On health care, let's do the impossible
by Jonathan Tahini - CNN - September 25, 2017
(CNN)Pleading for passage of his version of the repeal of the Affordable Care Act, Sen. Lindsey Graham is the one who, unintentionally, has telegraphed the lasting impact of the 2016 Democratic presidential contest.
"It's either this," he said of the Graham-Cassidy bill in a radio interview with Breitbart News, or "we're going to Obamacare and Berniecare." The significance of Bernie Sanders' Medicare for All Act of 2017, and his role in CNN's national health care debate Monday, signals the embrace of transformational policies by millions of people.
Transformational politics is not simply a set of rhetorical flourishes that promise a pony, as some Democratic Party insiders have sniffed derisively. Transformational politics resets our social and political priorities by marrying economics and public policy with a willingness to challenge the conventional ways that society and government exercise power. Nelson Mandela summed uptransformative politics succinctly: "It always seems impossible until it's done."
For example, I would have thought it impossible in July 2015, when Sanders' presidential campaign was registering in the low-double digits in the polls, that 16 Democratic senators would stand with him two years later as he introduced a sweeping single-payer "Medicare For All" bill.
Recent polling shows a majority of voters supporting "Medicare for All," which expands coverage, compared with an overwhelming majority of voters opposed to Graham-Cassidy, which would take away health care for millions of people.
Before 2016, "Medicare for All" was not central to the Democratic Party's agenda. True, Rep. John Conyers had championed a single-payer bill in the House since 2003, but it was only supported by some members of the Progressive Caucus. When Sanders introduced his Senate version in 2013, he had not a single co-sponsor. Single-payer was considered a politically impossible idea.
Fast-forward to 2016, where Sanders' campaign had a singular characteristic: From the outset, it embraced transformational politics.
Helping people envision things that can improve their lives, even when mainstream rhetoric tells them those big changes are impossible, works only when it syncs with people's beliefs, making them clearer than they were before.
This has great value to our society because it can encourage people who gave up on politics and have forsaken civic engagement to re-engage. Once the mind is unshackled and encouraged to think beyond a small policy box, our circuitry can be rewired in other arenas. Free college tuition and rebuilding the infrastructure, for example, become obvious, affordable choices. On race, we can even consider the notion of reparations for slavery -- an important issue heretofore chained to the fringes of considered debate.
Over many months during the 2016 campaign, Sanders told people they had an inalienable right to cradle-to-grave affordable health care. Then he showed the math, juxtaposing the great efficiency of Medicare compared with the colossal waste of billions by the insurance industry. Finally, he put his finger on the corrupt political system blocking people from attaining such a right, and charted a path of action.
The shift wrought by transformational politics is on parade in the amount of Democratic support for Sanders' bill. A number of the co-sponsors -- Sens. Kirstin Gillibrand, Jeff Merkley, Kamala Harris and Cory Booker -- are generating buzz as potential 2020 presidential aspirants; they likely see support for "Medicare for All" as necessary to connect with the grass-roots activists who are so crucial in primaries. And over in the House, the Conyers bill now has more than 100 co-sponsors, a significant majority of the overall Democratic Caucus.
Transformational politics can even elicit a flicker from unexpected corners. Two billionaires, Warren Buffet and Mark Cuban, have in recent months opined that, as I argued back in January, single-payer is the most rational solution for business. While they and other business leaders may have held such beliefs in the past, the emerging transformational shift clearly helped to encourage them to speak up.
As I have written before, single-payer is a no-brainer for CEOs in particular: It would allow them to save money, give workers a raise, have more money to put into research and development, and boost international competitiveness.
To be sure, "Medicare for All" is not likely to happen overnight. Republicans currently control the levers of government, and could potentially expand their majority in the Senate in 2018 -- and, then, try yet again to repeal the Affordable Care Act when the Democratic Party is even weaker.
That is precisely the point the Sanders movement has been trying to make: Establishment economics and policies that benefit elites are bad politics, not to mention damaging to the lives of millions of people. The Democratic Party will be stronger if it embraces a transformational vision.
One Way for G.O.P. to Achieve Some Repeal Goals? It’s Already Part of Obamacare
by Margot Sanger-Katz - NYT - September 23, 2017
On Friday, Senator John McCain of Arizona announced that he would not support the latest Republican push to overhaul the health care system. He didn’t disapprove of the objectives of the bill, but to its process, which was too rushed and partisan, he said in a statement: “A bill of this impact requires a bipartisan approach.”
Mr. McCain’s vote most likely dooms the current Obamacare repeal effort, which can afford to lose the votes of only two Republican senators. (Senator Rand Paul of Kentucky and Senator Susan Collins of Maine are generally regarded as no votes as well.) But there is, in fact, a bipartisan effort that could help Congress achieve many of the goals that the recent bill’s authors say they hope to accomplish. The catch: It would be hard for Republicans to call it Obamacare repeal.
