Relevant and even prescient commentary on news, politics and the economy.

WA Senator Murray Thinks She has a Deal to Save the CSR

Sen. Lamar Alexander (R-TN), chairman of the Senate health committee, said he hopes to release a bill this week, in collaboration with Sen. Patty Murray (D-WA), the senior Democrat on the committee, to fund the cost-sharing reduction payments and give states more leeway on insurance rules.”

Not sure why Senator Murray feels the need to go down this avenue when the preceding Executive Order already wandered into greater flexibility for states, states rights, and who decides what. As has been explained by the CBO, Drum, other pundits, and myself; the loss in out-of-pocket subsidies will result in increased premiums which are “still” paid for by the ACA between 138% and 250% FPL. In some cases, Bronze plans can be had for free, Silver plans become cheaper, and Gold plans offering better care and lower deductibles attainable.

Senator Murray is giving away the store if what Senator Alexander says is true. “Alexander said Murray agreed to a deal giving states ‘meaningful’ flexibility on coverage rules. Asked what the stumbling blocks to the deal are, Alexander replied: ‘The definition of meaningful.'”

We have already seen what the word meaningful means with regard to the expansion of Medicaid in some states . . . it never happened. I am hoping Senator Murray has second thoughts and decides not to go farther with her thoughts on negotiating with the Republicans as she is off base and we will be better off by not altering what is law already and it is the ACA.

Premiums will go up in 2018 as no one is going to trust Trump regardless of any deal reached with the Republicans.

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Healthcare News; ACA and CHIPs

Trump’s Healthcare Executive Order

Trump Signs Executive Order relaxing ACA health insurance rules. About a week or so ago, I had read this elsewhere, mentioned it, and was told there was no way this would happen. Similar to the three attempts to defund the ACA, Trump is doing what he says the Senate could not do and that is to take healthcare insurance away from the citizenry.

More of Trump’s Executive Order down the page.

Children’s Health Insurance Program

Also if you did not know this, the Children’s Health Insurance Program is being held hostage by the House. Rather than pass a clean bill, the House Republicans added provisions to the passage of new funding. 2017 CHIP Program funding was used up during the time period when Republicans were spending inordinate amounts of time trying to defund the ACA rather than attending to other needs of the country. Some states such as Minnesota have already run out of funds to pay for the 9 million children in the US who are dependent on this program; however, nothing appears to get in the way of the House working on a Tax Reform Budget Resolution giving $billions to 1% of the households making >$500,000 annually.

One provision put in place by Michigan Congressman Fred Upton is nonsensical and strictly for show. Mind you, Fred Upton was one of two Congressmen who tampered with the Risk Corridor Program causing premiums to rise for those in the individuals market place with incomes > 400%, Coops to go bankrupt, insurance companies to lose money, and insurance companies to withdraw from the exchanges. Today Mr. Upton proposes to increase Medicare payments for those making >$500,000 annually saying it will help offset the cost of CHIPs, these oldsters can afford it, and if they do not like it . . . do not sign up for Medicare.

Upton’s statement is cold hearted and mean except for the extra $135/ month means testing the “few” would endure. In the US there is ~1 million household with incomes in excess of $1 million annually. Few of them are old enough for Medicare and the return from the Republican proposed tax reform would more than outweigh the additional $135/month.

The Impact of Trump’s Healthcare Executive Order

President Trump’s Executive Order “directs the departments of Treasury, Labor and HHS to consider expanding healthcare coverage through low-cost, short-term health plans that are exempt from Affordable Care Act insurance market rules.” The plans would:

• Be Short Term and up to 364 days as opposed to the ACA’s 90 day limit.

• Would not have to comply with the 10 categories of minimum essential benefits or accept all applicants at the same rates without regard to pre-existing medical conditions.

• Expand access to so-called association health plans allowing employers to band together in healthcare plans and cross state lines.

• Allow the expanded association plans to market to individuals across state lines.

More than likely, the impact of the Executive Order will drive up premiums for those left in the ACA, increase premiums for those with pre-existing conditions, and increase premium costs for older citizens. Much of the increase could be covered by ACA premium subsidies; but, those with incomes > 400% FPL (~10 million) in the individuals market would bear the full cost increase.

