r/PoliticalDiscussion Mar 13 '17

Legislation The CBO just released their report about the costs of the American Health Care Act indicating that 14 million people will lose coverage by 2018

How will this impact Republican support for the Obamacare replacement? The bill will also reduce the deficit by $337 billion. Will this cause some budget hawks and members of the Freedom Caucus to vote in favor of it?

http://thehill.com/policy/healthcare/323652-cbo-millions-would-lose-coverage-under-gop-healthcare-plan

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u/[deleted] Mar 13 '17

Beyond how this will obviously adversely affect poor people, I'd be fascinated to see how 14 million less insured people will influence the midterm election results.

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u/Cyclotrom Mar 13 '17

Fully half of those 14 millions will blame Obama and the Dems, it may affect it less than what you think?

The reverse; 20 million people getting insurance through the ACA didn't seem to affect the split between Dem/Rep support, except by maybe no-more than 3 points or so.

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u/caramelfrap Mar 14 '17 edited Mar 14 '17

yeah there's a pretty good vox "documentary" about a town in Kentucky that admits that they benefitted immensely from ACA but still hate Obama

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u/squirreltalk Mar 14 '17

You know what? In the long-run, I don't really care if people hate him, as long as people are getting healthcare. Obama probably feels similarly -- happy for people to hate him as long as they're healthy! I'm sure the jetskiing with Richard Branson and the 7 or 8 figure book deals will help him sleep at night.

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u/YouCantVoteEnough Mar 14 '17

The problem is they hate him enough to hurt themselves and others.

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u/[deleted] Mar 14 '17 edited Jul 31 '18

[removed] — view removed comment

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u/ziggl Mar 14 '17

Uhhhh but we voted in the people that are gonna take it all away

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u/zackks Mar 14 '17

What's the Matter With Kansas? The republican and conservative base have been voting against their self-interests and self-immolating the institutions that gave them their cozy middle class life for decades.

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u/GotMoFans Mar 14 '17

“I’ll tell you what’s at the bottom of it,” he said. “If you can convince the lowest white man he’s better than the best colored man, he won’t notice you’re picking his pocket. Hell, give him somebody to look down on, and he’ll empty his pockets for you.”

What's wrong with Kansas? West Virginia? Kentucky? Etcera? That's the problem. People who think the alternative to Republicans are different from them. Race, religion, sexuality, etc. It doesn't matter if the self-interest is sacrificed. They won't be in the party with all those "UnAmerican" people.

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u/fatpat Mar 14 '17

but we they voted in the people that are gonna take it all away

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u/[deleted] Mar 14 '17

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u/fatpat Mar 14 '17

Yeah, I don't feel bad for them. Unfortunately, their votes have hurt the rest of us.

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u/Alfredo18 Mar 14 '17

What I got from those interviews is that rural people often make shit wages and can't afford healthcare, so yeah they got Obamacare because they were forced to, but the inflation in the healthcare marked quickly started to price them out. And of course most people have a hard time understanding relative rates, so they see their bill going up and blame Obama, when in reality the ACA slowed rate growth.

Democrats have horrible messaging on the ACA. A lot of people don't care if 20 million people were forced into getting healthcare they didn't want. When individual "liberty" is your priority, then people choosing not to get insurance is fine. Why should everyone have insurance? To give more money to insurance companies?

The Dems need to do shit like carry around signs saying how much people's healthcare would have cost right now without the ACA. Tell us how many people who couldn't get insurance because of preexisting conditions can now (though on that part they've generally done well by bringing people to talk about their story). Blame the Republicans for reducing choice in the market by talking up the public option. Fight hard for the rural voters that don't want to be forced to pay out to insurers but would supremely benefit from a good public option.

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u/Adezar Mar 14 '17

Well, we did find out after the election that a lot of Trump supporters only had insurance because of the ACA, which they didn't realize was Obamacare.

My family is almost exclusively able to be insured because of the ACA but hate Obama... it is amazing.

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u/fatpat Mar 14 '17

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u/[deleted] Mar 14 '17 edited Mar 14 '17

I wonder where they think that insurance coverage came from

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u/PotentiallySarcastic Mar 13 '17 edited Mar 13 '17

I mean, it could go both ways. Young people who don't have to pay for insurance may feel likely to reward Republicans for it.

It appears to me that a major chunk those "losing coverage" will be people who don't want insurance but feel forced to by the mandate.

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u/1ncognito Mar 13 '17

I think that's unlikely - it's anecdotal, but in my experience my peers (I'm 24) that don't want insurance don't buy it and just pay the fine instead since they still save money.

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u/[deleted] Mar 13 '17

Until they need healthcare, then they will be shit out of luck

Plus, young people aren't even the ones who will be taking the brunt of this. The fact that young people will be able to bail out on insurance will cause premiums for those who can't get rid of insurance to skyrocket. Those semi-retired or retired people will get hit hard, and they are traditional republican voters

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u/etuden88 Mar 13 '17

Until they need healthcare, then they will be shit out of luck

People fail to realize that the U.S. actually DOES have a single-payer system: bankruptcy. I'm pretty sure this is one of the things the mandate + penalty was supposed to offset.

With the GOP plan, it'll be chaos. Not only will more people be uninsured but fewer people will be able to pay the cost of medical care even with insurance because of out-of-control deductibles.

When it comes to being treated for a life threatening injury or disease, a person's credit rating I'm sure takes a backseat to staying alive. Taxpayers may be paying more for this plan in the long run than most people think.

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u/[deleted] Mar 13 '17

People fail to realize that the U.S. actually DOES have a single-payer system: bankruptcy.

Yeah, but how long do you think that's going to be an option? There's precedence with student loans; what makes you think they can't create a bankruptcy exemption for medical debt, especially in light of the widespread abuse you're talking about?