Senator Lindsey Graham of South Carolina, who brought the legislation with Senator Bill Cassidy of Louisiana, has said that one of his key goals was to eliminate Obamacare’s top-down approach, giving states more power to run their own health care systems according to local preferences and conditions. “I’m trying to take the money and power in Washington and send it back closer to the patient,” he said during a news conference Tuesday, adding that “government closer to the people is the best government.”
Mr. Cassidy has said he wishes to protect insurance coverage for Americans with pre-existing health conditions, though many independent analysts have questionedwhether the text of the legislation would, indeed, offer such a protection.
Both senators say they wish to reduce federal spending on health programs, and to make care more affordable in the future.
Buried in the Affordable Care Act is a provision that could help promote all of these goals.
That provision allows states to waive nearly all of the rules about how they run their insurance marketplaces under Obamacare, if they can prove that their replacement plan would offer similarly comprehensive insurance to just as many people, at the same or lower cost. An older, related program allows states to make modifications to their Medicaid program that don’t cost the federal government more money, if the states adhere to various guidelines.
The Obamacare program, known as the “state innovation waiver,” was set up to kick in this year. And, so far, it appears that only a handful of states wish to refashion the Obamacare status quo.
Two states have put waivers into effect. Hawaii used one to do away with Obamacare’s small-business insurance marketplace. Alaska established a special fund to pay medical bills of patients who needed very expensive care, lowering the premiums on the market. Several other states have applied for waivers of various sorts, and these are undergoing federal review.
Why haven’t more states come forward? One reason is that coming up with a brand-new health care system is hard, and not every state may be interested in doing it. Another is that states have complained that the Obamacare application rules are too strict and onerous. The rules require states to pass legislation endorsing a state plan, to undergo a six-month review, and to adhere to tests to make sure that the new plan will protect the people who are helped by Obamacare.
States have also said that it can be hard to make related reforms to both the marketplace and Medicaid programs, since they must undergo separate reviews for their budgetary effects.
But in recent hearings, the Senate Committee on Health, Education, Labor and Pensions has been discussing options to address state requests, and ease the process. The committee’s chairman, Lamar Alexander of Tennessee, has been pushing for changes that would make it easier for states to try new policy approaches.
And Patty Murray of Washington, the ranking member, was willing to make some concessions in exchange for a promise to fund insurance subsidies caught up in a court fight. The Alexander-Murray negotiations were shelved as the Graham-Cassidy bill picked up steam, but they could begin again. In his statement, Mr. McCain mentioned the Alexander-Murray negotiations as an avenue for bipartisan reform and said, “I hope they will resume.”
The idea of the innovation waiver originally came from the Democrats. Senator Ron Wyden of Oregon wrote the provision because he wanted states to have more options. An expanded innovation program might lead to more experiments from the left — something approaching a single-payer system from a state like Vermont, say — as well as those from the right. But making it easier for states to receive waivers could be a way for Republican senators to give states more flexibility.
There were, of course, many other features of the Republican bill that could not be easily replicated by waiver. The Graham-Cassidy bill would have redistributed a big pool of federal funding among states. And it would have changed the structure of the 52-year-old Medicaid program, putting spending on poor children, disabled Americans and many people living in nursing homes on a strict diet. Any bipartisan deal would require the votes of at least eight Democrats, which makes drastic changes to the current rules unrealistic.
But there remain opportunities for state experimentation. The Trump administration has signaled that it is eager to help promote state flexibility. Tom Price, the secretary of health and human services, wrote to governors in March, urging them to apply. Not every state has felt its proposals were welcomed with enthusiasm so far.
If a top Republican concern is about the rigid structure of Obamacare, and states really want to build their own systems, there are still avenues to move in the direction Mr. Graham and Mr. Cassidy have sketched. But while they might achieve many of the same policy goals, those efforts are likely to be cast as Obamacare revisions, not replacements.
Health Bill Appears Dead as Pivotal G.O.P. Senator Declares Opposition
by Thomas Kaplan and Robert Pear - NYT - September 25, 2017
WASHINGTON — A last-ditch attempt by President Trump and Senate Republicans to dismantle the Affordable Care Act appeared to collapse on Monday as a pivotal senator announced her firm opposition to the latest repeal plan, virtually ensuring that Republicans would not have the votes they need for passage.
The announcement by the senator, Susan Collins of Maine, effectively dooms what had been a long-shot effort by Republicans in the Senate to make one more attempt at repealing the health law after failing in dramatic fashion in July.
The demise of the latest repeal push means that Republicans are now all but certain to conclude Mr. Trump’s first year in office without fulfilling one of their central promises, which the president and lawmakers had hoped to deliver on quickly after Mr. Trump took office.