Kaiser’s Larry Levitt said; “ Association plans exempt from the ACA can cherrypick healthy people and make coverage unaffordable for those with pre-existing conditions. Insurers will leave the ACA marketplaces as soon as they can or hike premiums a lot.”

The only thing standing in the way of Trump’s Executive Order “easing the ACA’s statutory insurance market rules” from taking place is the legal challenges. As one legal expert posited; “I do not believe you can solve this problem without changing the law. It has to be done by statute, not regulation.”

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Trump Ends CSR Payments Immediately

According to Modern Healthcare:

“In a brash move likely to roil insurance markets, President Donald Trump will ‘immediately’ halt payments to insurers under the Affordable Care Act.

Before sunrise Friday morning, Trump went on Twitter to urge Democrats to make a deal:

‘The Democrats ObamaCare is imploding, massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!’

The Department of Health and Human Services had made the announcement in a statement late Thursday. ‘We will discontinue these payments immediately’ said acting HHS Secretary Eric Hargan and Medicare administrator Seema Verma. Sign-up season for subsidized private insurance starts Nov. 1, in less than three weeks, with about 9 million people currently covered.”

This could be devastating to those with incomes less than 250% of the Federal Poverty Limit. It is a direct attack on US citizens by a president who can not get his way politically and is meant to punish citizens and politicians alike for not following his dictates. Let me assure you, the ACA was not imploding and most of the cost issues with it were caused by Republicans such as former Alabama Senator Sessions and Michigan and Colorado Representatives Upton and Kingston tampering with the Risk Corridor Program.

However, what will happen is the differences will be picked up by increases in premium subsidies as I have said previously for those in this category of 138% to 250%. Indeed as the CBO has pointed out, it becomes cheaper in some cases to bump up to a Gold plan for some. See Tables 1 and 2. Net cost of the ACA increases by $31 billion over 10 years.

Trump asserted: “Obamacare is a broken mess. Piece by piece we will now begin the process of giving America the great HealthCare it deserves.”

The only thing broken today is the Presidency as it is occupied by a madman. One has to wonder if this is Trump’s last hurrah before indicted.

At this time, I have no polite words I can print on AB.

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Oxfam America President Abby Maxman Questions Slow Aid Response to Puerto Rico

Oxfam is a global organization working to end poverty. Its goal is to help people build better futures for themselves, hold those responsible accountable for the failures of people in power and/or government, and work in disaster areas. Their mission as stated is: “ To create lasting solutions to poverty, hunger, and social injustice.”

Earlier in the week Oxfam acknowledged the ongoing tragedy in Puerto Rico. Oxfam President Abby Maxman said:

“Oxfam has monitored the response in Puerto Rico closely, and we are outraged at the slow and inadequate response the US Government has mounted in Puerto Rico. Clean water, food, fuel, electricity, and health care are in desperately short supply and quickly dwindling, and we are hearing excuses and criticism from the administration instead of a cohesive and compassionate response. The US has more than enough resources to mobilize an emergency response; but, it has failed to do so in a swift and robust manner. Oxfam rarely responds to humanitarian emergencies in the US and other wealthy countries; but as the situation in Puerto Rico worsens and the federal government’s response continues to falter, Oxfam has decided to step in to lend our expertise in dealing with some of the world’s most catastrophic disasters.”

And still what Trump thinks about during a visit to the island is the debt owed Wall Street. “They owe a lot of money to your friends on Wall Street and we’re going to have to wipe that out. You’re going to say goodbye to that, I don’t know if it’s Goldman Sachs but whoever it is you can wave goodbye to that”. Trump was and is holding Puerto Rico hostage to getting aid on behalf of Wall Street.

Abby Maxman continues:

“Oxfam will join forces with Puerto Rican leaders to appeal to Congress and other federal agencies in Washington to dedicate resources to the response and remove barriers that are keeping aid out, and to commit to long-term support to help Puerto Rico build back better. We’ll also engage policy makers about the roles inequality and climate change are playing.

In addition, Oxfam has sent a team to San Juan to assess a targeted and effective response. We are currently determining how best this response could benefit from our expertise, such as meeting the needs of rural communities who face increasing risks of disease like cholera without clean water, providing shelter and meeting other immediate needs.”