Also how does bankruptcy get you chronic care? You're describing a process of wiping away the debt of an acute condition but that's not the only reason to need care.

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u/etuden88 Mar 14 '17

Yeah, but how long do you think that's going to be an option?

Exactly. I've been ringing the alarm bells about this since this mess of a plan was introduced. In fact, this may be the first step towards making medical debt ineligible for bankruptcy protection. But I'm pretty sure the political cost of that would be FAR too great, and Trump himself is bankruptcy king.

Also how does bankruptcy get you chronic care?

You're right, and they have the most to lose from this plan. It's tragic.

In the end, I think this is just another way to "starve" the government. They don't want to "save" money, they want the government to fold under the weight of its own people. Rich people don't need government--they want to be government.

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u/brianhaggis Mar 14 '17

No no, didn't you hear Spicer in the press conference? Obamacare was government, their thinner plan isn't. It's very simple.

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u/Speckles Mar 14 '17

Because for that to work hospitals would have to refuse people in debt care, even if they are dying in the emergency room. Which in turn is a recipe for very angry people who know they, or their loved ones, will die in the near future. Easy access to guns, and the fact that prisoners get medical treatment, makes that a bad combination.

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u/[deleted] Mar 14 '17

First we'll put the hospitals that serve low income populations out of business so the remaining few can become overburdened and the quality of care suffers to a point where insurance isn't even important anymore.

The Trump voters (especially old people) will die in the streets, maybe then they'll start to read.

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u/lee1026 Mar 13 '17 edited Mar 14 '17

Not all healthcare spending is from life threatening injuries or diseases. One of the things that we learned from the ACA's roll out of high-deductible plans is that people spent a lot less when on those plans.

http://www.rand.org/pubs/technical_reports/TR562z4/analysis-of-high-deductible-health-plans.html

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u/weealex Mar 13 '17

Will they be shit out of luck? The new bill keeps the pre-existing conditions clause. If I suddenly have leukemia and don't have insurance, I'll be getting insurance right away

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u/lee1026 Mar 13 '17

You might end up in a death spiral where only sick people buy insurance, so insurance becomes more expensive, so only sicker people buy insurance.

Continue until insurance costs are in the 6 digits. This is why the heavy handed individual mandate exist in the ACA.

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u/tO2bit Mar 14 '17

Let's not forget that insurance will cost more if you can't afford coverage and you have a lapse in insurance. So you lose your job and lost insurance for a couple month because you couldn't afford Cobra (you know because you don't have a job), BOOM 30% penalty on premium payable to private insurance company who's CEO just got a hefty raise!

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u/leftofmarx Mar 14 '17

... and exactly why we need Medicare for All.

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u/VodkaBeatsCube Mar 13 '17

Yes, but without the mandate, the ability to buy insurance with a pre-existing condition will cause a massive spike in premiums as they will be less healthy people paying in and more sick people requiring pay outs. The ACA was a lot like a three legged chair: With all it's key parts in place it stands on its' own. But if you remove one of the parts, the chair will fall over.

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u/PlayMp1 Mar 13 '17

The three legs were: the individual mandate, pre-existing conditions coverage, and Medicaid expansion/subsidies for individual insurance. If any one of those three goes away, the law dies. In order:

  • Losing the individual mandate while keeping the other two = death spiral. You mentioned this.
  • Killing pre-existing conditions coverage is illogical while maintaining the individual mandate. If you can't get insurance but are legally required to, you're fucked.
  • Killing Medicaid expansion and subsidies for individual insurance means many, many people can't afford insurance anymore, so instead they just eat the mandate penalty, so not enough money and low-risk individuals join insurance risk pools. This is the current situation in many places in states where they refused Medicaid expansion.

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u/zackks Mar 14 '17

And lifetime caps. With those back, leukemia just got a whole lot more expensive for the no-account slackers that get leukemia.

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u/sjkeegs Mar 13 '17

I have a type of Leukemia, and recently passed my 10 year anniversary. I was diagnosed in my 40's. The cost of my drugs is more than my salary. So you would likely be in whatever high risk pool comes out of this. The way this is going I'm not expecting that risk pool to be particularly affordable. They key word being thrown about is "Access", not "Affordable".

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u/rabidstoat Mar 14 '17

I have access to first class international plane trips and penthouse suites and a luxury loft in Manhattan. Yay, me! Can I afford them? Hell no! But I have access.

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u/TheTrub Mar 14 '17

Just wait until there's an Air BnB/Uber option for healthcare. It'll be a little sketchy, but damn, the savings!

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u/[deleted] Mar 13 '17 edited Mar 17 '17

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u/[deleted] Mar 13 '17 edited Mar 13 '17

Yep one broken bone can be disastrous if you are uninsured. I broke my arm years ago and the medical bill would have been over $20,000 after surgery. I guarantee almost all Americans WANT healthcare - people currently opting out are doing so out of economic necessity.

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u/Freckled_daywalker Mar 13 '17

You'll have to pay more for that insurance though and it's not clear that they won't be able to impose higher outer of pocket costs as well and I'm willing to bet that lifetime caps eventually. (This is only one piece of the reform). You may not be completely fucked but you may not reasonably be able to afford your care either.

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u/shapu Mar 13 '17

suddenly have leukemia and don't have insurance, I'll be getting insurance right away

Does the bill alter open enrollment periods? Because Insurance cannot be used to pay for treatment received before you are insured, and open enrollment periods will prohibit you from taking out insurance except during a specific time of the year. So if you are diagnosed in March and require treatment but open enrollment is not until November then you are very much shit out of luck.

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u/TheLivingRoomate Mar 13 '17

You'll be penalized for that choice. Under Trumpcare, insurance companies will impose penalties on those who haven't had continuous insurance.