For seven years, Republicans have said they would repeal President Barack Obama’s signature domestic achievement and replace it with a new health care system more palatable to conservatives. But they were never able to formulate a replacement that was both politically and substantively viable.
Ms. Collins, one of three Republican senators who opposed the last repeal attempt in July, described the latest plan as “deeply flawed.” She expressed concerns about cuts to Medicaid as well as the rolling back of protections for people with pre-existing medical conditions.
“Health care is a deeply personal, complex issue that affects every single one of us and one-sixth of the American economy,” Ms. Collins said in a statement, lamenting the rushed process and the content of legislation that has shifted as Republican leaders scrambled for votes. “Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target.”
The Senate majority leader, Mitch McConnell of Kentucky, now faces the unpalatable choice of admitting defeat or moving ahead with a vote that appears certain to fail.
Republican leaders in the Senate can afford to lose only two of their members, and they now have three firm opponents within their ranks: Rand Paul of Kentucky, John McCain of Arizona and Ms. Collins. Additionally, Senator Ted Cruz, Republican of Texas, has withheld his support and requested changes to the bill.
Time is not on their side: Republicans have only until the end of the month to pass the bill through the Senate while being protected from a Democratic filibuster.
Beginning in October, Republicans would need Democratic votes in order to pass a repeal bill, a seeming impossibility given that Democratic senators have been unified in opposition to the repeal push.
Some Republican senators have suggested starting over, with parliamentary language in a new budget blueprint that once again would shield repeal legislation from a filibuster. But that could terribly complicate Republican efforts to overhaul the tax code, a risk the leadership may not want to take.
Ms. Collins’s announcement came three days after Mr. McCain said that he could not “in good conscience” support the latest repeal proposal, written by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana.
“We’re going to press on,” Mr. Graham said hours later, during a Monday night CNN debate on health care. He raised the possibility of still holding a vote, even as he acknowledged it might fail: “It’s O.K. to vote. It’s O.K. to fall short, if you do, for an idea you believe in.”
The senators released a revised version of their bill on Monday morning, hoping to win over holdout Republicans in part by shifting more funds to states like Alaska and Maine. The bill would take money provided under the Affordable Care Act for insurance subsidies and the expansion of Medicaid and send it to states, with vast new discretion over how to use it for health care or coverage.
But writing a repeal bill that could win over at least 50 of the 52 Republican senators has proved extraordinarily difficult, and putting together a complicated bill against the backdrop of a ticking clock only added to the challenge. Insurers, hospitals, doctors and patient advocacy groups assailed the proposal, as did the late-night talk show host Jimmy Kimmel.
The Capitol complex looked at times like a hospital ward on Monday as patients swarmed through the corridors, pleading with senators not to take away their health insurance. Some wore T-shirts that said, “I Am a Pre-Existing Condition.”
The Senate Finance Committee held a hearing on the repeal bill on Monday, and it was immediately disrupted by people in the audience shouting opposition to the proposal. “No cuts to Medicaid,” they chanted. “Save our liberty!” Capitol police officers removed the protesters, some of whom were in wheelchairs.
As Mr. Cassidy and Mr. Graham revised their bill to try to build support, critics asserted that their last-minute changes further weakened protections for patients, including those with cancer and other pre-existing conditions.
Dick Woodruff, senior vice president at the lobbying arm of the American Cancer Society, said that under the bill, patient protections provided by the Affordable Care Act would be up to each state to decide.
“Some states could decide not to cover even preventive services, like cancer screenings, routine mammography or colonoscopy,” Mr. Woodruff said.
Republican senators had to make up their minds with little information about the measure’s implications.
The nonpartisan Congressional Budget Office said Monday that “millions of additional people would be uninsured” under the Graham-Cassidy bill, compared with the number of people expected to lack coverage under current law.
“Enrollment in Medicaid would be substantially lower because of large reductions in federal funding for that program,” the budget office said.
But the budget office said it did not have time to produce a more complete assessment, leaving senators without specifics on how the bill would affect coverage and health insurance premiums.
The rushed process contributed to the bill’s demise.
Mr. McCain, who killed the last repeal effort in July with a dramatic middle-of-the-night vote, faulted Republicans for trying to pass sweeping health care legislation without the participation of Democrats or extensive public deliberations.
Mr. Paul had previously said he would oppose the Graham-Cassidy bill because it did not go far enough in repealing the health law. On Monday, he continued to denounce it as a “fake repeal.”
Mr. Paul presented himself as open to compromise, voicing support for a narrower measure. But he rejected the Graham-Cassidy bill’s core concept of providing block grants to the states to use for health care — leaving little room for Republican leaders to win his vote unless they radically altered the legislation.
“I think if you vote for this bill, you put your stamp of approval on a trillion dollars’ worth of Obamacare spending,” he said.