Where are our Congresspersons and Senators? The population of Puerto Rico are US Citizens. I would urge people to write your representatives and senators pushing them to pressure the President to move quicker and forget the banking and financial sector Main Street bailed out. If this were a white population, no one would stand for this type of treatment.

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Will October 1 Bring Another Repeal Effort?

It could . . .

With the Senate vote tomorrow canceled on the Graham – Cassidy ACA defunding bill, the effort to defund and repeal the ACA will cease for the rest of this budget year ending September 30, 2017. With the passage of a new budget and a new resolution the effort could go onward in an attempt to repeal the ACA.

As I have said, there can only be one resolution per year. Let me clarify the one reconciliation per budget year statement. Unless the Senate passes more than one budget resolution, there can be only one Reconciliation per year for each of three subjects; spending, revenues, and debt limit in one or multiple bills. Since there was no budget passed last year, the Republicans had a unique opportunity to do two Reconciliations . . . one to defund the ACA and the 2nd one to do Tax Reform. The present Reconciliation affected Spending and Revenues thereby killing those two subjects for Reconciliation in 2017.

If one bill covers spending and revenue, Reconciliation using a budget resolution is expended for those two subjects. Budgets end September 30 of each year.

2018 is a different year and again Congress could take up the repeal of the ACA. And why not when they can get 49 votes to pass it any time they wish to do so. Maybe one of the remaining three Republican Senators will side with them or a Dem may have a weak moment. Since Republicans want to do tax reform, they will use Reconciliation again as it only requires a majority vote and defund the ACA to provide the revenue for it. The opportunity to do two Reconciliations due to two budget resolutions will not be available for Republicans. It may end up being both ACA and Tax Reform in one Reconciliation of just one meaning the ACA or Tax Reform.

Martin Longman at Washington Monthly does a good job of explaining Reconciliation. I believe I beat him in predicting a new run at Reconciliation which can be found in the comments section in early September. I was happy he did write on it as few people have done so till the very end. If still interested, here is a detailed primer on the topic also.

Did the effort to repeal the ACA hurt it going forward? Trump’s threats to kill the CSR which funds out-of-pocket expenses for those between 100% FPL and 250% FPL would not be impacted by this move. For those between 100% and 250% FPL, healthcare insurance premium increases would be picked up by the ACA. Those above 250% to 400% FPL would have premiums limited by the a ratio of ~9% of income. Above 400% FPL, some of our readers and everyone else would take on the full impact of the premium increase. Trump has done everything possible to cause issues with the ACA and this would include lying to the public as well.

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Healthcare Insurance History

Last 21 Days ACA Healthcare History

On September 7th and shortly after Pelosi and Schumer decided to be nonpartisan and help Republicans who still had an ounce of decency to pass hurricane Harvey aid and set a new National Debt Limit, I wrote about the inherent dangers of being so magnanimous. Lets face it, during the Obama 8 years, Republicans made it a vow even before he took office to oppose everything coming from the other side of the aisle even refusing to participate in committee meetings. The ACA passed by Democrat votes only.

The danger with being nonpartisan with Republicans and passing good things which are beneficial to the constituency is you allow Republicans afterwards to concentrate on issues which will not favor the constituency or Democrats. Passing hurricane aid and a new debt limit did allow Republicans to get back to the more partisan effort of defunding the ACA and more money for the already rich through tax reform. The two are interlinked. The repeal passes funding for tax reform.

Angry Bear wrote on September 7 about the danger inherent in helping Repubs, wrote again on September 13 about Republicans being confident on defunding the ACA and its impact, again on September 15 about trusting Trump and Republicans with a hand-shake-deal, and last week on September 21 when Kimmel called Cassidy out as a liar and Krugman, other columnists, and blogs finally woke up to the impending danger of the Graham – Cassidy Bill.

Angry Bear called it early in the month on Republican treachery to defund the ACA. The vote will be this week before the 30th. I do not trust McCain. Hopefully, I am wrong on McCain.