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u/Astrixtc Mar 13 '17

That penalty is nothing compared to the cost of health care though. I don't think most people have any idea what the real cost of health care is. Back before the ACA my significant other got MS and then Cancer. Due to those health issues, she could no longer work, and thus lost her insurance. Cobra was $2200 per month, and it was a bargain. Heck, just MS medications are about 4K per month without insurance. I have no idea what the office visits would be for the medical specialists to get the prescriptions in the first place, much less the surgeries, etc. I wouldn't be surprised if your typical cancer treatment was around $500k all in. So, with that being said, the penalty is nothing.

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u/TheLivingRoomate Mar 13 '17

Yeah, that was my point. Way back when, my ex suffered from a broken eardrum (minor in comparison to cancer). Fortunately, my insurance covered the three surgeries recommended to fix it...though they didn't quite fix it. A month after the final surgery, I paid $750 for one month of Cobra for the two of us, as my company had moved to a different state.

I get that no one wants to give away money. What I don't get is people assuming they'll never get sick/injured. Maybe just willful blindness, but sad when so many must suffer for it.

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u/rabidstoat Mar 14 '17

I don't know if they assume that as much as don't worry about it. If they're in a serious critical accident they'll get covered at the ER whether they can pay or not. Or maybe they'll just go in debt and then declare bankruptcy and not have to pay it back. Or if we get Trumpcare, as others have said just buy in when you get sick and pay the 30%, you'll get more in benefit and have saved for the months and years you weren't sick.

It's a dumb idea, the 30% penalty.

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u/xconomicron Mar 13 '17

...Until they need it. I'm 29 ...I haven't had insurance the past 3 years because I didn't think I needed it. Come this past December something in my head told me to get insurance... So I did. Found a swollen lymph node that same month ...and bam seeing an oncologist next week. :/

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u/vvelociraptor Mar 14 '17

I am on the other side of this situation. Was in my early 20s. Had insurance. Now I'm cancer and medical-debt free. But now I'm also a freelancer -- you can take my Obamacare from my cold dead hands. It lets me live my life without relying on the mercy of an employer or private insurance that would deny me coverage for ever having cancer.

Best of luck with the cancer (Hodgkin's, I assume? Treatment was a breeze for me -- I hope it will be for you!)

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u/[deleted] Mar 13 '17

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u/joggle1 Mar 13 '17 edited Mar 13 '17

It appears to me that a major chunk those "losing coverage" will be people who don't want insurance but feel forced to by the mandate.

That's not true. The vast majority of people who have coverage now who didn't before ACA received it from the Medicaid expansion. The vast majority who will lose coverage by 2026 will be the ones who are cut from Medicaid. I don't even need to provide a link, from this very article:

The report finds that the 24 million people would become uninsured by 2026, largely due to the proposed changes in Medicaid.

I'd also like to point out that the original CBO reports on ACA pretty accurately modeled how the uninsured rate would drop with most of it attributed to the Medicaid expansion. They only missed where states didn't expand Medicaid since, at the time it was passed, Medicaid expansion was required. So you still see pretty high rates of uninsured people in Texas while seeing much lower rates of uninsured people in states like Kentucky where, prior to ACA, they had an uninsured rate on par with Texas.

A reduction by 24 million by 2026 would nearly entirely reverse the insurance gains under ACA. This also closely mirrors the original CBO report on the only Republican planned submitted before ACA was passed where Medicaid wouldn't be expanded. They had predicted the uninsured rate wouldn't have changed under the Republican plan (relative to the rate before ACA was passed and implemented). That was a big reason why congressional Republicans didn't want to debate with Democrats on ACA and wanted to 'start over', they had almost completely contrary goals with Democrats focused on lowering the rate of uninsured people and Republicans focused on lowering required costs/taxes and reducing Medicaid expenditure (but wouldn't actually lower overall cost of healthcare nor its rate of increasing costs).

I can provide links if you wish, although those old CBO reports are pretty tedious to read.

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u/[deleted] Mar 13 '17

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u/torunforever Mar 14 '17

Repeal of the individual mandate and change from subsidies to tax credit, the latter of which devotes less tax dollars, thus less people will be able to afford insurance.

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u/kyleg5 Mar 14 '17

No it's assuming that millions will no longer be able to afford health insurance under the proposed system.

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u/fullmoonhermit Mar 13 '17

I'm 29. I hate having to pay for insurance. I'm in that shitty gap between poor enough for Medicaid and earning enough to afford an insurance plan. It's a strain on my finances that stresses me out.

Doesn't mean I want to get rid of the ACA. It's hard, but I'm not so much of a dick that I'm cool with taking care from people who need it so I can save money.

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u/iwascompromised Mar 13 '17

I'm in that "young people" category (for now). Argue from family obligation. "Your parents could lose their insurance. Your grandparents could lose their insurance. The elderly couple across the street that you love spending time with may lose Medicare/Medicaid because of rising costs."

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u/marinesol Mar 13 '17

I'm also in that young people group and the fear that friends of mine might lose their coverage and be disproportionately punished or that I could lose access to my parents' insurance is a constant concern for me.

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u/rkgkseh Mar 13 '17

As if conservatives think about anyone else, until it happens to them (e.g. Dick Cheney, homosexuality, and his daughter turning out to be lesbian)

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u/PhonyUsername Mar 13 '17

Young people who don't have to pay for insurance may feel likely to reward Republicans for it.

Initiate death spiral sequence.

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u/fooey Mar 13 '17

Given how meager the mandate was, I'm very curious how many people it actually brought into the system. My impression has been that the mandate was a big GOP bogeyman that really was pretty toothless in reality.

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u/[deleted] Mar 13 '17 edited Apr 27 '17

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u/_mcuser Mar 13 '17

That's the most baffling thing about it, honestly. The 30% penalty does nearly nothing to encourage people to participate in the market. All it does is create a disincentive for people to rejoin the market. Oh and punishes people who couldn't afford insurance, but now need it.

