Monday, June 12, 2017

Senate health care bill: "We have no idea what's being proposed"

That’s what Missouri Senator Claire McCaskill furiously said about the Senate Republicans’ crafting of a health insurance bill “We have no idea what’s being proposed.” (Video clip here) And neither do the rest of us. Here’s why.

Mitch McConnell has deployed The Senate’s three tools on health care: Sabotage, speed and secrecy.

Senate Majority Leader Mitch McConnell (R-Ky.) had a problem when the American Health Care Act arrived from the House last month. What to do with a bill that is clogging your agenda but only 8 percent of Americans want you to pass and members of your own caucus swore was dead on arrival? McConnell couldn’t have missed the town halls filled with angry Americans who rely on Medicaid and see the Affordable Care Act’s protections for those with preexisting conditions as a godsend. The House bill — which the Congressional Budget Office estimates would cause 23 million to lose coverage and end those protections for many — threatened all of that.

Faced with that reality, McConnell could have started over and had the Senate develop its own legislation, perhaps even working with Democrats on a bipartisan alternative that could withstand the test of time. Instead, McConnell put a plan in place to pass something close to the House bill using three simple tools: sabotage, speed and secrecy.

Sabotage: Given the unpopularity of the AHCA, Republicans have just one argument: Obamacare has failed. The GOP premise is “bad” beats “dead.” The problem is the facts don’t support this. Medicaid — which accounts for the bulk of the ACA coverage expansion — is successful, popular and bipartisan. The ACA’s individual insurance exchanges got off to an uneasy start, but after five years, insurer filings and independent reports all point to profitable insurers and stable or stabilizing markets — at least until President Trump intervened to rattle insurers.

Speed: As he watched House members scrupulously avoid constituents while on recess, McConnell clearly recognized that his best bet would be to hold a vote before the July 4 recess in hopes this would minimize pressure on vulnerable senators …

So last week McConnell deployed Rule XIV, a fast-track procedure that bypasses the committee process and moves the bill directly to the floor. Just as in the House, we’re on track to have a vote with no hearings (there were more than 100 for the ACA). Knowing the coverage loss will be significant, McConnell plans to vote within only days, or possibly even hours, of the release of the CBO score. Moving fast leaves opponents, and the public, with no time to catch up to the details.

Secrecy. None of this will work if the content of the bill cannot be kept secret for as long as possible. A small group of Republicans is amending the House bill behind close doors. And for all the talk of having the Senate start over and fix the bad House bill, their reported changes appear to be minimal, and to follow the blueprint laid out by Senate Majority Whip John Cornyn (R-Tex.) that: “80 percent of what the House did we’re likely to do.” The ACA’s expansion of Medicaid would end. The caps on Medicaid spending imposed by the House bill would remain. With state approval, insurers would still be able to offer Swiss cheese policies that drop benefits people with preexisting conditions need most.

As Senate Republicans inch closer to far-right health care overhaul, Steve Benen (MSNBC/MaddowBlog) explains what’s in it for against us.

About a week ago, health care advocates had reason to feel optimism. Senate Republicans publicly conceded that their efforts to craft their own health care blueprint weren’t going especially well. …

But while those comments offered hope to health care proponents, as the week progressed, the winds began to shift direction. Vox’s report on Friday afternoon is consistent with everything I’ve heard about the state of the debate.

Behind closed doors, the Senate is drawing closer to passing a health care bill that looks a lot like the widely disliked version that cleared the House.

Any agreement currently on the table would almost certainly result in millions fewer Americans having health coverage, including low-income workers on Medicaid. It could roll back some Obamacare protections for people with pre-existing health conditions.

This is a big story with a lot of moving parts, so it’ll probably be easier to go through this in a Q&A.

I’ll snag a few that seem critical to me.

I feel like I haven’t heard much about health care lately.

That’s because you haven’t, and part of that is by design. Certainly, Donald Trump’s Russia scandal is dominating the headlines, and for good reason, but Senate Republicans have created a “working group” that’s writing their bill in secret, entirely behind closed doors. They’ve been quite effective in keeping details out of the public eye, knowing that the more Americans learned of their ideas, the more controversial their plan would become.

Is there a Senate GOP bill?

Not yet, but by all accounts, the Senate’s legislation is coming together, and it’s a safe bet they’ll have a final version fairly soon.

Assuming there’s legislation, is it true GOP leaders will simply skip over committee hearings and bring the secret bill directly to the floor for a vote?

Yes. Senate Majority Leader Mitch McConnell (R-Ky.) last week invoked Rule XIV, which allows him to expedite the legislative process and bypass every relevant committee. This is, of course, the opposite of how Democrats passed the Affordable Care Act in 2009 and 2010.

But if they skip past committee hearings, how will anyone have a chance to scrutinize the bill?

That’s the point: Republicans are hoping to avoid scrutiny. It’s why they’re writing a bill in secret, and are moving forward with no hearings, no amendments, no transparency, no input from subject-matter experts, and no effort at bipartisan negotiation.

So how close are they to having the votes?

There’s no firm head-count, and by most reports, the votes aren’t yet in place. It’s likely to come down to a handful of members who’ll dictate the outcome. … To stop this bill, health care advocates will need some GOP members to break ranks.

Is that realistic?

Maybe. Sen. Susan Collins (R-Maine), for example, has balked at the House version, and she said yesterday that any bill resulting “in 23 million people losing coverage is not a bill that I can support.” What’s less clear is what she might do with a bill in which 15 million – or 10 million, or 5 million – lose coverage. Sen. Rand Paul (R-Ky.), meanwhile, has criticized any legislation that relies on tax credits to subsidize coverage, and tax credits are at the core of both the House and Senate approaches.

Other members who are considered “in play” are senators who are up for re-election next year (Nevada’s Dean Heller and Arizona’s Jeff Flake), senators whose constituents would face brutal consequences if the ACA is gutted (Alaska’s Lisa Murkowski and West Virginia’s Shelley Moore Capito), and senators representing states where the uninsured rate has already dropped thanks to the ACA (Colorado’s Cory Gardner and Ohio’s Rob Portman).

Time to put pressure on Flake because:

GOP leaders have publicly said they plan on bringing the bill to the Senate floor before their 4th of July recess, which means a vote no later than Friday, June 30. Health care advocates that I’ve spoken to privately have said there’s been less public activism on the issue in recent weeks, but it’s their hope that the public will start contacting senators’ offices in greater numbers once there’s a bill and the threat to millions of families is more real.

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