Jul 23 2017

Trumpcare: Is This Thing Finally Dead?

Update 15:25 7/23/2017: Karoli Kuns at Crooks and Liars ha an excellent summary of the parliamentarian’s ruling on what’s in and out of the Trumpcare bill:

Good news! Almost everything the Senate and House want to do to gut health care for the entire country has been ruled out of order by the Senate parliamentarian, meaning it would be subject to the 60-vote threshold.

Here’s the high-level overview of some of what they can’t pass with 51 votes:

  • Defund Planned Parenthood
  • Remove tax credits for policies that cover abortion care
  • Dropping Essential Health Benefits (EHB) coverage for Medicaid
  • Requiring a “six-month lockout” for anyone whose coverage lapses
  • Allowing states to determine the Medical Loss Ratio (what insurers can spend on overhead and marketing instead of health care)
  • Allowing states to roll over unused Medicaid block grant funds to the following year and spend them on anything, including things which are unrelated to health care.
  • State-specific buyoffs like the House-based “Buffalo buyout“

The only provisions which can pass with 51 votes are the Medicaid work requirements, the extra money allocated to non-Medicaid expansion states, repealing cost-sharing subsidies, and some reporting requirements.

The Parliamentarian is still reviewing the state waivers for Essential Health Benefits, Association health plans, the Age Tax allowing insurers to charge older people 5 times what younger people pay, and the Medicaid block grant provisions.

The Senate Parliamentarian has dealt a setback to the latest version of Trumpcare which may actually, this time, be it death knell.

In a major, and perhaps fatal, blow to any version of Trumpcare, Senate parliamentarian Elizabeth MacDonough has excluded several key features of the latest bill to repeal and replace Obamacare as items that cannot be enacted under the filibuster-immune special-budget rules.

In an explanatory document (pdf) released late Friday by the Senate Budget Committee, a number of provisions have run afoul of the parliamentarian’s so-called “Byrd Bath,” a review (named after the late Sen. Robert Byrd) designed to ensure that budget bills stick to dictates that have an impact on the budget.

On the wonky side of the ledger, the big blow is the exclusion of a provision called the “Six-Month Lock Out,” a measure imposing a waiting period for people applying for initial individual insurance policies. This was the GOP’s replacement for the hated individual mandate, which was Obamacare’s mechanism for discouraging younger and healthier people from waiting to buy insurance until they actually needed it. Without it, the system set up by Trumpcare could unravel via a “death spiral” as individual-insurance risk pools are increasingly dominated by less healthy people.

Politically, though, the bigger problem is the parliamentarian’s exclusion of two provisions dealing with abortion: a one-year ban on any federal funding for Planned Parenthood and a separate prohibition on use of health-care-purchasing tax credits to obtain a policy with abortion coverage. The latter provision was always a little questionable on Byrd Rule grounds, but the former was thought to be less of a problem, since it was included in the 2015 bill repealing Obamacare (subsequently vetoed by President Obama).

In all there are seven provisions that do not meet the requirements for a simple majority vote. One of the really big ones is the “Buffalo Buyout” which targets how the counties of upstate New York pay for their share of the states Medicaid expense. The parliamentarian made it very clear that provisions targeting individual states were not “Byrdable” according to Minority Leader Sen. Chuck Schumer (D-NY).

This makes it most likely impossible for the Republicans to get the necessary votes, even 50 if these provisions were stripped from the bill.

Appearing this morning on ABC’s “This Week,” Sen. Schumer said the Democrats were open to discussing single-payer healthcare and that the party in the past had been too cautious in addressing it.

“We were too cautious, we were too namby-pamby, this is sharp, bold and will appeal to both the old Obama coalition … and the Democratic voters who deserted us for Trump,” he said. [..]

“We’re going to look at broader things [for health care],” he said. “Single-payer is one of them.. Many things are on the table. Medicare for people above 55 is on the table. A buy-in to Medicare is on the table. Buy-in to Medicaid is on the table. On the broader issues, we will start examining them once we stabilize the [health care] system.”

 

House Majority Leader Mitch McConnell has scheduled a vote on repeal and replace the ACA for Tuesday. Which version is unknown but in all probability none of them will pass. Fingers crossed.