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The Pronk Pops Show 981, October 11, 2017, Story 1: Major Bubble and Major Bust When Congress Fails To Pass Both Fundamental Tax Reform and Total Repeal and Replacement of Obamacare — Results Count — Trump Runs Against The Do Nothing Congress of Democrats and Republicans in 2020 –American People vs. Political Elitist Establishment — Golden Opportunity Missed and Replaced By Smoke and Mirror Postcard Propaganda For Timid Tiny Tax Cut and Fake Repeal of Obamacare — Trump Narrowly Wins Second Term — National Debt Hits $25 Trillion & Unfunded Liabilities Hit $250 Trillion By 2024 –Videos — Story 2: How Obama Destroyed The Democratic and Damaged The U.S. Economy — Will Trump Reform The Republican Party and Revive The U.S. Economy — Videos

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Pronk Pops Show 975, September 29, 2017

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Pronk Pops Show 930, July 18, 2017

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Pronk Pops Show 928, July 13, 2017

Pronk Pops Show 927, July 12, 2017

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Pronk Pops Show 924, July 6, 2017

Pronk Pops Show 923, July 5, 2017

Pronk Pops Show 922, July 3, 2017

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Story 1: Major Bubble and Major Bust When Congress Fails To Pass Both Fundamental Tax Reform and Total Repeal and Replacement of Obamacare — Good Intentions No Substitute For Results —  Golden Opportunity Missed and Replaced By Smoke and Mirror Tax Return Postcard and Spending Cuts Propaganda Spin For Timid Tiny Tax Cut and Fake Repeal of Obamacare — Trump Runs Against The Do Nothing Congress of Democrats and Republicans in 2020 –American People and Trump vs. Political Elitist Establishment —  Trump Narrowly Wins Second Term — National Debt Hits $25 Trillion & Unfunded Liabilities or Obligations Hit $250 Trillion By 2024 –Videos —

U.S. Debt Clock.org

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http://www.usdebtclock.org/

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US Debt & Unfunded Liabilities-Where we are going-Dr. Yaron Brook

Milton Friedman – Why Tax Reform Is Impossible

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2018 United States federal budget

From Wikipedia, the free encyclopedia
2018 Budget of the United States federal government
Submitted March 16, 2017
Submitted by Donald Trump
Submitted to 115th Congress
Total revenue $3.654 trillion
Total expenditures $4.094 trillion[1]
Deficit $440 billion
GDP $20,237 billion
Website https://www.whitehouse.gov/omb/budget
‹ 2017

The United States federal budget for fiscal year 2018, named America First: A Budget Blueprint to Make America Great Again, was the first budget proposed by newly-elected President Donald Trump, submitted to the 115th Congress on March 16, 2017. If passed, the $4.1 trillion budget will fund government operations for fiscal year 2018, which runs from October 1, 2017 to September 30, 2018.[2][3]

Background

Donald Trump was elected as President of the United States during the November 8, 2016 elections, campaigning for the Republican Party on a platform of tax cuts and projects like the Mexican border wall. During his campaign, Trump promised to cut federal spending and taxes for individuals and corporations.

Trump administration budget proposal

The Trump administration proposed its 2018 budget on February 27, 2017, ahead of his address to Congress, outlining $54 billion in cuts to federal agencies and an increase in defense spending.[4] On March 16, 2017, President Trump sent his budget proposal to Congress, remaining largely unchanged from the initial proposal.[5]

CBO scoring of the budget

CBO chart explaining the impact of the 2018 budget on spending, tax revenue, and deficits over the 2018–2027 periods.

The Congressional Budget Office reported its evaluation of the budget on July 13, 2017, including its effects over the 2018–2027 period.

  • Mandatory spending: The budget cuts mandatory spending by a net $2,033 billion (B) over the 2018–2027 period. This includes reduced spending of $1,891B for healthcare, mainly due to the proposed repeal and replacement of the Affordable Care Act (ACA/Obamacare); $238B in income security (“welfare”); and $100 billion in reduced subsidies for student loans. This savings would be partially offset by $200B in additional infrastructure investment.
  • Discretionary spending: The budget cuts discretionary spending by a net $1,851 billion over the 2018–2027 period. This includes reduced spending of $752 billion for overseas contingency operations (defense spending in Afghanistan and other foreign countries), which is partially offset by other increases in defense spending of $448B, for a net defense cut of $304B. Other discretionary spending (cabinet departments) would be reduced by $1,548B.
  • Revenues would be reduced by $1,000B, mainly by repealing the ACA, which had applied higher tax rates to the top 5% of income earners. Trump’s budget proposal was not sufficiently specific to score other tax proposals; these were simply described as “deficit neutral” by the Administration.
  • Deficits: CBO estimated that based on the policies in place as of the start of the Trump administration, the debt increase over the 2018–2027 period would be $10,112B. If all of President Trump’s proposals were implemented, CBO estimated that the sum of the deficits (debt increases) for the 2018–2027 period would be reduced by $3,276B, resulting in $6,836B in total debt added over the period.[6]
  • CBO estimated that the debt held by the public, the major subset of the national debt, would rise from $14,168B (77.0% GDP) in 2016 to $22,337B (79.8% GDP) in 2027 under the President’s budget.[7]

