more of their discretionary income if they felt richer and would have spent less if they felt poorer.

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Still Not a Win and Just a Delay

The biggest lie coming out of the Senate today:

“’One of the major problems with Obamacare was that it was written on a strict party-line basis and driven through Congress without a single Republican vote,’ McCain said. He added that Congress must now ‘hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors.’”

An African-American comes to be President and Republicans vow from day one to obstruct. McConnell made it his “single most important thing to achieve is for President Obama to be a one-term president.” There was no intent to ever work with Barack Obama then or Democrats today.

Lets not forget, the Republicans have until EOM September to pass a bill under Reconciliation to change the ACA. October 1 is a new budget year and the Republicans will have to decide whether to change those parts of the ACA using Reconciliation or pass Tax Reform using Reconciliation. They can not do two Reconciliations in one budget year. One or the other will have to wait.

Besides blocking the Risk Corridor Program which caused much of the premium increase since 2015, insurance companies to lose money and withdraw from healthcare exchanges, and Coops to go bankrupt; President Trump has threatened to withhold CSR subsidies for out-of pocket expenses to those 100% – 250% FPL with Silver Plans. This subsidy goes directly to insurance companies. Withholding it will cause premiums again to increase and more companies to withdraw from the exchanges.

The second biggest lie coming out of Congress comes from a Congressman who relied on SS benefits to put him through college and who hopes to deny healthcare to his constituents and others as well.

“’The Senate’s got to pass a bill for us to even move the process forward,’ Congressman Ryan said. ‘That’s the next step. So, we’re hoping that they can achieve that next step so that we can bring real relief.’”

This is what Trump means by making the ACA fail or worst than what has occurred to date with Republican meddling in it.

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R and D

Angry Bear has over the years described the Pharma industry and its spending on Rand D and stock buybacks, among other developments in comparing US health outcomes to other countries.

Via New York Times discussing this study at Ineteconomics.

US Pharma’s Financialized Business Model
JUL 2017 |

Price gouging in the US pharmaceutical drug industry goes back more than three decades. In 1985 US Representative Henry Waxman, chair of the House Subcommittee on Health and the Environment, accused the pharmaceutical industry of “gouging the American public” with “outrageous” price increases, driven by “greed on a massive scale.” Even in the wake of the many Congressional inquiries that have taken place since the 1980s, including one inspired by the extortionate prices that Gilead Sciences has placed on its Hepatitis-C drugs Sovaldi since 2013 and Harvoni since 2014, the US government has not seen fit to regulate drug prices. UK Prescription Price Regulation Scheme data for 1996 through 2010 show that, while drug prices in other advanced nations were close to the UK’s regulated prices, those in the United States were between 74 percent and 181 percent higher. Médecins Sans Frontières (MSF) has produced abundant evidence that US drug prices are by far the highest in the world.

The US pharmaceutical industry’s invariable response to demands for price regulation has been that it will kill innovation. US drug companies claim that they need higher prices than those that prevail elsewhere so that the extra profits can be used to augment R&D spending. The result, they contend, is more drug innovation that benefits the United States, and indeed the whole world. It is a compelling argument, until one looks at how major US pharmaceutical companies actually use the profits that high drug prices generate. In the name of “maximizing shareholder value” (MSV), pharmaceutical companies allocate the profits generated from high drug prices to massive repurchases, or buybacks, of their own corporate stock for the sole purpose of giving manipulative boosts to their stock prices. Incentivizing these buybacks is stock-based compensation that rewards senior executives for stock-price “performance.”

Like no other sector, the pharmaceutical industry puts a spotlight on how the political economy of science is a matter of life and death. In this paper, we invoke “the theory of innovative enterprise” to explain how and why high drug prices restrict access to medicines and undermine medical innovation. An innovative enterprise seeks to develop a high-quality product that it can sell to the largest possible market at the most affordable price. In sharp contrast, the MSV-obsessed companies that dominate the US drug industry have become monopolies that restrict output and raise price. These companies need to be regulated.

“The key cause of high drug prices, restricted access to medicines and stifled innovation, we submit, is a social disease called ‘maximizing shareholder value,’” the study’s authors concluded.

This concept, the authors said, is actually “an ideology of value extraction.” And chief among the beneficiaries of the extraction are drug company executives, whose pay packages, based in part on stock prices, are among the lushest in corporate America.

