The TrumpCare comes back from the dead (...and lives!) thread

[The_Doctor]

The President is unable to grasp that a major law that is more popular than him is going to stay on the books. For the record, he's bluffing. They're making the subsidy payments to insurance companies still.

This is called "we surrender, let's move onto tax reform." He's mouthing off about healthcare reform but I don't think there is a serious plan. They will keep trying to whack at it until they realize that half of the GOP House doesn't want to repeal ObamaCare.

[The_Doctor]

The Administration will blink.

61% of the voting public would blame Trump if ObamaCare goes south, not the Democrats, according to a recent poll. Combined with the lack of unity in the GOP House for replacing the law, and Trump's bluffing. This isn't a real estate deal where the Democrats aren't holding some good cards. This is a political situation where the Democrats have tons of good cards that were only bolstered by the GOP imploding over the AHCA.

Trump at the end of the WSJ (or NYT?) interview indicated as much saying that he recognized that he was now in charge and would be blamed or credited for ObamaCare, indicating that it would probably sway his mind on the payments.

Not sure why or who is selling him the crack that he can replace the law at this point. The emboldened Democrats already sense blood in the water and Trumpy doesn't have the world's best hand going forward on this issue.

[The_Doctor]

Breaking: HFC announces support for new bill:
https://mobile.twitter.com/AP/status/857275725119991808

Once more with feeling, if it touches Medicaid and Medicare, it is not passing.

[The_Doctor]

Also have these guys failed to realize that Donald Trump is supremely unpopular and thus the law they want to pass needs some popularity in order to, well, pass?

[The_Doctor]

18 Republicans are a no. So that's 220, they need 216. I doubt they have 216 votes. They can afford only 22 defections.

[The_Doctor]

Almost certainly dead in the Senate. They need 50 votes and the Senate has more moderate Republicans. This increasingly looks like a bid to notch an achievement on the 100th day. 

The AARP and the American Hospital Association (I think that's the name) are opposed to this which tells you a lot.

[The_Doctor]

21 now, reportedly. That means at best 217-214. 22 is 216-215. 23 is dead. Most likely there are 23 no's, minimum.

ObamaCare is here to stay IF this is true.

EDIT: http://thehill.com/homenews/house/330966-new-obamacare-repeal-bill-on-life-support#.WQJ7bIGX540.twitter

[The_Doctor]

@GeorgiaModerate: The truth is that the Republican Party has caught the car and is now confused what to do. For six, seven years they had a winning issue of repealing ObamaCare and their coalition was okay with all this bluster and rhetoric. It won votes, it was a unifying touchstone, it was a political winner.

When Trump won the reality became harder. They had to repeal the law but replace it with an equivalent law that preserved all the good things. Unfortunately, since Obama stole a ton of Republican ideas in crafting the law, the Republicans aren't left with much in the way of viable options.

The Republican coalition will never point blank accept anything to the left of the law. But because significant blocs rely on Medicaid, the exchanges, the pre-existing conditions being banned, the kids on parents' healthcare, the community ratings and so much else - not to mention the giveaways to Big Pharma - the law has a huge coalition behind it. So repeal is out of the question. A meaningful replacement is also out of the question.

Since the Republicans never campaigned on a replacement plan, and since Trump won on a populist agenda that promised to protect entitlement spending,  the party can't easily toss the Medicaid expansion or clipping many of the benefits.

The activists are pushing hard in the delusion that they can push the House and Senate Republican conferences to pass a meaningful replacement. Ryan is trying to please the White House, who is the only stakeholder who wants the law gone, aside from activists. The House and Senate Republican conferences don't want Republican turnout down in 2018 so they're hoping for a repeal - and someone else to do it.

[The_Doctor]

Why are people here saying it "died". Am I missing something? It's a regular occurence not to put something on the floor if you don't have enough votes.

There are 19 no votes and enough undecideds that if half vote for it, it will be enough.

There are 21. More likely, more than 21. It's dead, most likely. They keep trying to put it on the floor and it keeps not getting there. Do you understand, out of curiosity, why this isn't going to pass the Senate, let alone go to conference? If they pass it out of the House, the Senate will gut it like a fish.