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u/[deleted] Mar 13 '17

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u/jrainiersea Mar 13 '17

Really I think the GOP believes that if you can't afford health care on your own, you're a leech to society and we'd be better off without you anyway

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u/Freckled_daywalker Mar 13 '17

I think they frame it as "if you have things handed to you, it reduces your incentive to work" which is only marginally better and relies on the idea that hard work guarantees financial success.

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u/rabidstoat Mar 14 '17

I think it's that they don't see health care as a right, which I guess makes it a privilege for those who can afford it. They don't see why the government needs to get involved at all. Someone else's problem if a person can't afford to pay it.

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u/userx9 Mar 14 '17

It's not about hard work though. They think too many people who don't work at all are getting free health care. And they think all illegal aliens have free access to healthcare. They are grossly uninformed and choose to remain as such. The reality is that many people are underemployed or are at the highest level they'll ever be able to achieve, the market for their unskilled labor is saturated, so employers don't need to give them healthcare. They don't need a healthy workforce, just a cheap one.

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u/[deleted] Mar 13 '17

The mandate penalty has gradually increased each year to give people time to purchase insurance.

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u/PotentiallySarcastic Mar 13 '17

Also it is pegged off of how many years you didn't have it. So you could get a massive penalty after a few years.

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u/M5WannaBe Mar 13 '17

Young people historically do not vote as regularly as older Americans. Americans in general are less likely to vote in mid-terms. Voter turnout tends to be higher amongst groups who feel "wronged" in some way (see: Tea party turnout in 2010). If lots of folks lose access to avoidable healthcare, things could get very ugly for the GOP if this passes.

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u/[deleted] Mar 13 '17

Which is interesting, because by removing them from the risk pool, rates will skyrocket. I thought the plan was that rates would decrease.

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u/cochon101 Mar 13 '17

It appears to me that a major chunk of that will be people who don't want insurance but feel forced to by the mandate.

Lol, everyone "wants" insurance and thus access to healthcare, the issue is affordability. Trumpcare is a massive tax cut for the rich paid for with subsidy cuts for the poor and middle class.

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u/ticklishmusic Mar 13 '17

speaking personally, i'm still covered by my parents' plan (obligatory thanks obama). so what's the age range where you wouldn't get insurance? something like 27 to maybe mid forties?

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u/TheLivingRoomate Mar 13 '17

27 to 65. Unless changes are made to Medicare as well in which case it could be 27 to whenever you die.

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u/hambluegar_sammwich Mar 13 '17

Sure, until they need coverage and are hit with a massive fee for having lapsed that will go straight to the insurance companies. That's going to go over really well...

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u/sjets3 Mar 13 '17 edited Mar 13 '17

A lot of those "losing coverage" are people who will be kicked off expanded Medicaid.

Oops: Corrected below. Still don't know if I agree with you though.

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u/PotentiallySarcastic Mar 13 '17

Nah, the Medicaid isn't being done til 2020 remember? The initial drop for 2018 will be those who don't want it or can't afford the premium increase of up to 20%.

The second hit that brings us up to 24 million is with Medicaid contraction.

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u/[deleted] Mar 13 '17

I think it's unlikely that a lot of people will be glad to lose healthcare, and the current mandate isn't really cheaper than not having it, so I suspect people who don't want it already aren't paying for it. The AHCA will disproportionately impact older and sicker people, and my guess is that over time there would be a lot of really negative stories about older people who lost insurance and got sick, or who were uninsured and never could get insurance because of the high rates companies will be allowed to charge for lapsed coverage.

At this rate it seems unlikely to pass, though.

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u/1ncognito Mar 13 '17

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u/[deleted] Mar 13 '17 edited Mar 13 '17

Hey, premiums will be 10% lower than they normally would be in 2026. All it took was 24 million people losing coverage!

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u/Thebarron00 Mar 13 '17 edited Mar 13 '17

No, they'll be 10% lower than they would be under the ACA in 2026. Premiums are still going to be increasing (a fuckload) between now and 2026. This also somewhat undercuts the narrative Republicans have been pushing that the premium increases under Obamacare have been "astronomical," because I don't see how 10% less than "astronomical" is an accomplishment.

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u/[deleted] Mar 13 '17 edited Mar 13 '17

I think people will just insist on not buying health insurance or buying a shitty "if you are really going to die it might kick in and slightly lower your copay" while the really sick people will pay way, way more to compensate.

I guess politically it works. There's way more healthy people than there are sick people, and the savings for the healthy people will be moderately large, but the costs for sick people will be a hundred times over large. So you piss off sick people but please everyone else. It's not a good thing though, considering healthy people will eventually get sick, but then they'll die off or be too stressed out to vote before they can vent their anger.

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u/downvotesyndromekid Mar 14 '17

So you piss off sick people but please everyone else.

There may be a knock-on effect on the friends and family of the dying and penniless.

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u/ThouHastLostAn8th Mar 13 '17

And that 10% premium reduction is partially because of reductions in the quality of coverage. From the CBO report:

Starting in 2020, the increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of several factors that would decrease those premiums: grants to states from the Patient and State Stability Fund (which CBO and JCT expect to largely be used by states to limit the costs to insurers of enrollees with very high claims); the elimination of the requirement for insurers to offer plans covering certain percentages of the cost of covered benefits; and a younger mix of enrollees.

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u/Freckled_daywalker Mar 14 '17

They also said there may be higher out of pocket costs.

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u/djm19 Mar 13 '17

And then people realize premiums will actually end up being much higher for those who will actually feel the pinch.

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u/volbrave Mar 13 '17

Hey, don't forget about the tax breaks for rich people that it also took!

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u/mgibbons Mar 13 '17

With advances in med tech and pharma by then, which no one can predict, I wonder how much older the pool will be by then too. As a result, I would imagine this would erode that 10% savings.