“There’s no shortage of spending on R&D in the U.S. economy, and no shortage of spending on life sciences, even though it has declined somewhat in real terms,” one of the authors, William Lazonick, a professor of economics at the University of Massachusetts, Lowell, said in an interview. “But there really is very little drug development going on in companies showing the highest profits and capturing much of the gains.”

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Some Thoughts on ACA and BCRA

I’m not sure if this is worth posting here, but I have some thoughts on health care reform reform.

The Republican arguments have become absurd in interesting ways.

HHS secretary Price said something which makes no sense: “the Senate health care bill strengthens and secures Medicaid for the neediest in our society,” putting the program, which serves more than 70 million low-income people, on “a path to long-term sustainability.”

Republicans regularly describe cuts to Social Security pensions or Medicare benefits as needed to “strengthen and secure” those programs. In those cases, the argument isn’t absurd, because OASDI and Medicare plan A have trust funds which might run out. It makes no sense in the case of Medicaid which is financed by general revenues. I think the dedicated financial streams and trust funds make Social Security and Medicare vulnerable. It is possible to convince people that the trust funds reaching zero will cause something like the bankruptcy of a firm (and also people tend to assume that claims on bankrupt firms are worthless when historical recovery ratios average around 70 cents on the dollar).

The argument for dedicated taxes and trust funds, which I have read here among other places, is that otherwise the programs are like welfare and would be unpopular. The massives support for Medicaid demonstrated now that Republicans are trying to cut it undermines this argument.

Also in the same article Sen Cornyn flat out lies “Mr. Cornyn acknowledged that “there’s uncertainty about what the final outcome will be.” Asked what would happen if the bill did not pass, he said: “I assume we’ll keep trying. But at some point, at some point, if Democrats won’t participate in the process, then we’re going to have to come up with a different plan.” Of course Democrats have begged to participate in the process and have been excluded by Republicans. Robert Pear quoted the lie without noting that it is false. I think this is bad journalism. Also Cornyn is hinting that they might have to (shudder) try bipartisan negotiation. His statement would only make any sense if it were rephrased “If Democrats will participate in the process”. “Keep trying” means keep trying to pass a bill while completely excluding all Democrats. Cornyn is admitting that it was a mistake to be 100% partisan. He wants to blame the Democrats. The result is not just a lie, it is garbled nonsense based on a lie.

Finally Rand Paul is insane. He actually said “it keeps the fundamental flaw of Obamacare. It keeps the insurance mandates that cause the prices to rise, which chase young, healthy people out of the marketplace and leads to what people call adverse selection, where you have a sicker and sicker insurance pool and the premiums keep rising through the roof.” This is so crazy that I can’t think of a reply. All the claims are false — the BCRA would lead to adverse selection, because they eliminate the mandates. The idea that mandates cause selection is plainly insane. It is hard to understand how the statement could be generated by a human brain. And the ACA might survive because of that nutcase. Insane extremism causes sane policy in Bizarro World.

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Bizarro World

At least 40 Republican Senators and possibly the critical 50 have decided to stand up to the lobbyists, the interest groups and big business. They are willing to vote for the Cruz amended BCRA which would not just repeal Obamacare, but also destroy US individual market health insurance. If they do so, they stand up to many of the most powerful lobbies including the AMA and the AARP (but not the NRA or AIPAC). Most importantly, they reject the very firm claims and fierce arguments of the relevant health insurance industry lobby AHIP

AHIP (and BCBS) wrote an extraodinarily passionate and detailed letter to the Senate which included “this provision will lead to far fewer, if any, coverage options for consumers who purchase their plan in the individual market. As a result, millions of more individuals will become uninsured.” Notice the future indicative (which I will never ever use). The claim is definite and made with absolute confidence. They express 100% confidence that enacting the reform (with the Cruz amendment) will cause a disaster.

The amazing thing is that AHIP is demanding that its members be regulated. They are asserting that they will damage the country if allowed ““As healthy people move to the less-regulated plans, those with significant medical needs will have no choice but to stay in the comprehensive plans, and premiums will skyrocket for people with preexisting conditions”. This correctly asserts that AHIP members will cherry pick if they are allowed to. AHIP correctly assumes that AHIP members will destroy the health insurance system for short term gain if allowed. It’s like a serial killer cherry picker writing “stop me before I medically underwrite again”.