Mr. Paul was not the only conservative with reservations. Mr. Cruz said on Sunday that he had not yet been won over and was seeking changes to the repeal plan, though he said he wanted to ultimately wind up in favor of the bill. An aide to Mr. Cruz said on Monday that he still wanted to see changes.
Before Ms. Collins’s announcement on Monday, Mr. Trump expressed frustration that Republicans had talked for years about repealing and replacing the Affordable Care Act but failed to deliver now that a Republican was in the White House.
On the “Rick & Bubba Show,” a radio program, Mr. Trump singled out Mr. McCain, calling his vote in July “a tremendous slap in the face of the Republican Party.” And the president seemed resigned to defeat in the latest attempt at repeal.
“We’re going to lose two or three votes,” he said, “and that’s the end of that.”
Trumpcare Is Dead. Long Live the Trumpcare Opposition.
by David Leonhardt - NYT - September 25, 2017
It’s over. And it’s not over.
The effort to take away health insurance from millions of people — known by the name it deserves, Trumpcare — seems to have failed again. The latest version, the Graham-Cassidy bill, looks doomed, with three Republican senators joining all 48 Democrats and independents in opposition. Three plus 48 equals 51, and 51 no votes equal defeat.
Thank goodness. More specifically, thank goodness for the citizens who have rallied against the bill — the disabled activists who protested on Capitol Hill yet again on Monday, the callers who flooded the Senate switchboard, the experts who dispassionately explained the bill’s brutal effects, and many others.
This outpouring has left Republican leaders without the votes to pass a bill by Saturday, the end of the federal fiscal year. If they don’t meet that Sept. 30 deadline, Senate rules force them to start the process all over again. Which is why many observers are declaring Obamacare repeal to be dead.
But it is not dead. By now, everyone should have learned that President Trump and Mitch McConnell are not going to give up until absolutely forced to.
They didn’t give up when bills failed this summer, and they won’t give up if they miss the Sept. 30 deadline. They have promised their base and their donors that they will repeal Barack Obama’s signature achievement — extending decent medical care to the sick, the poor and the middle class. As long as Trump and McConnell believe that they are close to finding 51 votes, they will be tempted to try again. They can restart the process in October or beyond.
That’s why the next few days are important. Of particular importance are the positions that the remaining undecided senators take, starting with Alaska’s Lisa Murkowski.
For one thing, it’s not Sept. 30 yet. McConnell can still try to flip the bill’s opponents. Susan Collins, John McCain and Rand Paul all look like solid no votes, but nothing is guaranteed. Trumpcare has tended to fare best when people assumed it was kaput and stopped paying attention.
And the margin of defeat matters, too. The more senators who oppose Graham-Cassidy, the less likely that yet another version of Trumpcare will emerge.
For Murkowski, the decision is a character test, as it was for McCain. He passed his test, keeping a promise to oppose any rushed, secretive bill that made a mockery of the Senate, as Graham-Cassidy has.
Murkowski’s promises are different, but no less stark, as The Washington Post’s Greg Sargent has noted. She has said, “We must continue to prohibit insurers from discriminating against pre-existing conditions.” Graham-Cassidy would instead allow insurers to price sick people out of the market.
Murkowski has also insisted that Alaska not lose federal health care money, and the bill’s authors have tried to buy her vote with late changes. But the bill still reduces Alaska’s funding — and claims otherwise with a blatantly misleading data table. It was quickly debunked by health care experts.
The question for Murkowski is whether she is willing to let her vote be bought — for a cut-rate price, no less. My hope and guess is no. She stood firm against earlier versions of Trumpcare. But her lack of an answer so far is worrisome.
There are several other uncommitted Republicans, as well. Shelley Moore Capito of West Virginia and Rob Portman of Ohio are on the list, and both of their states would suffer badly under Graham-Cassidy. Ted Cruz of Texas and Mike Lee of Utah also have not announced their stances. All are now freed from the pressure of being the decisive vote.
The margin of Graham-Cassidy’s defeat (regardless of whether the Senate actually votes) will shape the next steps on health care. If Republicans come to terms with their total lack of a reasonable repeal plan, more of them will be open to a bipartisan compromise to fix Obamacare’s flaws. Such a compromise would encourage red states to sign up fully for Obamacare and, in turn, make future repeal efforts less likely.
To his credit, Lamar Alexander, the Tennessee Republican, started work on a bipartisan deal, before abandoning it last week, out of partisan loyalty to Republicans pushing Graham-Cassidy. But if the bill seems permanently defeated, Alexander will be able to resume the role of Senate statesman. He is well suited for it — in his third term, having previously been a governor and a cabinet member — and he doesn’t need to let himself get pushed around again.
The off-again-on-again fight over Trumpcare has been grueling. The activists, congressional staff members and others who have done heroic work in defense of their fellow citizens have good reason to feel exhausted. Unfortunately, it’s still not time to rest or celebrate. But victory is getting closer.
https://www.nytimes.com/2017/09/25/opinion/trumpcare-dead-opposition-healthcare.html?