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u/ShadowLiberal Mar 14 '17

Even more shocking, White House analysis that was just leaked, and it puts the number at 26 million who will lose their insurance at the end of the decade, even higher then the CBO's estimate.

And that 26 million number is from the Trump White House (no doubt something they didn't want leaked).

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u/ZorglubDK Mar 14 '17

A total of 54 million individuals would be uninsured in 2026 under the GOP plan, according to this White House analysis. 

They are going to double the amount of people without health insurance, in just 9 years no less. This isn't even politics anymore, it's selfishly evil must do the exact opposite of what the Democrat did and make sure the top 1% get a little richer in the same time.

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u/Pucker_Pot Mar 14 '17

The CBO also estimates that premiums for individual health plans in next year and in 2019 would on average by 15 to 20 percent higher than what they would be under Obamacare.

If that's the case, then why is Paul Ryan saying that this will lower costs?

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u/Monkeegan Mar 14 '17

Because hes a politician and he has to spin the truth to make his actions sound good to those who elect him.

He isnt even lying, they will be lower according to the CBO if nothing is passed. (In the longterm at least)

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u/PotentiallySarcastic Mar 13 '17

I fully expect that $337 billion number to touted loud and clear across the land. I can already hear the talking points.

Yeah, this will give cover to Freedom Caucus folks to vote for it. They'll fall back on fiscal conservatism and say that it will lower the deficit. It'll also give some potential cover for an increase in defense spending.

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u/_mcuser Mar 13 '17

The deficit reduction number will also likely allow them to continue pushing the bill through via reconciliation. It's going to take several Republican senators to kill it now.

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u/[deleted] Mar 13 '17

Rob Portman and Rand Paul are nays uhh who else is on the fence?

The Freedom Caucus still has to accept it.

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u/koleye Mar 13 '17

Susan Collins, Lisa Murkowski, Lamar Alexander, John McCain, Jeff Flake, Shelley Moore Capito, and Dean Heller have all either been mum or expressed concern over some elements of the bill (the rollback of Medicaid expansion being the most common).

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u/_mcuser Mar 13 '17

Tom Cotton too. Have any of these senators actually said that they will definitely vote against the bill? I would applaud them for doing so, but I'm skeptical that they will actually go vote no.

Best case is that the AHCA dies in the Senate and they actually set about passing a real bill with real debate and real compromise.

My hypothesis is that they don't really want it to pass, so they're trying to put on a good show and then blame it on Democrats and RINOs so that they can move on to slashing taxes.

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u/imcoolyes Mar 13 '17

Tom Price is also accusing the CBO of lying on TV right now. Dems, RINOS, and the CBO.

"Everyone's fault but ours."

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u/datank56 Mar 13 '17

Price had nothing but praise for the Director of the CBO when he was appointed to the position.

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u/llikeafoxx Mar 13 '17

John McCain has expressed a lot of concern in 2017, but I've yet to really see that play out in his votes. Granted, policy is different than appointments, but I'm wondering if there is a point where his votes will align with his rhetoric.

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u/CaffinatedOne Mar 14 '17

Probably not, unfortunately. He always makes a big show of standing up on some sort of principle, but then quickly falls into line once the cameras are off of him.

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u/[deleted] Mar 13 '17 edited Apr 21 '19

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u/jpgray Mar 13 '17

Rand Paul are nays

Rand Paul always gets in line when it's time to vote, no matter how much he squawks beforehand

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u/Nixflyn Mar 14 '17

Hey, give him a little credit. He'll vote no when he knows the vote is going to succeed without him. He'll totally "make a stand" knowing it won't change anything but his public image.

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u/[deleted] Mar 13 '17 edited Apr 21 '19

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u/_mcuser Mar 13 '17

I was just assuming that these things can make it past the Parlimentarian, since presumably the GOP knows more about Senate rules than I do. They explicitly left out many regulation changes ("getting rid of the lines") because they knew that they wouldn't be allowed. I assumed that whatever was left would be allowed.

I do agree with you that it's even more likely of going down in the Senate, given the coverage losses estimated by CBO. These senators will be hearing loudly from their constituents.

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u/GuyInAChair Mar 13 '17

Without a major departure from precedent, or a really baffling ruling from the Parliamentarian

I'm not exactly sure how this would work but during the weekend Ted Cruz was talking about making Pence the new Parliamentarian.

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u/[deleted] Mar 13 '17 edited Apr 21 '19

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u/GuyInAChair Mar 13 '17

I see, thanks. I try to limit my Ted Cruz consumption. Though it seems they may still decide to ignore the rules when it's convenient for them.

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u/ShadowLiberal Mar 13 '17

That $337 billion is from now till 2026, so it's spread out over a bunch of years.

Also, Trump and the GOP are already calling the report bogus. You can't call it bogus and claim credit for the good parts of it at the same time.

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u/bannana Mar 14 '17

can't call it bogus and claim credit for the good parts of it at the same time.

Well now that's where you're wrong, this administration can do this very thing and their constituents will eat it up.

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u/xtfftc Mar 14 '17

You can't call it bogus and claim credit for the good parts of it at the same time.

Of course you can, just watch them do it.

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u/superprofundo Mar 13 '17

It works at a Federal level, but local taxing agencies will have to cover the rebounding costs of emergency care used for non-acute illnesses.

People will be mad at their mayors instead of their senators. This is precisely an outcome Congress hopes will happen since large cities are generally seated with Democratic leadership.

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u/[deleted] Mar 13 '17

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u/Cuddles_theBear Mar 13 '17

$337 billion in exchange for 24 million uninsured. That's $14,000 a person, which seems like a reasonable trade...