Department and program changes

The proposed 2018 budget includes $54 billion in cuts to federal departments, and a corresponding increase in defense and military spending.[8][9]

Department Budget Amount change Percent change Notes
Department of Agriculture $17.9 billion $-4.7 billion −21% Includes the elimination of food for education and water and wastewater loan programs. Decreases funding for the United States Forest Service by $118 million.[10]
Department of Commerce $7.8 billion $−1.4 billion −16% Includes cuts to coastal research programs at the National Oceanic and Atmospheric Administration, and the elimination of the Economic Development Administration
Department of Defense $574 billion $52 billion +9% Includes an increase in the size of the Army and Marine Corps, as well as the Naval fleet
Department of Education $68.2 billion $−9.2 billion −14% Cuts programs and grants for teacher training, after-school and summer care, and aid to low-income students. Eliminates $1.2 from the 21st Century Community Learning Center program and cuts $732 million from the Federal Supplemental Educational Opportunity Grant. Eliminates Striving Readers/Comprehensive Literacy Development Grants as well as cuts funding for Supporting Effective Instruction State grants by $2.3 billion[11].
Department of Energy $28 billion $−1.7 billion −6% Largest cuts go to the Office of ScienceARPA-E and Departmental Loan Programs eliminated. Increases spending on National Nuclear Security Administration by 11.4% while slashing high energy physics and almost all other science programs (Basic Energy Sciences, Biological and Environmental Research, Fusion Energy Sciences, High Energy Physics, Nuclear Physics, Infrastructure and Administration, Workforce Development for Teachers and Scientists) by 18%. The only science program not to receive a cut is the Advanced Scientific Computing Research program, which is to receive a small budget increase of $101 million. Money spent on the NNSA would go to the modernization and upkeep of nuclear weapons as well as $1.5 billion going to naval nuclear reactors. The budget cuts funding for energy programs by over 50% reducing the funding by $2.4 billion. Energy programs cut include: Energy Efficiency and Renewable Energy, Electricity Delivery and Energy Reliability, Nuclear Energy, Fossil Energy Research and Development.[12][13]
Department of Health and Human Services $65.1 billion $−15.1 billion −18% Cuts funding for the National Institutes of Health and training programs
Department of Homeland Security $44.1 billion $2.8 billion +7% Increases spending on border security and immigration enforcement and builds a wall on the US-Mexico border. Cuts funding for certain FEMA grant programs.
Department of Housing and Urban Development $40.7 billion $−6.2 billion −13% Eliminates grant programs for community development, investment partnerships, home-ownership, and Section 4 affordable housing
Department of the Interior $11.7 billion $−1.6 billion −12% Eliminates over 4000 jobs. Eliminates funding for 49 National Historic Sites and decreases funding for land acquisition. Decreases funding for Cooperative Endangered Species Conservation Fund. Cuts funding by $2 million for dealing with invasive species.[14][15]
Department of Justice $27.7 billion $−1.1 billion −4% Reduces spending on prison construction and reimbursements to state and local governments for incarceration of undocumented immigrants
Department of Labor $9.6 billion $−2.6 billion −21% Eliminates funding for senior-work programs, grants for non-profits and public agencies used for health training, and closes some Job Corps centers
State Department $27.1 billion $−10.9 billion −29% Eliminates funding for United Nations programs, including peacekeeping and climate change mitigation
Department of Transportation $16.2 billion $−2.4 billion −13% Eliminates funding for the Federal Transit Administration‘s New Starts grant program, long-distance Amtrak service, cuts the TIGER grant program and eliminates funding for the Essential Air ServiceAir traffic control would be shifted to private service under the proposal.
Treasury Department $11.2 billion $−0.5 billion −4% Reduces funding for the Internal Revenue Service
Department of Veteran Affairs $78.9 billion $4.4 billion +6% Expands health services and the benefit claims system. Slashes disability benefits to 225,000 elderly veterans. The VA currently provides additional disability compensation benefits to Veterans, irrespective of age, who it deems unable to obtain or maintain gainful employment due to their service-connected disabilities through a program called Individual Unemployability (IU). The IU program is a part of VA’s disability compensation program that allows VA to pay certain Veterans disability compensation at the 100 percent rate, even though VA has not rated their service-connected disabilities at the total level. These Veterans have typically received an original disability ratings between 60 and 100 percent. Under this proposal, Veterans eligible for Social Security retirement benefits would have their IU terminated upon reaching the minimum retirement age for Social Security purposes, or upon enactment of the proposal if the Veteran is already in receipt of Social Security retirement benefits.These Veterans would continue to receive VA disability benefits based on their original disability rating, at the scheduler evaluation level. IU benefits would not be terminated for Veterans who are ineligible for Social Security retirement benefits, thus allowing them to continue to receive IU past minimum retirement age. Savings to the Compensation and Pensions account are estimated to be $3.2 billion in 2018, $17.9 billion over five years, and $40.8 billion over ten years.[16]
Environmental Protection Agency $5.7 billion $−2.5 billion −31% Eliminates more than 50 programs and 3,200 jobs
National Aeronautics and Space Administration(NASA) $19.1 billion $-0.1 billion −1% Cuts funding for Earth science programs and missions, and eliminates the Office of Education. Cuts funding for the Aeronautics Research Mission Directorate by $166 million (−21%). Cuts funding for Space Technology research by $148.4 million (−18%). Cuts funding for Human Exploration Operations by $4478.9 million (−53%). Cuts funding for the Education program by $62.7 million (−62.7%).[17][18]
Small Business Administration $.8 billion $−0.1 billion −5% Eliminates technical-assistance grant programs