Older Healthcare Insurance History

I thought this comment by a blogger was interesting to read as we wait for the Senate to take up the Graham – Cassidy Healthcare Insurance Bill which will defund the ACA if passed this week. I wander the blogosphere and I run into some interesting people from time to time. This particular commenter had a wealth of knowledge on healthcare insurance going back a ways. I have captured the commenter’s words to present them to Angry Bear. Hope you enjoy them.

“When, early in our adventures in managed care, I was marketing for clients like Sisters of Providence, who were attempting to set up their own managed care, non-profit PPO (which ultimately they did not see to completion), in the late 1980s, health care insurance was still non profit.

At that time ‘commercial insurers’ did not refer to health insurers at all. Commercial insurers provided for-profit RISK insurance — which health ‘insurance’ isn’t (and can’t be without defeating its original purpose; to help more people afford care while helping providers maintain expensive facilities and services). Health insurance was created as an additional way, beyond taxes and charity, to socialize increasing health care costs — to assure the healthy, self-interestedly, that the resources to meet their inevitable health care needs would be there when needed. And to ensure hospitals would have a revenue stream to help them maintain the increasingly sophisticated and varied resources to meet the modern care needs of their communities.

Although the first actual, modern health insurance program is credited to a hospital in Texas in the 1920 which contracted with school district employees to provide services to for a monthly premium (it was non-profit); proto-insurance schemes based on the same principle — asking healthy EMPLOYED people to contribute a modest monthly amount to cover care if and when they were injured or ill — were used long before. The Sisters of Providence, for instance, established the first hospitals in my part of the world, the Pacific Northwest, in the middle of the 19th century, offered loggers care for their not-infrequent injuries for a payment of $1 a month (this I understand having cut down trees while gaffing up them). The connection between health insurance and employment did not, as many people believe, just arise as a government idea with favorable WWII tax policies. It arose from a much older recognition of the reality that injury and illness compromise patients’ ability to work, earn and pay — and the recognition the employed, especially those in the more commonly dangerous occupations, had both the income with which to make regular payments and an incentive to make arrangements to provide for themselves, as eventual patients, with care when needed despite the economic vulnerability illness caused — while providing providers with resources that helped maintain facilities and services and workforce to provide that care.

Until the advent of ‘managed care,’ which deregulated the health insurance market in ways giving insurers a greater ability to limit who was covered and what was covered — to their own benefit (but not necessarily to the benefit of our social need for broadly available health care, or increasingly, premium payers’ needs either). In fact, commercial insurers avoided the health insurance market like the plague.

It was understood by everyone that there was no way to make a profit in it While still meeting policy holders actual needs.

Health insurance was created solely as a way to socialize costs for health care consumers.

It did and does not and can not work like a car, flood, or even life insurance where insurers work out, and profit from, fairly reliable actuarial probabilities about what percentage of policy holders are likely to ever make a claim, the likely length of time the average policy holder will be paying premiums before making a claim, and from those probabilities charge — and deny coverage — accordingly. People, the overwhelming majority of policy holders, will depend on health care coverage again and again and again — for services large and small — with more and more needs, and more serious needs, accumulating over time.

Inviting commercial insurers into the market as we did in the late 70s and 1980s, with managed care, was a big mistake.

But many countries, Germany, Switzerland, France, provide excellent, cost-effective universal systems that are not single payer — they rely in different ways on a networks of non-profit and public insurance. Although some countries allow for-profit insurers who provide some limited extra coverage, they are very limited.

I don’t think we should throw their examples out while looking for the best way for the US to provide universal coverage.

Especially considering how many Americans do receive coverage through insurance at work, and are happy with that coverage, and our long history with that method of socialization.”

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A Wake-Up Call for Students

Guest Author: Alan Collinge, StudentLoanJustice.Org,Both Alan and I have written various posts on the student loan crisis. Alan has been featured on Angry Bear Blog from time to time.

If you are in college and looking for something worthy to fight for today; as a student, you should consider the student loan issue. Student loans and how they are administered are the national injustice of our time reaching threatening proportions and impacting the livelihood of young adults going forward. While at first glance, the problem appears complicated, confusing, and overwhelming; it is actually quite simple and its debt genesis hearkens back to the creation of this country. This problem transcends partisan and cultural divides and could serve to bring together those on the left and right on campus.