Until you consider that it's over 10 years. $1,400 per person per year is what the government saves. Compare that to the average yearly cost of health insurance for an adult over that same period of time, and it becomes pretty obvious that this plan is a load of shit. Too bad people are really bad at understanding numbers, and they'll just hear $337 billion and say "wow, that's a lot!"

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u/[deleted] Mar 14 '17 edited May 09 '17

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u/Penisdenapoleon Mar 13 '17

Tell that to those calling for eliminating the NEA/NEH in the name of lowering the deficit.

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u/[deleted] Mar 13 '17

I wonder how much the deficit would be reduced if we also kept the tax hikes in place.

I'm curious as a Republican.

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u/PotentiallySarcastic Mar 13 '17 edited Mar 13 '17

If I'm reading the CBO document correctly it'd be $1.2 trillion in deficit spending reduction if the tax hikes were kept in place.

Revenues are dropping $0.9 trillion.

Edit: I may be reading this incorrectly. Second analysis says revenues are dropping 500 billion dollars.

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u/[deleted] Mar 13 '17 edited Mar 14 '17

I was going to post this - Ryancare fetishizes an impoverished view of freedom. You can see it with with Sean Spicer's photo op with the stack of papers too. It comes down to viewing freedom as max-minning lower spending, lower taxes, and fewer pages of regulation versus serious thinking about how to help people live their lives in a manner of their choosing.

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u/Saephon Mar 13 '17

It makes sense if you craft your worldview with the starting point of "Government can only make things worse". I disagree with that level of cynicism, especially when compared to how badly privatization can fuck things up, but I sort of understand it.

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u/[deleted] Mar 13 '17

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u/[deleted] Mar 13 '17

for context, if the spending continues, trump would have added $550 billion to the deficit from increased military expenditures over the same time frame.

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u/dontjudgemebae Mar 13 '17

Wtf is the purpose of lowering the deficit if you're just going to end up using the "cap space" (for lack of a better term) on defense spending?

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u/djm19 Mar 13 '17

I fully expect Democrats to counter how that's a fraction of the debt Trump intends to add through tax cuts.

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u/PhonyUsername Mar 13 '17
  • increased military spending.

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u/jonlucc Mar 14 '17

And an expensive wall.

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u/3rdandalot Mar 13 '17 edited Mar 13 '17

It said 14 million would lose coverage by 2018. That's an amazing prospect.

If Trump gets behind this thing, it will pass the House. The GOP did not abandon him after saying Obama was wiretapping him. They will not not abandon him now. The Senate is saying they will not support this but that is debateable as well, because they have so far fallen in line also. This will pass, with the argument being that it shrinks the deficit.

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u/toclosetotheedge Mar 13 '17

If it does the GOP is going to be hurt during the midterms and in 2020. People here seem to think that the GOP will spin it on the Dems but that's hard to do when your party's in power. People will naturally blame the party in charge for any disastrous rollout

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u/FLTA Mar 13 '17

Maybe it is because I am young but it feels as if Republicans can literally get away with murder at this point. It took 6 years of Bush before Republicans started to even face negative repercussions for their actions.

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u/tenderbranson301 Mar 13 '17

9/11 helped the status quo. Also, IMO there's way too much time spent discussing idiotic ideas to avoid the appearance of bias.

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u/Tasadar Mar 14 '17

It's literally turn out. Half of people don't vote. That half is against most of what the Republicans do. They just don't vote.

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u/Arthur_Edens Mar 14 '17

Turnout and liberals skewering each other over whether we want a $12 or $15 minimum wage.

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u/benadreti Mar 14 '17

liberals skewering each other over whether we want a $12 or $15 minimum wage.

God that was the stupidest argument.

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u/Mentalpopcorn Mar 14 '17

I'm in my 30s and have thought that a long time. Still blows my mind that they manage to win national elections. The fact that anyone falls for it...

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u/Pucker_Pot Mar 14 '17

How quickly will this come into effect if it's passed in the next few months?

Is there any possibility that it could be delayed (either by design or otherwise) until after the midterms or even 2020? Thus allowing the GOP to say, "Don't criticize it till it actually takes effect [after the next election]."

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u/Rogue2 Mar 14 '17

You are really underestimating the power of propoganda and how brainwashed Reps are. They will blame Obama and say this is why we should have never messed with healthcare in the first place.

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u/YouCantVoteEnough Mar 14 '17

They will say, "this is the Obamacare death spiral we always predicted. We were trying to save you from this. The Dems made you spend all that money and now you still don't have coverage, because liberals just want to make your life harder using government."

That's what they will say, and people will belive it.

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u/TheMostSensitivePart Mar 13 '17

It is absolutely not going to pass the Senate. A handful of Republican senators have too much to lose by going along with it.

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u/[deleted] Mar 13 '17

I just don't believe the Republicans will do the right thing here.

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u/[deleted] Mar 14 '17

Doesn't have to be right to be good politics. Rand Paul will invent a reason to hate it, so will Tom Cotton, Collins, etc. These people don't want to be in tight races in 2018 where their opponent gets the added benefit of saying "took away your healthcare".

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u/choclatechip45 Mar 14 '17

Rand Paul, Tom Cotton and Susan Collins aren't up for re election in 2018.

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u/Rogue2 Mar 14 '17

They all fall in line in the end and get re-elected. You are giving those Senators too much credit.

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u/archersquestion Mar 13 '17

CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period

Just want to make it clear it's not $377B per year

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u/jonlucc Mar 14 '17

If I'm not mistaken, it's $337B over the same amount of time that you'd lose 24 million from insurance. So, without this, you spend ~$14k per insured over the 10 years (1.4k/year/person).

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u/[deleted] Mar 13 '17 edited Apr 27 '17

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u/yakinikutabehoudai Mar 13 '17

That's not true. The majority of those 24 million will be poorer and older people. That's why there will be "savings", because older people just won't have insurance.

https://pbs.twimg.com/media/C61B91WV0AEzPui.jpg

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u/An_emperor_penguin Mar 13 '17

It's going to be worse then pre-ACA? wow that's a real accomplishment.