[The_Doctor]

[

Do you not understand what a joint committee is? You think the legislation that passes the house is the same legislation the senate votes on?

Why don't you go back and look at the ACA bill initially passed by the house.

Its not called a joint committee. It's called Conference committee in the first place.

You do understand that the Conference Committee usually has to reconcile the bills that command majority support in both chambers and usually the point is to create a bill that has that level of support. Now if the House and Senate have wildly diverging bills they don't pass squat.

What you're not grasping is that the ACA wasn't wildly divergent in both chambers when it passed in 2009-2010. There was enough overlap that both chambers passed the law and Obama signed it.

The problem, as you clearly don't understand, is that Republicans don't want to pass a bill in the first place that threatens benefits. There is no amount of moderates negotiating that changes this essential fact. Go look at the opposition and why it's happening. Go look at the releases -- do some research.  A ton of the Republicans have a problem because AHCA would limit the Medicaid expansion, threaten current benefits, and millions would lose measurable benefits. So of course people like Tom Cotton and Rand Paul all come out against it. Ditto Steve Daines and Susan Collins and a ton of other Republicans.

Even if the current AHCA passes the House, somehow, the Senate can't water it down so significantly that they can pass a bill that keeps all the benefits and call it a repeal with a straight face.

the whole “let the moderates” negotiate it isn't even the issue. The moderates want to keep the law functionally!

[The_Doctor]

22 no votes, based on the Hill. Pence was bluffing to try to get moderates on board to make it appear that Trump had the votes and they would be left behind.

And since Trump committed to making the co-pays as part of the budget deal, the Affordable Care Act is now ... the GOP's responsibility.

Barack Obama KO the GOP, in other words. Watch the GOP modify it but leave 80-90% of it on the books. Probably means a more limited tax reform deal incoming too.

EDIT: As long as the exchange subsidies are untouched, ditto Medicaid and Medicare, and possibly community ratings for women's breast cancer and stuff like that, the GOP CAN pass something. Unfortunately, they keep running headlong into the brick wall and expecting the bricks to tumble, which is ... not happening. This is why Billy Long of Springfield is opposed to the law. I know, I know, Missouri doesn't have a Medicaid expansion but the exchanges and subsidies and so on are helpful for the residents. So if Billy is opposed, imagine the GOP representatives from PA, MI, WI, OH, and WV?

[The_Doctor]

Jason Chaffetz is being rushed out foot surgery and summoned to the House to try and shore up votes

But what if he sticks his foot in his mouth again? Will that require more reconstructive surgery?

[The_Doctor]

Billy Long is retweeting articles highlighting his opposition to the law and being quite vocal. He's from a (PVI) R+23 district and is a Trump ally. Is it possible he's giving moderates cover to oppose the bill this week? His behavior is a tad odd for someone who's a Trump man and he's in no danger at all of losing re-election.

It's not on the up and up which makes me think he's providing cover to other House Republicans who want to oppose the law as well as imply to the White House it's dead.

With 19-22 defections it suggests strongly that there are dozens of House Republicans who want to vote no but need political cover to defy the president. They need in essence a Trump ally who the president has been reliant on to do the back-stabbing.

If true the law probably has 30-40 House Republicans voting no.  That's a minimum of 230 No's in the House.

[The_Doctor]

Fred Upton (R-Mich.) is a no. It's dead. Ryan can't deliver the House votes.

I can hear the screaming and the sulking from the White House. If they had a shred of competence or an ounce of intelligence, they would have gone with a bill that reformed the worst of the ACA law and called it a day.

[The_Doctor]

Losing Fred Upton is big, but this isn't dead until it's dead. No whip count currently has 23 hard and public Nos, which is what is needed for this to fail.

22, with Billy Long (R-Springfield) and a member of the House GOP leadership against it? I mean, it's 90% dead. We'll see, when the vote is tomorrow or whenever. I doubt Ryan lets it go to the floor.

[The_Doctor]

None of the moderates on record as a no were sold. However they're trying to get it close enough that Reichart and Paulsen vote yes apparently. Diaz-Balart seemed a no. Fuller (HuffPo) seems like he's tracking the vote the best.