George Washington, Thomas Jefferson, and others were in debt up to their eyeballs to British banks and merchants. They came to understand how a lending system could be used against the citizens. Of course it was not just the Founders who were being exploited, many early settlers were indebted to English banks as well. John Adams famously remarked;

“There are two ways to enslave and conquer a country. One is by the sword. The other is by debt”

.

When the Founders created the Constitution, they made it a point to reflect on bankruptcy rights prominently. Few people realize that a uniform bankruptcy system is called for before the power to raise an army or a navy, ahead of the power to coin currency, and even ahead of the power to declare war in Article I, Section 8 of the Constitution.
Obviously, bankruptcy rights were very important to these men.

Free men are not forced into any type of behavior by the government that We The People established and ordained. The government is to serve the people – not to force them into servitude and obedience. The people are sovereign, as the people came before the government and the Constitution that gave rise to the government.

Adam Smith, the founder of free market economics provided the basis for western economic theory, was compelled to advocate for bankruptcy protection as a means to encourage entrepreneurship, risk taking, and also a means to compel good faith in a lending relationship.

When an individual or firm goes bankrupt, a legal process is instigated to discharge debts that cannot be repaid. In former times such debtors might have been put into a debtors’ prison and languished there for years. The process weighs assets against liabilities and allows the debts to be discharged at some fraction of their nominal value, leaving the debtor free of the burden, albeit subject to rules of financial behaviour and with a blemish on their credit record which can last for years.

Student loans violate longstanding economic principles and as such the beliefs of the Founders. Today, Congress has placed conditions on student loan bankruptcy so severe; that of 169,000 people with student loans who filed for bankruptcy in 2014, fewer than 20 received relief. When our legislators first restricted the right to student loan bankruptcy in the 70’s, some members warned that such a move had dire constitutional implications, but their concerns went unheeded. As one University of Connecticut expert Philip Schuhman testified to Congress:

” students should not be singled out for special and discriminatory treatment. I have the further very literal feeling that this is almost a denial of their right to equal protection of the law. Nor do I think any evidence has been presented that these people, these young people just beginning their years on the whole should be singled out for special, and as I view it, discriminatory treatment. I suggest to you that this may at least in spirit be a denial of their right to equal protection with the virtual pole star of our constitutional ambit.”

Today, student loans are the only type of loan in this country from which bankruptcy rights have been removed leading to consequences so severe as to result in a form of peonage. Despite peonage being made illegal after the civil war in 1867, it still flourished in the form of sharecropping with former slaves and poor farmers farming plots of land owned by others. Sharecroppers supposedly received a percentage of the profits from sale of grown crops. The sharecroppers were forced to take out relatively large loans just to get by and meet daily expenses, buy seed, rent land, and pay the interest rates imposed on them by landlords.

Also in the past African Americans could be accused of falsely owing money or trivial sums, given sham trials and quickly sold off by the courts into a privatized system of debt slavery to pay back debt. The peonage contracts contained enslaving terms and conditions, allowing the employer to trade, confine, whip and beat workers as long as the debt was deemed unpaid, which could practically last forever.

While not as severe as peonage, students in default are denied access to federal programs and unemployment benefits. Social Security and employment wages can be garnished leading to diminished lifetime earnings and poverty. All of these conditions have a severe impact upon the overall economy as younger workers do not achieve their full earning potential.

The student loan industry is willfully predatory and profitable for the banks who lobbied intensely for the removal of bankruptcy protections and work hard to keep their monetary advantage. As Mr. Potter would say; “The bank always get paid” and this comes no matter what the terms or conditions of the loan are.

(run75441) In my own discussion with a former University of Michigan lobbyist who was regaling me after I dared to make a statement to Michigan Senator Debbie Stabenow about what her stance and actions were with regard to student loans. “There is IBR and Repaye which are programs allowing payment back on student loans based upon income.” These programs are mostly failing because of one rule requiring the yearly application to the program rather than an automatic re-up into the program. The re-up is required to report income a factor which is automatically done for Medicare via computer systems. The manual yearly application for the programs was bound to be a failure just by this alone.