It is bizarre for an industry to demand regulation to protect consumers from them. The suspicion must be that the concern for the general public is an excuse for support for regulation which helps incumbents or limits competition. The second Bizarre thing is that I personally don’t doubt the sincerity of the lobbyists advocating regulation in the public interest of the members of the lobby. For one thing, their claims are obviously correct and at least an overwhelming majority of independent experts agree. In fact, I haven’t read a defence of the Cruz amendment by ultra hack Avik Roy (I think there is one by uber hack Stephen Moore). I don’t think that an honest case can be made that an industry lobby isn’t sincerely acting (this time) in what it’s officers consider to be the public interest.

But strangeness beyond strangeness, it seems possible that 50 GOP Senators will ignore all serious independent analysis and all of the relevant interest groups. I don’t recall the last time so many Republicans seriously considered standing up to big business. I don’t think it is really surprising that Republicans finally say no to an interest group when that interest group says the public must be protected from the socially damaging profit seeking which shareholders will fore on them.

Everything is updide down in Bizarro World.

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McConnell Again on Healthcare

Mitch McConnell and the Republicans in the Senate are not satisfied with the Tom Price appointed CBO chief, who insists that there are four fingers in front of his face and apparently won’t make numbers up to help take away health insurance from 22 million people.

So Mitch McConnell and the Republicans will rely upon, and I am not making this up, “ALTERNATIVE SCORING” to further the Ted Cruz amendment to Obamacare repeal through the Senate. Republicans are expecting it will take weeks to get the scoring from the CBO.”

Repubs are running out of time to repeal the ACA and achieve tax reform under reconciliation. The budget year ends EOM September. If the ACA is not repealed by then, it has to wait until next budget year. You can not do two reconciliations in one year and the other one is tax reform.

McConnell To Use Alternative Scoring for Healthcare Bill, Crooks and Liars, Frances Langum, July 13, 2017

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three bad ideas which I think would be political winners for Democrats

Matthew Yglesias commands,
I obey. Now I just have to come up with three bad ideas.

1) $25 minimum wage. I am not sure about the $15 dollar proposal. I’m pretty sure that $25 would be too high. I guess it would be popular too.

2) Protection that’s what you’re here for . I am sure that total protectionism is a bad idea, and hinting at it worked pretty well for Trump.

3) Eliminate all taxes on the lower 99%.

I tend to wonder if maybe this isn’t such a bad idea, but I suspect that it would imply either huge deficits, undesireable cuts to Federal spending, or taxes on the top 1% which are higher than optimal.

In any case, I am rock solid certain that many Republicans are sure that Democrats are soon going to propose this and win all future elections. They wouldn’t argue against class warfare in the complete absense of any class warfare (except for theirs on behalf of the rich) if they weren’t terrified.

4) I would say health care reform with coverage of pre-existing conditions, gauranteed issue, Community rating and no mandate (to promise all the nice things without the necessary costs and destroy the individual insurance market entirely) except that Obama has already done that (the Barack Hussein Obama Jr was elected president of the USA, so don’t even think of tyring to tell me that bad policy is bad politics).

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California’s Single Payer Plan

Reader EM put this comment up in the AB open thread. I thought it was interesting enough to place on AB as I also wonder about the question being asked and the answer; “can a state divert Medicare funds to support a state single payer system?” The simple answer is “no,” Medicare funds can not be allocated to states and the same holds true for VA funding for healthcare and the tax credit to companies for healthcare insurance. Congress would have to approve it in new legislation. David Dayan discusses this issue of California Single Payer starting at minute 31 David Dayen on CA’s SIngle-Payer Debacle on Politics and Reality Radio. This is in direct answer to EM’s question.

Furthermore for Medicaid and CHIPS a 1332 wavier for state contributions must be deficit neutral and not create a deficit in the Federal Program which is required for CHIP and Medicaid. I assume a similar wavier for Medicare fund diversion would also have to be deficit neutral so as not to cause harm to overall Medicare.

The state of California is one of the top 10 states in income (median income 9th). If a state such as California pulls out of Medicare, who makes up the difference in funding? There are other states such as McConnell’s Kentucky who rank in the bottom 10 with the lowest income (median income 46th) and a higher percentage of people living in poverty.