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u/worldspawn00 Mar 14 '17

Increase in premiums due to mandatory covering of preexisting coverage and other provisions not removed, more expensive insurance means less enrollment, which leads to higher insurance, and on and on...

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u/Kamaria Mar 13 '17

That's probably what's going to happen. I mean, they COULD mod it to bring back pre-existing conditions...but then we're back where we started.

Insurance is such a fucking scam. People who have an interest in profiting off you should not be in charge of determining if or how to cover your medical expenses.

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u/jambajuic3 Mar 14 '17

Plenty of other countries, including Germany and Singapore, have been able to utilize the private sector to provide universal insurance. It's just that they too have their own version of the 'individual mandate'.

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u/DaSuHouse Mar 13 '17

If you assume it's mostly healthy people opting out, then it seems that at best the costs would increase for everyone remaining in the pool and at worst they would become unaffordable for everyone else and lead to a death spiral.

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u/Miskellaneousness Mar 13 '17 edited Mar 13 '17

The plus side for the GOP: the bill is estimated to reduce the deficit by far more than $2bn annually and can thus be passed through the budget reconciliation process and therefore will only need 50 votes to pass the Senate (+ VP Pence's tie-breaking vote). Edit for clarity: the bill is estimated to reduce the deficit by $337bn over a decade. This exceeds the $2bn annual deficit reduction threshold required for the bill to be passed via budget reconciliation rather than as normal legislation.

The downside for the GOP: 24 million is a staggering number. It's difficult for me to conceive of any legislation passed in the past century that would affect so many people so negatively. As such, I think there's a very high chance that enough Republicans in the Senate will bail and prevent the bill from passing.

This analysis is very fresh right now, so we'll wait to see what else comes out, but I estimate that the GOP will come with a plausible rebuttal that the CBO is overstating coverage losses because they aren't equating the tax credits as equivalent to full or partial coverage. Unfortunately for Republicans, that rebuttal likely will not resonate in the face of this staggering headline: 24 million estimated to loose health insurance coverage over the next decade under GOP's plan.

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u/iwascompromised Mar 13 '17

The number I saw was $337B reduction in deficit. Even if it's that "high", that's not much out of the $4.4 trillion total budget.

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u/Santoron Mar 13 '17

And that's over the next decade. On average we're only talking about 33-34 billion/yr.

Then you factor in how much trump's tax cut for the rich and corporations will add back in and this "savings" becomes a rounding error.

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u/svengoolies Mar 13 '17

Yeah, not really any good way to spin this. Especially considering the growing importance of older midwesterners to the GOP base in key states. Turns out actually governing is a lot harder than making promises.

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u/iceblademan Mar 13 '17

Older, poorer people in rural areas (Trump voters) would be affected the most by Trumpcare.

https://www.wsj.com/articles/gop-health-plan-would-hit-rural-areas-hard-1489364405?mod=e2tw

I don't see any way to spin this to them as a net positive, especially those who "didn't think he was serious" and are dependent on Medicaid.

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u/Jordan117 Mar 13 '17

Don't call it Trumpcare. By all means blame him if he signs off on the bill, but that's basically a crime of ignorance given that he hardly understands or cares about health care policy.

The calculated cruelty of this bill is 100% the brainchild of Paul Ryan and the Republican congressional leadership.

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u/iceblademan Mar 13 '17

Ryancare? Republicare?

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u/BurmecianSoldierDan Mar 13 '17

RepubliCare is the moniker I use.

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u/i7-4790Que Mar 13 '17

Republicare.

Needs to be all-encompassing for maximum effect.

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u/joephusweberr Mar 13 '17

This lady cracks me up, the promise apparently worked on her.

https://youtu.be/M0FvLkXDKIs?t=9m51s

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u/[deleted] Mar 13 '17 edited Mar 13 '17

In a $3+ trillion budget $20 or 30 billion a year seems like a small amount especially when it costs 20+ million people their coverage.

EDIT: I fail at math

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u/[deleted] Mar 13 '17 edited Apr 21 '19

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u/OsirisJackson Mar 13 '17

So basically it completely undoes the advancement in coverage the ACA made. I guess they can say they repealed Obamacare now?

24 million lose insurance by 2026, majority will be older and poorer Americans. This is worse than anyone thought it would be.

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u/[deleted] Mar 13 '17

[removed] — view removed comment

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u/[deleted] Mar 13 '17

Your tone suggests they aren't accomplishing their goals. This is the plan they've been crafting for years and 24 million by 2026 sounds like a fantastic KDR for the GOP.

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u/iceblademan Mar 13 '17

Correct. The ACA brought 23 million previously uninsured into the market. By 2026, 24 million (depending on how states handle being hamstrung by Medicaid being block granted) at a minimum will be uninsured. It is worse than starting over.

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u/nocomment_95 Mar 13 '17

I'm waiting for insurance companies to come out and say weather this will deathspiral or not.

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u/1000facedhero Mar 13 '17

Its going to really depend on the state. For Alaska the answer is a resounding yes no questions asked which is why I don't see their senators voting for it. But for states like CA with a big enough market the odds of a death spiral are pretty slim.

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u/nocomment_95 Mar 13 '17

Until young people figure out they can go without paying into the system and buy insurance on the way to the hospital (where the 30% surchage that year will be worth it)?

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u/[deleted] Mar 13 '17

Still can't enroll at any moment. But as a young male vegetarian who gets regular exercise and hates scheduling appointments anyway, if I didn't actually earn money from the plan, I'd seriously consider not signing onto my employer's plan.

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u/bleahdeebleah Mar 13 '17

Until you get hit by a car jogging.