'Millions' Fewer Would Have Coverage Under GOP Health Bill, Says CBO Analysis
by Alison Kodjak - NPR News - September 26, 2017
The proposal the Senate is considering that would repeal and replace the Affordable Care Act would result in millions losing health insurance and a $133 billion reduction in the deficit by 2026, according to the Congressional Budget Office's report on the Graham-Cassidy legislation.
The CBO did not have enough time to estimate specifically how many people's insurance would be affected as it has done when it scored previous repeal bills. But the analysis it released Monday evening says "the number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions" compared with current law.
The CBO did not have enough time to estimate specifically how many people's insurance would be affected as it has done when it scored previous repeal bills. But the analysis it released Monday evening says "the number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions" compared with current law.
The bill, known as Graham-Cassidy, would dismantle the major components of the Affordable Care Act, or Obamacare. Gone would be the subsidies that help people buy insurance, the mandate that requires people to be covered and the expansion of Medicaid.
All the money from those programs would be rolled up and redistributed to states in the form of block grants. Each state would then decide how to spend those funds. Because of that, says the CBO, the number of people without health insurance "could vary widely depending on how states implemented the legislation."
The bill also changes Medicaid by capping the federal contribution — giving states a fixed amount per person and increasing it at a rate that is slower than health care inflation.
CBO says it can't do a complete analysis of the plan in the short window requested by lawmakers. Senate Republicans are looking to vote on the bill this week, before a deadline at the end of September would require they get support from Democrats to be able to pass the legislation.
Earlier attempts to overhaul the health care system failed in part because the CBO analyses showed the proposed changes would very likely cause tens of millions of people to lose their insurance coverage. The major drivers of those losses, according to the CBO, were the loss of the individual mandate that requires people to buy insurance and the rollback of the expansion of Medicaid that was allowed under Obamacare.
The latest proposal includes both provisions as well as even further cuts to state funding and Medicaid, so some analysts say the results will be the same.
"With less money, fewer people will be covered. That's just math," says Nicholas Bagley, a law professor at the University of Michigan who specializes in health law. "And since Graham-Cassidy is a lot less money, a lot fewer people will get covered."
An analysis by the Brookings Institution estimates that about 21 million people would lose coverage under Graham-Cassidy compared with the current law through 2026, and eventually 32 million people would lose it because of the block grant funding changes.
A separate report by the health care consulting firm Avalere Health estimates that states would lose about $700 billion in federal health care funding over 10 years and $3.5 trillion over 20 years.
The bill's sponsors, Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., introduced a revised bill on Monday. "Whatever the CBO score is will be superseded by another score later this week," Cassidy said Sunday on ABC's This Week.
Read the C.B.O. Report on the Graham-Cassidy Health Care Bill
Senate GOP effort to unwind the ACA collapses Monday
by Sean Sullivan, Juliet Eilperin and Kelsey Snell - The Washington Post - September 25, 2017
The latest Republican effort to unwind the Affordable Care Act collapsed Monday as a third GOP senator announced her opposition and left the proposal short of the votes needed to pass.
While one top Republican senator held out the possibility that the Senate might still vote on the bill, others accepted the reality that the push had sputtered out after Sen. Susan Collins (R-Maine) joined two of her colleagues in formal opposition.
“Everybody knows that’s going to fail,” said Senate Finance Committee Chairman Orrin G. Hatch (R-Utah), who led a raucous, five-hour hearing on the bill Monday afternoon. “You don’t have one Democrat vote for it. So it’s going to fail.”
Monday’s developments amounted to a massive setback for Senate Majority Leader Mitch McConnell (R-Ky.) and President Trump, who spent the past week trying to rally support for a last-ditch attempt to fulfill a seven-year Republican promise. The effort lost much of its steam in the past four days, as it became clear that the new proposal had not resolved the same disagreements that plagued Republicans in a failed July push.
Collins announced that she could not back the measure — which would redistribute federal health-care funding across the country and sharply curb spending on Medicaid — moments after the release of a much-anticipated Congressional Budget Office analysis that forecast “millions” of Americans would lose coverage by 2026 if the bill was enacted.
Sens. Susan Collins (R-Maine) and Rand Paul (R-Ky.) listed their concerns on Sept. 24 about a health-care bill sponsored by Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.). (Bastien Inzaurralde/The Washington Post)
Two GOP senators — Rand Paul (Ky.) and John McCain (Ariz.) — had already come out against the bill and were not swayed by a new draft that emerged Monday morning. Republicans hold a 52-to-48 advantage in the Senate; they can lose only two votes from their party and still pass legislation with the help of a tiebreaking vote from Vice President Pence.