Per Fuller, 20 GOP are locked in as no with 7 GOP leaning no. 13 GOP are undecided. The lean yes number 20 (but could flip to no if it looks like a failed vote). So assuming 193 D, 20 R that's 213 no.  The yes contingent stands at 191. The rest are undecided. 27 Republicans are basically not committed. For perspective, that's 47/238 Republicans not on the yes team (and that's a fifth of the GOP caucus).

McHenry and Ryan would need to win 92% of the undecided and lean yes folks to win 216 votes. I'm a tad skeptical but its in theory possible.

[The_Doctor]

None of the moderates on record as a no were sold. However they're trying to get it close enough that Reichart and Paulsen vote yes apparently. Diaz-Balart seemed a no. Fuller (HuffPo) seems like he's tracking the vote the best.

It's entirely against the interests of Reichart and Paulsen to vote in support for this bill. They'd get flambeed in the midterms.  

I'll throw up a post here about the undecided votes after doing some research about their districts you're largely right. They're on the list as if the bill is within 3-4 votes. Issa is refusing to say what his vote should be.

[The_Doctor]

Losing Fred Upton is big, but this isn't dead until it's dead. No whip count currently has 23 hard and public Nos, which is what is needed for this to fail.

22, with Billy Long (R-Springfield) and a member of the House GOP leadership against it? I mean, it's 90% dead. We'll see, when the vote is tomorrow or whenever. I doubt Ryan lets it go to the floor.

The reason Long is against it is because his daughter has cancer so he knows what this bill will really do: bankrupt him

Might be or someone saw him as a convenient messenger to shoot the bill. He's not the only House Republican with a family member who had cancer recently. I'm cynical because a ton of other Republicans are no and they're probably in similar situations as Long or have been so in the past.

I don't think he did it entirely from political motives but at the same time politics definitely entered his equation.

[The_Doctor]

just out of curiosity TD, what type of replacement bill would YOU want?

1. Not this abortion of a bill.
2. I doubt very much you do either.
3. The most conservative bill that can pass the House and Senate and has popular support. I'm not insane. I don't go jumping off cliffs with flags flying. Government being involved in our healthcare is now a settled question. I don't like Social Security and Medicare but guess what? That ship has long since sailed and we deal with that fact. Just write up a solid bill, sell it to the public, and call it a win. Ryan is deluded in his bid to replace the ACA w/ the AHCA. So is the GOP.  Romney was the last real chance to stop it.

But since you asked --

a. Repeal ObamaCare. Break up the HMOs state by state, do decent drug patent reforms, guarantee catastrophic coverage through Medicaid, mandate everyone cover insurance personally up to 8% (more based on their health and any behaviors like weight or smoking), of their income and then the government would subsidize the rest, allow States to negotiate market rates, allow people to be charged premiums based on past health and weight (in the sense a smoker or overweight person should pay more than a healthy person). The exchanges would stay without subsidies.

Obviously birth control woud be covered out of pocket as would minor issues like the flu and regular checkups (see more on this below). We want people to use their coverage for really big issues like mammograms, cancer, heart attacks, and strokes.

Ideally a doctor visit would come down to a reasonable cost that can be paid out of pocket and we would end the employer sponsored health insurance market with a shift to everyone purchasing individual and family plans (one way to do it is ending the tax break for employers to cover their employees). They would see the charges and one of the biggest problems we face is that a lot of these charges aren't transparent. We need to really change that and that's one way to bend the cost curve.

Medicaid and Medicare reforms would need to be part of the package as well. I personally think there are people on these programs that shouldn't be there and we need to assess that appropriately. I certainly believe ex smokers and overweight people should pay a premium to these programs to get on it. EDIT: Under my plan, we would probably replace these programs with the 8% premium plan.

All of this is pretty similar to the Swiss model, one of the more conservative European healthcare models. I'd like to think my plan is a sellable conservative solution to healthcare.

EDIT: You could refuse healthcare coverage, actually, under my plan but you would be denied entry into any kind of subsidised healthcare for any reason if you let your coverage lapse. You would need to pay up the full price and pay a Medicaid and Medicare premium if you opted in.