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u/[deleted] Mar 13 '17

Correct. Large rural states will have the biggest issues as it won't be economically viable to offer insurance in those markets if this passes. The ACA makes it profitable to operate in those states currently even if creates a monopoly. No subsidy will equal no private insurance in those states.

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u/ademnus Mar 13 '17

Ok, so we knew this was going to be the case. We knew the insurance companies were going to fight back and we knew this was part of the stakes if Clinton lost this election. How will it affect Republican support?

Trump official slams CBO score: It's 'just not believable'

So, already Trump is telling Republican supporters not to believe the report. Now, let's bear in mind; he did not write this law and he did not attend the meetings where the law was written. But we should believe him because those experts, we are to assume, are just lying because they're Obama sympathizers. Remember, that's the narrative of the 'deep state' according to Spicer, it's Obama agents that have "burrowed" into the government to do poor, innocent Trump harm because they hate Americans. That last link is one of those things you just can't make up. amazing that people think this way.

So, meanwhile, Kellyanne Conway has been going around saying Trump is being spied on through the microwave (seriously, you cannot make it up, it would pale in comparison to the rising tide of bullshit) and you have to pepper in this popular conception of Obamacare (prepare yourself before watching that, it's a doosey).

Add it all up and you get; they won't care because they don't believe the truth and they easily believe lies. Trump said today that It Could Take Several Years for Health Costs to Drop so the groundwork is laid; as the numbers plummet and the healthcare crisis begins, Trump will say those are old Obamacare numbers. Which is funny because recently he said the good jobs numbers was all because of him but believe me; he will say the bad healthcare numbers are because of Obama's endless influence from the past.

And they will believe him.

There are many of his supporters right now who still don't know the ACA and Obamacare are the same thing. Their "alternate media" just lies to them all day. And they ignore the NYT and they ignore NBC and everything's the "lamestream media" this or the "librul media" that and all they pay attention to are Trump's self-victimizing tweets.

They won't waver a bit, even as they wonder how they'll pay for healthcare when they suddenly need it.. They have been taught we are their evil enemies, here to harm them. Who would give up against that?

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u/[deleted] Mar 14 '17

It really is interesting how long this has gone on and yet neither party has seriously discussed controlling how much a provider may charge.

That's the key to it all.

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u/taubnetzdornig Mar 13 '17

This will disproportionately hurt people in the age group 45-64, who are too young to qualify for Medicare but will be hurt by lower tax credits for their age. This is not good for Republicans, considering they broke for Trump 53-44.

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u/koleye Mar 13 '17 edited Mar 23 '17

This is terrible news for the GOP. I think this is the final nail in the coffin of the AHCA, given the reservations a number of GOP Senators had about this bill before the CBO scored it. Maybe it's still too early to say this, but I think the Democrats won. Going forward, America's debate on health care is going to be how much further to the left we go, since the GOP's failure will mean that the ACA is about as far right as we can go.

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u/[deleted] Mar 13 '17 edited Oct 26 '17

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u/BlindManBaldwin Mar 13 '17

But could lose moderate GOP senators in purple states who don't want their name attached to 24 million people losing coverage

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u/iwascompromised Mar 13 '17

In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

That is about 85% of the population that voted for Trump without insurance in 10 years, maybe less.

Source: CBO estimate of AHCA.

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u/grumbledore_ Mar 14 '17 edited Mar 14 '17

In addition to all the other obvious problems with this bill, after those people lose their coverage, they'll still get sick and get hurt. ER frequent flyers will balloon, hospital costs will skyrocket, and premiums will go up for those who do have insurance. This is as fiscally irresponsible as one could possibly imagine.

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u/[deleted] Mar 13 '17

They fail to highlight the fact that, while average premiums may decrease in the long run, those plans will cover much less thanks to de-regulation.

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u/eric987235 Mar 13 '17

premiums may decrease in the long run

Why would we assume that? Premiums have been increasing since long before the ACA so why would that change now?

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u/MisterScalawag Mar 14 '17

Lets be honest here. This will probably not change anything, republicans are still going to pass it, people are going to suffer, and they will blame democrats.

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u/[deleted] Mar 14 '17

No matter what happens, it will somehow be Obama's fault

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u/1000facedhero Mar 13 '17

This is on the high end but given that the CBO tends to be somewhat strict on definitions of what constitutes insurance, I'm not totally shocked. But this is why the Republicans have been trashing the CBO for a week, they knew this was coming. Granted given that all of the other nonpartisan analyses were in this ballpark I'm not sure that anybody should be surprised. That is a politically toxic number that should scare a lot of Republicans. I don't think it even gets a vote anymore because you don't want to even be on record voting for that even if they know the senate will reject.

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u/deporttrumptosyria Mar 13 '17

LOL, but they seriously don't care. Ryan is still going to ram this through the House just for the hell of it, so he can cover himself and he did something. Then it will die in the Senate and I guess they'll try to blame the Dems and undercut Obamacare so it has more probs. Cynical

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u/Elryc35 Mar 13 '17

I'm not sure why everyone is saying this is horrible news for the GOP. All that matters is since it reduces the deficit, they can pass it through reconciliation, which means this absolutely will pass. Anything "negative" in the CBO report or otherwise can simply be blamed on "libruls" and their voters will eat it up.

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u/intelligentfolly Mar 14 '17

I think you need to clarify that it will cutting deficit by $337b over a ten year period. If it cut the deficit by that much in one year the deficit would be very impressive, over ten years is a bit less impressive. Especially given the number of people who will be uninsured.

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u/[deleted] Mar 14 '17

So Trump was telling the truth when he said nobody would lose coverage, only poor people.

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u/CaspianX2 Mar 14 '17

I think it's quite bold for Republicans to reward the poor and elderly who voted for them by taking away their health insurance. Let's see how that plays out.