A fourth Republican, Sen. Ted Cruz (Tex.), indicated through his aides Monday that he could not back the bill in its current form because it would not go far enough in repealing the 2010 law.
Senate Majority Whip John Cornyn (R-Tex.) did not rule out the possibility of holding a vote on the proposal despite clear signs that it did not have sufficient support to pass. Many Republicans feel pressure from voters to keep pushing to repeal the ACA before moving on to other issues.
“There are a lot of people who want to vote yes and be recorded as voting yes,” Cornyn said, adding that the Republican conference would decide the matter Tuesday, when lawmakers will meet for the first time since leaving for recess last week. “I think there is some advantage to showing you’re trying and doing the best you can.”
Neither a series of last-minute changes over the weekend nor the CBO’s preliminary analysis managed to shift any votes in the bill’s favor. If anything, the CBO report worsened the proposal’s chances by noting that it was impossible to forecast the number of Americans likely to lose coverage but that “the direction of the effect is clear.” The report also estimated a $1 trillion loss of federal funding for Medicaid by 2026.
Collins delivered a scathing assessment of the bill in a statement, saying the fourth version that the senators had produced in an effort to win new votes “is as deeply flawed as the previous iterations.”
Speaking to reporters Monday evening, the senator said the administration had lobbied her hard to endorse the bill — and she received a call from the president himself before the CBO score was announced.
“I told him that I would go back and look at the numbers one more time, but I was straightforward with him that I was not likely to be a yes vote,” she said, adding that the process had been too hasty. “Last night, a whole new bill came out, which to me epitomizes the problem.”
Speaking on the Senate floor Monday, McConnell thanked Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.), the bill’s authors, but suggested that their work had stalled out. He thanked other lawmakers and committees of jurisdiction, as one might do at the official conclusion of a legislative push.
“I’d like to thank each of these committees, their chairs, their members and their staffs for their hard work to provide the American people with a better way than Obamacare and its years of failures,” McConnell said.
The legislation’s sponsors had rewritten the bill to deliver more money to Alaska and Maine, in the hopes of winning over Collins and Sen. Lisa Murkowski (Alaska), another key GOP centrist.
The contentious debate erupted into public view Monday afternoon as protesters chanted so loudly at the hearing’s outset that Hatch was forced to temporarily adjourn as police officers arrested and removed 181 of them.
“No cuts to Medicaid! Save our liberty!” one woman in a wheelchair screamed as she was wheeled out.
Sen. Ron Wyden (Ore.), the top Democrat on the panel, questioned why Republicans were rushing to pass a measure this week that was just having its first hearing — and one that he considered “a lemon.”
“Nobody has to buy a lemon just because it’s the last car on the lot,” Wyden said.
The rush to rewrite the bill was so frenetic that Cassidy posted two separate bills on his website Monday morning. “The last version was just correcting drafting errors,” he told the Finance Committee.
Unlike with earlier GOP proposals to repeal the ACA, Senate leaders have remained one step removed from the process this time. Asked whether any staffers outside his own had been involved in making changes to the bill over the weekend, Cassidy declined to answer.
While the figures in the revised draft aimed to ease the concerns of several key senators, there was no indication that the sponsors had abandoned their plan to make steep cuts to Medicaid through a per capita cap.
Such a move would reduce federal funding by billions of dollars by 2026 and would mean that even with a carve-out for Alaska elsewhere in the bill, the state may end up losing money. And other states would still be hit hard.
Graham, who spoke quickly and intensely in support of the bill’s approach before the Senate panel Monday, said it reflected his trust in politicians who have more direct interaction with their constituents.
“My goal is to get the money and power out of Washington, closer to where people live,” he said.
But even Trump expressed skepticism Monday about the bill’s chances of passage, blaming McCain and Collins for its expected demise in an interview on the “Rick & Bubba Show,” an Alabama-based syndicated radio program.
McCain came out against the measure Friday, arguing that Republicans should work with Democrats to produce a bill that can attract wider support.
“You can call it what you want, but that’s the only reason we don’t have it, because of John McCain,” Trump said of efforts to repeal the 2010 health-care law, adding later: “Looks like Susan Collins and some others will vote against. So we’re going to lose two or three votes, and that’s the end of that.”
Democrats, for their part, continued to rail against the measure during the Senate hearing. Sen. Michael F. Bennet (D-Colo.) was especially animated during his remarks, raising his voice as he questioned the motivations of Republican senators.
“Why are we here, colleagues, making matters worse?” he asked.
Cruz made it clear over the weekend that he had grave reservations. On a Monday call with reporters, his aides said the senator had moved from yes to no after learning that the bill would not include the “consumer freedom” changes he had wanted from the start.
