Politics

CB-OH NO: The Latest on the AHCA

The Congressional Budget Office releases its estimates on the new AHCA bill.


On May 24, 2017, the Congressional Budget Office (CBO) released new scoring for the latest iteration of the American Health Care Act. In their findings, the CBO and the Joint Committee on Taxation (JCT) estimated that over the next decade, the federal deficits would be reduced by $119 billion and that by 2026 23 million more people would be uninsured compared to the current law. Most of that 23 million would occur within the first year, with the CBO estimating that in 2018, 14 million people would be uninsured under the new bill (H.R. 1628).

The bill was passed in the House on May 4, 217 to 213 with 20 Republicans voting against and no Democrats voting for. The first attempt to pass the AHCA ended with Speaker of the House Paul Ryan (R-Wis.) pulling the bill hours before it was about to be voted on because it lacked the numbers to pass.

The new version passed without an official CBO score, having had mostly cosmetic tweaks to garner more support. According to The Atlantic, the AHCA stops states from “enrolling new people under Medicaid expansion” and it “incentivized states to drop the expansion altogether.” The new bill would also introduce per-capita caps on federal spending, reducing the number of people covered and their benefits. The AHCA also removes the employer mandate, which forces employers to provide affordable health insurance to 95% of their full-time employees and children up to the age of 26.

The bill also removes the individual mandate, which penalizes people who don’t sign up for health insurance. What this does, essentially, is take the burden off of healthy people who might not necessarily need insurance. But without those people paying into the system, the onus is on the sicker, older people to pick up the deficit.

The new bill also introduces a set of waivers: one that would allow states to “modify the requirements governing essential health benefits” (Remember that from last time?) and one that would allow insurers to “set premiums on the basis of an individual’s health status.” Roughly 1/6 of the population resides in areas where states would utilize those waivers and the result would be increasing difficulty for less healthy people to purchase insurance on account of rising premiums.

The waivers were the result of an amendment from Representative Tom MacArthur. Business Insider reported that it was the MacArthur amendment that gathered the support of 20 members of the Freedom Caucus, the conservation caucus that largely withheld support for the first AHCA on account of it being too lenient.

A CNBC article quoted Dr. Andrew Gurman, president of the American Medical Association, as saying, “Today’s estimates from the nonpartisan Congressional Budget Office show that last-minute changes to the AHCA made by the House offered no real improvements.”

The bill will now go to the Senate, where it requires at least 50 votes for it, thus leading to Vice President Mike Pence acting as a tiebreaker. Even with majorities in both chambers of Congress, and a 52-percent majority in the Senate, there is still the likelihood that the AHCA will not pass. Or that if it does, it will have to be severely rewritten to get any support.

Bottom line, even after months of rewriting, the AHCA bill has barely improved and, if anything, has gotten crueler by allowing states waivers on essential health benefits. Older, sicker Americans will see increased premiums and restricted care, and younger, healthier Americans won’t see any incentive to buy insurance. The GOP was more concerned with cosmetic Band-Aids to get conservative support than they were with crafting a bill that would benefit their constituents.

There is one bright side to the AHCA passing: this is probably the first time in months that Paul Ryan hasn’t had violent diarrhea from Congressional stress. Unfortunately, Congress-related diarrhea is no longer covered under the new plan.

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Politics

THE AMERICAN HEALTH CARE ACT GOES TO VOTE TODAY, FRIDAY MARCH 24

Update 3/25: the American Health Care Act was pulled from the floor and did not go through the voting process. Speaker Ryan has stated that the Affordable Care Act will be the law for the “foreseeable future.” President Trump has since stated that he will wait for the ACA to “explode” and then create a “greater healthcare plan.”

Today, Friday, March 24, 2017, the House of Representatives will vote on the Affordable Care Act replacement bill—the American Health Care Act—with significant changes having been made last night and without the Congressional Budget Office analyzing those changes. Previously the CBO offered projections of, despite a decrease of ~$337 billion in the deficit, roughly 24 million people without coverage by 2026. Even by just repealing the ACA leaves 18 million people uninsured.