Here is EM’s dilemma:

Mother Jones, Kevin Drum, June 29, 2017 12:38 PM; “I Get Letters

The single biggest proponent of SB562, California’s single-payer health care bill, is the California Nurses Association. But here’s something I didn’t know until yesterday: the CNA is aggressively using support for SB562 as a litmus test for being a true progressive. The bill is basically unpassable, but it’s being used as a way of whipping up the Bernie wing of the Democratic Party against traitors who fail to support it.

Apparently this applies even to B-list bloggers. I got an email today from Chuck Idelson, Communications Director for CNA’s umbrella organization, National Nurses United. Here is how it ended:

“Having seen two years of your hatred for Bernie Sanders, it’s not surprising you would be equally hostile to ideas he champions like single payer, but it would be nice if you were a little more honest with your readers, or maybe you can recommend the name of your magazine be changed from Mother Jones – who actually fought for working people – to Milton Friedman, which would better reflect your class sympathies.”

It is good to see that progressive organizations are learning communications skills from the Trump administration. But, I wonder if this kind of attitude is helpful in attracting and maintaining support for progressive causes?

POSTSCRIPT: “Just for the record, I have supported single-payer health care for at least the past 25 years. But for a variety of reasons, it needs to be done at the national level. No state has ever been able to make it work.”

EM: Still trying to find answers to this Cal single payer thing in terms of financing.

New Republic, Clio Chang, June 30, 2017, “ What Killed Single Payer in California?

“A legislative analysis found that California’s single-payer plan would cost $400 billion to implement, $200 billion of which would be new spending. Critics were quick to point out that this “hefty” price tag is twice the state budget. Furthermore, the bill did not include a funding plan (although the bill’s language ensured that Healthy California would not launch unless it was funded).

However, a report by professors at the University of Massachusetts Amherst, commissioned in part by National Nurses United, estimated that after taking in the savings of single-payer, such as lower administrative costs and prices of pharmaceuticals, the actual cost of the plan would end up at around $331 billion. And, because 70 percent of the state’s current health care spending is covered by public programs like Medicare and Medi-Cal, California would only need to come up with $106 billion in new revenue, which researchers proposed could be done through two new taxes (a 2.3 percent gross receipts and sales tax), with exemptions for small businesses and tax credits to offset costs for low-income families. In exchange, nearly all of Californians’ medical expenses would be covered, doing away with premiums, copays, and deductibles . . .

But according to the Affordable Care Act’s Innovation Waiver, if a state comes up with a credible alternative to the ACA, the federal government is obligated to provide the funding. Pollin said that while it is impossible to know in advance what the Trump administration will do, “you can also pass the bill, and obviously it has to be contingent on us continuing to get 70 percent of funding that we now get.” Pollin felt that Rendon’s objections were technical ones — they need to be addressed, but don’t raise any issues that can’t be worked through. “The concerns that they raised were pretty narrow. Nobody said this is crazy, we can’t do this,” he said.

There are problems other than the fact that the bill did not include a specific funding mechanism. The biggest hurdle may be Proposition 98, a complicated California funding law that requires that around 40 percent of the state’s budget go to schools. This means that a huge portion of any increase in the state budget would have to go to education, so legislators would have to come up with almost double the money to cover the single-payer plan. To get around this, voters would have to first pass a ballot initiative.”

EM: I cannot find anything at all in the ACA’s Innovation Waiver that says Medicare funds can be used.

FamiliesUSA,Cheryl Fish-Parcham, January, 2016 “ What Advocates Should Know about 1332 State Innovation Waivers

“The 1332 waivers apply only to private health insurance coverage and the marketplace, not to public programs like Medicare or Medicaid. But states can seek multiple waivers from HHS at the same time. For example, they might ask permission to change their Medicaid programs under an 1115 waiver and their marketplace coverage under a 1332 waiver. However, the federal government will evaluate each type of waiver separately – an 1115 waiver must still meet all of the existing standards for Medicaid 1115 waivers, and a 1332 waiver must meet the requirements we describe below. How Could a 1332 Waiver Affect Medicaid or CHIP?

EM: I cannot believe there is anything in Medicare law that would allow such a transfer, and it does not appear to me there is anything in the ACA that even mentions using Medicare funds.

Perhaps someone in here has more knowledge than I have been able to find, but I see no purpose whatsoever in this financing plan from Pollin that relies on funds that cannot be accessed. All this thing does is confuse the issue.

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