Republican leaders could call on Sen. Lamar Alexander (R-Tenn.) to revive negotiations with Sen. Patty Murray (D-Wash.) on a bipartisan package to stabilize the current insurance marketplaces. The pair had appeared to be reaching an agreement on a plan to guarantee subsidies to help cover out-of-pocket expenses for low-income people in exchange for limited waivers to give states more flexibility in how they spend that money. Those talks stalled when Alexander stepped aside to allow GOP leaders to focus on winning votes for Cassidy-Graham.
Many Republicans, however, oppose legislation to approve the subsidies without reforming the ACA insurance market.
A Canadian Doctor
Cassidy is ‘sorry’ about the Cassidy-Graham process. He should be.
by Dana Milbank - The Washington Post - September 25, 2017
Maybe the Senate janitor’s closet was already booked?
For Monday’s hearing on the Cassidy-Graham bill to repeal Obamacare — the one and only hearing scheduled on the measure — Republicans trying to hurry it through Congress gave every sign that they did not want to be noticed.
Senate hearing rooms that could have fit hundreds were left idle Monday afternoon, and instead Republicans chose one that could fit just 30 members of the public, leaving hundreds waiting in the hall outside. Many reporters, too, were turned away — the better to avoid scrutiny.
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Or so they thought. But the attempt at concealment backfired.
The moment Finance Committee Chairman Orrin Hatch (R-Utah) hammered the gavel, about 20 disabilities rights activists in the room — the bulk of the public gallery — broke into a chant: “No cuts to Medicaid! Save our liberty!”
Hatch hammered the gavel, ineffectually. After 10 minutes, he called a recess. Capitol Police cuffed the activists, several in wheelchairs, and carried or wheeled them from the room.
Hatch returned after seven minutes and started scolding: “If you can’t be in order then get the heck out! . . . Shut that door and keep it shut!”
Who he was yelling at wasn’t clear, because after the mayhem the cops had allowed only five spectators to remain in the room — and three of them looked like lobbyists.
That’s right: Five members of the public allowed to witness the lone hearing for a plan that would cut more than a trillion dollars from health care, deny health insurance to millions and dump the whole health-care mess on ill-equipped states.
“I’m so sorry about this process,” Sen. Bill Cassidy (R-La.), the Cassidy in Cassidy-Graham, testified to the panel.
He should be. It’s a sorry process.
Republicans complained about Democrats enacting sweeping health-care legislation without GOP votes; now they’re attempting to pass, with only GOP votes, legislation that would shift funds from blue states to red states.
They complained that they didn’t have time to read Obamacare before it was passed; the Cassidy-Graham bill was still being rewritten Monday with a vote required by the end of the week — because Republicans are using the same budget process they blasted Democrats for using with Obamacare.
They complained (falsely) that Democrats didn’t wait for the Congressional Budget Office to say how much the bill would cost; they’re now proceeding without such an analysis.
Sen. Chuck Grassley (R-Iowa), the Judiciary Committee chairman, essentially acknowledged that what’s in the bill doesn’t matter. “I could maybe give you 10 reasons why this bill shouldn’t be considered,” he said last week. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”
Now this sorry process is heading to a sorry end.
Obamacare repeal failed in the Senate. Then “skinny repeal” failed. And now, “last-ditch” Cassidy-Graham is foundering. Trump acknowledged as much when he tweeted Sunday: “Eventually we’ll win, whether it’s now or later.”
A sure sign of trouble — ever more extravagant vote-buying.
Republicans howled about the goodies handed out to reluctant senators to win their votes for Obamacare — the Cornhusker Kickback and the Louisiana Purchase. Back in the spring, Sen. Lindsey Graham (R-S.C.), the Graham in Cassidy-Graham, warned, “if they start doing that crap, they’re going to lose me.”
Now he’s doing it. He added cash for states such as Alaska and Maine — some Polar Payola and a Caribou Cashout for a wavering Sen. Lisa Murkowski (R-Alaska) and a Bangor Bribe as a Down East Inducement for a skeptical Sen. Susan Collins (R-Maine). But he risks losing them with the Cowboy Compensation he added to buy Sen. Ted Cruz (R-Tex.) — making it easier for insurers to avoid covering maternity care, older people and people with preexisting conditions. He even offered a Creole Kickback to his co-author Cassidy, a provision boosting states such as Louisiana that were late to expand Medicaid.
On Monday afternoon, Republicans reaped the chaos they sowed. Even after the protesters were removed from the room, the chants of hundreds of protesters in the hall could still be heard in the committee room: “Fight!” “Shame!” As cops strapped demonstrators to chairs and pushed them to elevators, protesters (181 of whom were arrested) screamed: “Kill the bill! Don’t kill us!”
In the hearing room, Democratic senators were only slightly milder: “A disgrace!” said Sen. Michael Bennet (Colo.). Sen. Mark Warner (Va.) saw a “travesty.” And Sen. Ron Wyden (Ore.) proclaimed that “nobody is going to buy a lemon just because it’s the last car on the lot.”