It was not just the banks cashing in on the removal of consumer protections. In 2012, the federal government booked over $50 billion in profit on the lending system and this has increased in more recent years. What is disturbing is White House Budget data showing a profit being made on defaults. Think about this: where a credit card company is thrilled to get back a dime on the dollar for their defaulted accounts; the federal government is actually getting back more than a dollar in return. This is a defining hallmark of a predatory lending system and unfortunately for the students, the Department of Education sits on top of it all doing everything it can to perpetuate this situation. Department of Education lawyers fight tooth-and-nail behind the scenes to deny legitimate bankruptcy. This form of government enforced peonage spans many presidents and Congresses and both political parties going back to the seventies.

In 1998, when Congress made bankruptcy permanently unavailable for the overwhelming majority of borrowers, the nation owed roughly $100 Billion in student loans. Today that has exploded to $1.5 Trillion. By the end of this year, nearly one in four borrowers will have defaulted on their loans. People’s lives are being devastated. Families are being torn apart, particularly where cosigners are put on the hook for their kid’s exploded loans. People are fleeing the country, and some are even committing suicide as a result of their student loan debt.

If you think you don’t need to worry because there are forgiveness programs in place, you are wrong. With 57% already kicked out of them income based repayment programs are failing misrably. Assuming the programs are not ended by Secretary of Education Betsy DeVos, I estimate only 10% will be successful and have their loans forgiven and still potentially taxed as income. The rest will be disqualified from the program and left owing far more than when they graduated.

Alan Collinge is the Founder of Student Loan Justice Org and author of “The Student Loan Scam” (Beacon Press).

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New State Laws Passed in California

Election Tax Returns

In an effort to force our present president when running for re-election and future presidential candidates to release income tax returns, California passed SB249 Disclose Act. California became the first state to require presidential candidates to release their tax returns in order to appear on the state ballot.

Lawmakers sent Gov. Jerry Brown AB249 Friday requiring candidates to publicly share five years of returns.

This comes after President Trump’s refused to release his tax returns during the 2016 campaign. His actions sparked similar legislation in dozens of other states. The documents reveal income sources, tax exemptions, charitable donations and potential financial conflicts of interest.

Until Trump, every major presidential candidates has released their returns for decades.

Criminal Background Checks

In new legislation, California employers could not initially ask during the interview process if potential employees have a criminal history. AB1008 Employment Discrimination: Conviction History bill was sent to Gov. Jerry Brown. The California Assembly on Friday gave final approval to a bill that supporters say would mean more ex-felons could get jobs and stay out of trouble.

Democratic Assemblyman Kevin McCarty of Sacramento says AB1008 would allow employers to ask about criminal histories later in the process. It requires businesses with five or more employees to inquire into and consider convictions only after the applicant has received a conditional job offer.

California joins nine other states with similar restrictions on asking about criminal history. There was no spoken opposition as the Assembly agreed with Senate restrictions on a 41-25 vote.

Campaign Advertising

California voters would know more about who’s paying for campaign advertising under AB249 just sent to Gov. Jerry Brown. AB 249 California Disclose Act requires ballot measure and independent expenditure committees to display the names of the top three donors.

AB249 also requires a clear disclosure of donors behind campaign committees having misleading names. The California Clean Money Campaign sponsoring the legislation said: “no other state disclosure laws reveals to voters more information about donors who increasingly hide behind a series of bland sounding political committees and groups to remove any identity of their contributions supporting candidates or new laws.”

Supporters say the bill will help voters make better decisions based on greater information.

Republicans say the bill should require labor unions to disclose individual members who contribute. Only the union would be listed under the bill and not its members.

The Assembly gave final approval on a 55-12 vote.

State Sanctuary Bill

California approved SB54 California Values Act, a “sanctuary state” bill Saturday that would limit how local and state police can interact with federal immigration agents. The bill is intended to provide more immigrant protections in the state which are already among the toughest in the nation.

It will now be considered by Gov. Jerry Brown, who announced his support after the top state Senate leader agreed to water down the bill and preserve authority for jail and prison officials to cooperate with immigration officers in many cases.

It looks like some states are doing something to counter big money, Republican values, and Trump.

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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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