This is not about statues, but about the frightening resurrection of white supremacy movements that many had thought were obsolete and yesterday’s news. So let’s first discuss the issues, then let’s discuss the symbols.
President Trump is considering ending federal ACA funding for cost sharing reductions. This ACA funding allows individuals with incomes up to 250% of the federal poverty level to reduce their copays and deductibles in the individual market. It costs about $7 billion annually and helps about 5.7 million Americans. He believes that if the funding was ended, the Health Insurance Exchanges would collapse and Democrats would agree to repeal and replace the Affordable Care Act.
Within this bi-partisan House caucus, there are several points of burgeoning agreement on the future of the Affordable Care Act (ACA): 1) Extend cost sharing reductions. 2) Fund states to reduce individual market premiums through reinsurance or high-risk pools. 3) Eliminate the medical devices tax. 4) Roll back the employer mandate to employers of 500 or more employees. 5) Value and outcome based Medicare reimbursements. 6) Cross state sale of insurance.
The House and Senate need to convene the problem solvers as opposed to the Freedom Caucus bomb throwers and work out the following issues: 1) cost sharing reductions, 2) reinsurance and risk adjustments, 3) care and coverage in rural regions, 4) incentives for cost effective care and 5) the uninsured in the non-expansion states.
Straight repeal has failed; repeal and replace has failed. Senate Republicans now will try to pass skinny repeal. Skinny repeal would at a minimum repeal the individual responsibility, the employer responsibility and the medical devices tax.
The latest CBO analysis concludes that the most recent proposed Senate Amendments will reduce coverage by 22 million Americans, will increase deductibles very dramatically in the individual market and the Exchanges, and will reduce the federal deficit by $420 billion over the next ten years. The key difference from earlier versions is jettisoning the cuts in taxes for high income Americans.
The Senate Parliamentarian has just ruled that key provisions in the Republican efforts to repeal and replace the Affordable Care Act will require 60 votes. The Senate rules require 60 votes to defeat a filibuster. Senate Republicans are trying to dodge that rule by entitling their changes as “Budget Reconciliation”, which they can pass with 51 votes, relying on Vice President Mike Pence to break a 50/50 tie.
President Trump and Republican Senate Majority Leader Mitch McConnell have abandoned “repeal and replace” Obamacare (the Affordable Care Act) and instead embraced a straight-out repeal of Obamacare as requested by President Trump, the House Freedom Caucus and Senators Cruz, Lee and Paul. Their calculation is that this threat will cause Democrats to join forces with them on a repeal and replace alternative. One might ask “what are they smoking?” “Why this crusade against coverage for low, moderate and middle income Americans, why this crusade to deny coverage for sick people?”
The Congressional Budget Office projects that, as compared to current law (ObamaCare), this repeal would increase the numbers of uninsured by 32 million, increase premiums by 100% in the individual markets and cause insurers to leave the individual market, such that 3/4th of nation’s population would have no insurer participating in the individual market.
Most but not all Congressional Republicans want to repeal and replace the Affordable Care Act, but they lack any coherent vision or level of agreement on what the replacement should be and they have been unwilling to share their visions with the American public, the Congressional Budget Office and their Democratic counterparts. So they are tinkering in the dark with a variety of ideas, nearly each one worst than the next as they try to bring the two wings of their party together on a jury rigged bill for which they hope to get 50 votes.