Wyden was so tough on co-author Cassidy that Hatch interrupted to ask for “respect” for Cassidy. “This is not easy for him,” the chairman said.
Selling this turkey? You bet it isn’t easy.
Explains How Her Country's Single-Payer Health Care System Works
by Michelle Martin - NPR - September 24, 2017
The idea of a single-payer health care system is getting some renewed attention in the United States as Sen. Bernie Sanders, I-Vt., and some Democrats are advocating for it.
Sanders' "Medicare for All" bill was co-sponsored by 16 Democrats, including Kamala Harris, D-Calif., Elizabeth Warren, D-Mass., and Cory Booker, D-N.J.
With a Republican White House and Congress, it's unlikely that a single-payer plan would pass in the near future, but the high-wattage support signals a major shift in the health care debate.
Recent polls suggest a growing number of Americans do support a single-payer system, which is the dominant model in other developed countries, including neighboring Canada.
While single-payer is defined and implemented differently in different countries, Danielle Martin, a Canadian physician, says there are a lot of misconceptions about how the plans work.
"What many Americans often don't realize about the Canadian system is that it's not a government delivered system," Martin says.
Martin, who is also vice president of medical affairs and health system solutions at the Women's College Hospital in Toronto, talked with All Things Considered host Michel Martin about how the services in Canada are paid for by the public, but delivered, in large part, by private doctors.
This interview has been edited for length and clarity.
Interview Highlights
On what single-payer means in Canada
People often talk about so-called government run health care or socialized medicine — we don't actually have that in Canada. What we have is a system where the insurance is paid for through a public plan. The services are paid for through general taxation, but the services are not delivered by government employees. [As] a family doctor, I am not an employee of the government. I deliver my services in a very similarly looking model to Americans physicians. But instead of billing a private insurance company or billing my patients directly, I simply bill the government plan.
On the issue of long wait times and physician availability
I think its critical for people to know that when Canadians are seriously sick — when the issue is urgent — they don't wait. So this myth that people are sort of dying in the streets, waiting for care is just that is just that — a myth. Part of the reason that we know that is because our health outcomes are good. When compared to the U.S., outcomes for a whole variety of different diagnoses — including life expectancy, including infant mortality — all of these things actually, the Canadian system delivers as good or better care on average across the population than we see in the U.S.
But you are absolutely right, when people have a non-urgent issue in Canada, sometimes they wait. Sometimes they wait, in my opinion, too long. That's something we're really grappling with here is trying to figure out how we're going to deal with that.
On whether single-payer systems create a taxation burden
People often talk about so-called government run health care or socialized medicine — we don't actually have that in Canada. What we have is a system where the insurance is paid for through a public plan. The services are paid for through general taxation, but the services are not delivered by government employees. [As] a family doctor, I am not an employee of the government. I deliver my services in a very similarly looking model to Americans physicians. But instead of billing a private insurance company or billing my patients directly, I simply bill the government plan.
On the issue of long wait times and physician availability
I think its critical for people to know that when Canadians are seriously sick — when the issue is urgent — they don't wait. So this myth that people are sort of dying in the streets, waiting for care is just that is just that — a myth. Part of the reason that we know that is because our health outcomes are good. When compared to the U.S., outcomes for a whole variety of different diagnoses — including life expectancy, including infant mortality — all of these things actually, the Canadian system delivers as good or better care on average across the population than we see in the U.S.
But you are absolutely right, when people have a non-urgent issue in Canada, sometimes they wait. Sometimes they wait, in my opinion, too long. That's something we're really grappling with here is trying to figure out how we're going to deal with that.
On whether single-payer systems create a taxation burden
When we compare country to country, I think it's important that we do a complete arithmetic, and that in addition to considering taxation rates, we need to consider what Canadians are getting for their tax dollars, and what they're not having to pay for in terms of the private insurance market.
I mean here's the reality if you look internationally, the United States pays more per capita for health care than any other country in the world. You're closing in on 20 percent of your GDP in terms of what you spend. So there's a lot of money being spent publicly and privately on health care services in the U.S. It seems to me that ought to be more than enough to pay for health care for everybody.
I mean here's the reality if you look internationally, the United States pays more per capita for health care than any other country in the world. You're closing in on 20 percent of your GDP in terms of what you spend. So there's a lot of money being spent publicly and privately on health care services in the U.S. It seems to me that ought to be more than enough to pay for health care for everybody.
We in Canada spend 10 percent of our GDP on health care services and we cover virtually every single resident of our land. That's what I think is the more important question is how much you pay via taxes, but how much you pay via taxes, plus out-of-pocket, plus for private insurance, and who's in and who's left out, and who's at risk of not having coverage when they need it most. The last thing you need when you're sick is to be worried on top of your illness, about how you are going to pay for your care.
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