[The_Doctor]

just out of curiosity TD, what type of replacement bill would YOU want?

1. Not this abortion of a bill.
2. I doubt very much you do either.
3. The most conservative bill that can pass the House and Senate and has popular support. I'm not insane. I don't go jumping off cliffs with flags flying. Government being involved in our healthcare is now a settled question. I don't like Social Security and Medicare but guess what? That ship has long since sailed and we deal with that fact. Just write up a solid bill, sell it to the public, and call it a win. Ryan is deluded in his bid to replace the ACA w/ the AHCA. So is the GOP.  Romney was the last real chance to stop it.

But since you asked --

a. Repeal ObamaCare. Break up the HMOs state by state, do decent drug patent reforms, guarantee catastrophic coverage through Medicaid, mandate everyone cover insurance personally up to 8% (more based on their health and any behaviors like weight or smoking), of their income and then the government would subsidize the rest, allow States to negotiate market rates, allow people to be charged premiums based on past health and weight (in the sense a smoker or overweight person should pay more than a healthy person). The exchanges would stay without subsidies.

Obviously birth control woud be covered out of pocket as would minor issues like the flu and regular checkups (see more on this below). We want people to use their coverage for really big issues like mammograms, cancer, heart attacks, and strokes.

Ideally a doctor visit would come down to a reasonable cost that can be paid out of pocket and we would end the employer sponsored health insurance market with a shift to everyone purchasing individual and family plans (one way to do it is ending the tax break for employers to cover their employees). They would see the charges and one of the biggest problems we face is that a lot of these charges aren't transparent. We need to really change that and that's one way to bend the cost curve.

Medicaid and Medicare reforms would need to be part of the package as well. I personally think there are people on these programs that shouldn't be there and we need to assess that appropriately. I certainly believe ex smokers and overweight people should pay a premium to these programs to get on it.

All of this is pretty similar to the Swiss model, one of the more conservative European healthcare models. I'd like to think my plan is a sellable conservative solution to healthcare.

EDIT: You could refuse healthcare coverage, actually, under my plan but you would be denied entry into any kind of subsidised healthcare for any reason if you let your coverage lapse. You would need to pay up the full price and pay a Medicaid and Medicare premium if you opted in.

Basically, everyone would be expected to pay everything they could afford, but no more. Am I right?

Yes.

This is more or less a market alternative to single payer and with the intent to retain insurance companies in the mix, to head off nationalization of healthcare. It retains a fairly free market framework with adequate coverage and a catastrophic coverage fund so that it covers things like cancer, etc. (Actually a catastrophic coverage fund might not be needed if insurance companies are basically covering everyone).

Everyone would be purchasing health insurance as a family / individually and would be keeping their coverage through that system, so no more employer funded insurance. That's one major step away from our current inefficient model (a lot of economists have called it a bad idea). So, in one key regard, we actually become more free market than we are today.

The idea is to retain the American system's innovation in healthcare solutions (that everyone in the world replicates for far cheaper than us) while creating adequate coverage for our citizens. Obviously my plans would include basic coverage standards and exclude things like abortion services, birth control, and cosmetic surgery.

The 8% of your income is to defray the costs of paying for this system. The denial of access to services if you don't get coverage is a semi-mandate that I find more constitutional.

I would also add my support for a sugar tax because of how damaging obesity can be to our healthcare costs. So that's another thing, going into the pool to help cover the costs of coverage.

There are a few other conservative ideas I'd toss in but that's the gist ...

[The_Doctor]

Maybe you should change the name of the thread? :-D

There's still 20 votes against it. It may or may not pass the House but the Senate will almost certainly kill it.

Out of curiosity do you grasp what the ACA and the repeal law does and do you understand the insurance markets in America? Somehow I think your nuance here is severely lacking and is reducible to “BAD DEMS.”

EDIT: Here, do your homework. Look up reconciliation. I'm fairly sure you have never ever grasped the concept of reconciliation before in a Congressional bill, let alone heard of it before.

[The_Doctor]

Does anyone have an estimated whip count.

There are now 20 votes for No from the GOP, the absolute max is 22.

They either need to flip a few more no's or run the table on the undecided votes.