The bill underwent multiple changes after receiving severe blowback from all Democrats and several factions of Republicans. GOP moderates felt that the plan was too ill-thought and would leave too many people uninsured. GOP conservatives felt the bill did not go far enough, and dubbed it “Obamacare-Lite.” Those divides postponed the vote, which was supposed to take place yesterday. Ryan and other proponents of the bill did not want to go forward without the votes.

 

The new bill would defund Planned Parenthood. The rationale for this is restriction of abortions. However, Planned Parenthood puts no federal funding towards abortions. They do put federal funding towards reimbursement for services like birth control, contraception, and cancer screenings. Patients use public health programs, like Medicaid and Title X, go to places like Planned Parenthood that take that coverage. They use the programs, Planned Parenthood sends the claim to Medicaid (for example), which reimburses them, and then Medicaid sends the bill to the federal government. Abortions, which account for roughly 3 percent of all PP services, do not get reimbursed.

So when the GOP says that they will defund Planned Parenthood, they are doing it out of spite, because what they’re actually doing is stopping people from being able to use Medicaid for non-abortion services.

Vice President Mike Pence, formerly the Governor of Indiana, recently posted a photo of himself and the President meeting with the Freedom Caucus. The Freedom Caucus is made up of the GOP conservatives who are dragging their feet about the bill.

To get them on the side of voting yes, those in charge of the bill—House Speaker Paul Ryan, VP Pence, and even Trump—have struck a deal with the Freedom Caucus. If the Caucus agrees to the bill, the Essential Health Benefits list will be removed from the bill.

What’s the Essential Health Benefits?

It’s a holdover from the Affordable Care Act. It requires insurances to cover—at the bare minimum—the following 10 items:

  • Emergency Services
  • Hospitalization
  • Ambulatory patient services
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services

There has been no analysis on the future consequences on striking off the Essential Health Benefits because the CBO has not been given enough time to conduct research.

Trump has put pressure on the GOP to push this bill through. It would solidify his stance as a deal-maker—something he ran on during the campaign—and would show his control over the rapidly dividing Republican party. He has also threatened that the Republicans will lose their majority if the bill does not pass. That pressure has forced massive overhauls to the bill. House Republicans and Democrats are set to vote on a bill that they haven’t read in full, or had sufficient or significant research on.

But perhaps the scariest part of this whole thing is that photo that VP Pence Tweeted out. Him and the President meeting with the Freedom Caucus. With the strength of the Freedom Caucus, the American Health Care Act is that much closer to being passed.

A circle of wealthy, privileged, heterosexual cisgender white men, deciding the fate of women, minorities, cancer patients, those with mental illness, and the vulnerable. We might not have seen the finished bill, but we have seen enough of the consequences. The AHCA would mostly affect the elderly and sick—premiums would rise due to declining assistance—while the young, healthy and wealthy would see tax benefits. In addition, according to Forbes, over the next decade, the plan outlines an $880 billion tax cut, with $274 billion going directly to the richest 2%.

If the AHCA, the new healthcare plan, only benefits the young, healthy and wealthy, while leaving premiums rising, care decreasing, targeting the elderly and the sick, and ~24 million uninsured—then it’s possible that this isn’t the best plan.

But this is the world we live in—the decision of this small cluster of white men, for whom this healthcare plan will only benefit, will impact the rest of us.

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BRINGING DOWN THE HAMMER, SENATE-STYLE: PAUL RYAN TRIES TO PUNISH DEMOCRATS FOR JUNE SIT-IN

Ryan and fellow Republicans are trying to introduce a package of rules that will stop lawmakers from live-streaming from the floor, proving that the government is A) well into the 21st century and B) petty AF.

House Speaker and resident DILF Paul Ryan (R-Wis.) is introducing a rules package that would penalize lawmakers for recording photo and video from the floor. A finalized version of the package will be voted on on Jan. 4. Shockingly, it’s not in response to Senator selfies or unflattering photos of frenemy lawmakers.