I count 18 hard no's, with Upton and Long back on the yes camp (what did I tell you? Long was doing this for political reasons. I was right to be cynical). But others have 20.

They still need to run the table to win this.

[The_Doctor]

18 no per Fuller. 8 Lean no, 10 undecided, 18 lean yes. 202 yesses, so far if you factor in the "lean yesses."

Ignoring everyone who's already a no except Upton and Long and focusing on the lean no and undecided voters --

To summarize, of Fuller's list, I expect Amash (Michigan), Faso, Polinquin, Roskam, Stefanik, Yoder, and Young to vote yes. Amash sounded like he wanted to vote yes. Faso, Stefanik, Polinquin, Webster (FL) and Yoder all come from Trumpkin districts and will want to stand with the President and GOP Leadership. Stefanik, Polinquin, and Faso, in particular, come from districts that went for Trump more than they went for Romney. Roskam is a former House Majority Deputy Whip, and will want to stay loyal to leadership.

Now to the folks I think will vote no. Curbelo (R-FL) is a no, most likely, based on his tweets and he's from a swing district. Issa is also a no, I believe, because he won by just 1,600 votes and he comes from a district that broke heavily for Clinton. Valadao is in the same boat but doing better, he won 57-43%  but needed heavy crossover from the Clinton/Obama voters to re-elect him (and his district is near LA). So, of the 18 No's right now, that brings us to 21. Steve Knight won 53-46% and hails from a Clinton district, so 22 no.

The deciding vote is probably Mike Coffman (Colorado). Clinton and Obama won the district by 9 points, and Coffman won 52-43%. However, the Democrat was well funded and the district includes Denver, Littleton and Aurora. I'd estimate Coffman as wanting to get yes, but he isn't sold on the preexisting conditions enough, so I expect him to be a no. So that's your 23rd no.

This bill is basically going to pass 216-215 if it passes at all. I'd think that it has about 213-215 yesses, and the majority no.

[The_Doctor]

Upton says he's not sure the vote changes convinced anyone other than Long and him. Fuller is saying that the vote counts look weaker than what the leadership is indicating. The 18 No's seem to hold. Coffman is not a yes yet, and indicates he leans no because the preexisting conditions thing is not strong enough for him.

I'm increasingly believing that the Upton Amendment was a false dawn and that the bill remains in deep trouble. The Medicaid expansion being cut is also the hidden reason a lot of No's are there. I also believe there are Republicans that aren't on any list that want to vote no.

NOTE: Please note the grassroots movement is against this as are a number of prominent organizations. I think this is understated but it will likely make it very hard for House Republicans to pass it without extreme political costs.

[The_Doctor]

They're doing a riverboat gamble. They're down about five votes in the House in one estimate. Webster is a yes (as I predicted). Fuller thinks it is a jump ball.

I'm skeptical that Issa, Curbelo, Coffman, and the other potential no votes I listed are actually going to walk the plank. Maybe they will but I am skeptical. David Young was a no but is now a maybe.

The thing I keep thinking about is why would House Republicans vote tomorrow to pass the bill when they know the Senate will be vastly more moderate and change it substantially? And why would they want to have that on their records in 2018 as they run again? The midterms may be older and whiter but they're also a midterm where Trump is at the 40s.

The attack ads write themselves. I think they're so jammed right now between the activists and the electorate that they seriously are doing jump ball without a CBO record. Which may in fact bite them in the arse.

The question to me, why risk it all? Why not kill the bill and repair ObamaCare, like a lot of other center right parties have done and take the credit? Repair it, move it to rhe right, and then claim credit?

The biggest reality is that this is a temporary 10 year bill. Meaning in ten ears they'll have to hope a Democratic White House isn't in place and that one chamber isn't in Democratic hands barring that. Given we almost certainly will have a Democratic White House by 2025 at the latest thats optimistic. That assumes no crisis.

I haven't even pointed out that the ACA has helped with the debt crisis coming in. So we'll see.

In other words the long term upside to fixing Obamacare is so much better than this.

Anyway I could be wrong and they pass it… but my gut says 213 yes, 218 no. Almost certainly it will die in the Senate.