Actually, the package (hold for giggles) is in response to Democratic lawmakers who organized a sit-in after the Republican majority refused to bring a gun-control bill to the floor in the wake of the Orlando massacre at Pulse nightclub. Yeah, that gun-control bill, the one that would broaden background checks and prevent those on the no-fly list from buying guns. In response, angered and hurt, the Democrats organized a sit-in, which spanned 25 hours.

The Republican-controlled House called a recess during the sit-in and cut access to C-SPAN, which is in general super-boring but in this case provided coverage of the sit-in. Access is typically cut when the House is not in session, which is true in the case of a sit-in, but due to the nature of the sit-in, it seems the camera should’ve been kept on. In response, Democrats pulled out their iPhones and began live-streaming the sit-in, using apps like Facebook Live and Periscope. Angered and embarrassed, apparently the House Republicans have been trying to figure out how to make sure nothing like this happens again.

Enter Paul Ryan, the Republican speaker who is often hailed as the savior of the GOP. Part of the package (again, such a funny word) will give Ryan the personal authority to punish and fine individual lawmakers for breaking the rules. Previously, it was up to the House to punish lawmakers, in Article 1 of the Constitution, which has been interpreted to mean that sanctions are passed after being approved by the entire House with a floor vote. The sanctions for using photo or video would be a $500 fine for the first time, and $2,500 for each subsequent violation, taken out of the lawmaker’s pay.

Democratic minority leader Nancy Pelosi (D-Calif.) called the move “a power grab” by the GOP. Pelosi was previously the House Speaker from 2007 to 2011 when the Democrats held the majority, the first woman to hold the position.

The move could be ruled as potentially unconstitutional. Reinterpreting Article 1 to circumvent a full-House vote would give Ryan the individual power to pass sanctions. So if the Republican majority passes this package, that would be mucho ironic, since Republicans are the ones who are always against interpretation of the Constitution and are very pro to-the-letter (re same-sex marriage, women’s rights, abortion, etc.).

Ryan said that the package will “help ensure that order and decorum are preserved in the House of Representatives so lawmakers can do the people’s work.”

But here’s where things get a little sticky. Yes, the House has the right to pass sanctions on an individual lawmaker—when they have broken the law. And yes, House rules prohibit the use of photo or video on the floor (funnily enough, my house has the same rules). However, lawmakers are beholden not to the House, but to their constituents. So if they protest the failure of passage (to even discuss) a gun-control bill, in the wake of the largest U.S. mass shooting, they are protesting on behalf of their constituents.

Those constituents (i.e. you, me, and everyone) have the legal right to know what our elected officials are doing with our vote. Transparency in the government is often a fraught issue, but the fact is that those Democratic lawmakers were attempting to hold their Republican counterparts accountable even after official coverage was revoked.

So Democrats are stuck in between a rock and a hard place. On one hand, they brought transparency to an issue that was being stifled, one that had incredible support outside the cosseted world of the government. On the other hand, they disregarded a prohibition. And equally, the Republicans are in a difficult spot: to discipline lawmakers who broke the rules, but dealing with the issue of transparency.

It seems to be a contradiction: transparency that breaks the rules. Do you follow the rules? Or do you follow what you believe to be right? I mean, we’re not talking about some serial killer who “believes” it’s right to make a necklace out of fingers. We’re talking about lawmakers who are trying to honor their constituents in the face of what they believed to be oppression.

And if Hamilton: An American Musical has taught us anything, it’s that “the Constitution’s a mess…it’s full of contradictions,” but “so is independence.” (I also quoted Hamilton in my “Early American Literature Until 1860” final essay; I did okay in that class).

I was personally bereaved and displeased that the gun-control bill was not passed. After the senseless massacre at Pulse, it seemed, to me, like a no-brainer. However, the Republican-held House blocked the bill from reaching the floor, where it would have been voted on. Obama was pissed, I was pissed, the nation was pissed. So in response, the Democrats reacted. It may not have been right, but it came from a place of righteous anger.

I am for greater transparency if I feel that my elected officials are not honoring the wishes of their constituents. That, too, seems like a no-brainer.

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Source: Twitter// I deleted and re-uploaded this screenshot because that Tweet got more likes. 

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