The $971 million budget for arts and cultural agencies, including the Corporation for Public BroadcastingNational Endowment for the Arts, and National Endowment for the Humanities, would be eliminated entirely.

Criticism

Economist Joseph Stiglitz said about the 2018 budget proposal: “Trump’s budget takes a sledgehammer to what remains of the American Dream”. Senator Bernie Sanders also criticized the proposal: “This is a budget which says that if you are a member of the Trump family, you may receive a tax break of up to $4 billion, but if you are a child of a working-class family, you could well lose the health insurance you currently have through the Children’s Health Insurance Program and massive cuts to Medicaid”.[19]

Related fiscal legislation

On September 8, 2017, Trump signed the Continuing Appropriations Act, 2018 and Supplemental Appropriations for Disaster Relief Requirements Act, 2017. The bill contained a continuing resolution and a suspension of the debt ceiling lasting until December 8, as well as additional disaster funding for FY2017.[20][21]

References

Employment Situation Summary Table A. Household data, seasonally adjusted

HOUSEHOLD DATA
Summary table A. Household data, seasonally adjusted
[Numbers in thousands]
Category Sept.
2016
July
2017
Aug.
2017
Sept.
2017
Change from:
Aug.
2017-
Sept.
2017

Employment status

Civilian noninstitutional population

254,091 255,151 255,357 255,562 205

Civilian labor force

159,830 160,494 160,571 161,146 575

Participation rate

62.9 62.9 62.9 63.1 0.2

Employed

151,926 153,513 153,439 154,345 906

Employment-population ratio

59.8 60.2 60.1 60.4 0.3

Unemployed

7,904 6,981 7,132 6,801 -331

Unemployment rate

4.9 4.3 4.4 4.2 -0.2

Not in labor force

94,261 94,657 94,785 94,417 -368

Unemployment rates

Total, 16 years and over

4.9 4.3 4.4 4.2 -0.2

Adult men (20 years and over)

4.6 4.0 4.1 3.9 -0.2

Adult women (20 years and over)

4.4 4.0 4.0 3.9 -0.1

Teenagers (16 to 19 years)

15.9 13.2 13.6 12.9 -0.7

White

4.4 3.8 3.9 3.7 -0.2

Black or African American

8.3 7.4 7.7 7.0 -0.7

Asian

3.9 3.8 4.0 3.7 -0.3

Hispanic or Latino ethnicity

6.4 5.1 5.2 5.1 -0.1

Total, 25 years and over

4.1 3.6 3.8 3.5 -0.3

Less than a high school diploma

8.5 6.9 6.0 6.5 0.5

High school graduates, no college

5.2 4.5 5.1 4.3 -0.8

Some college or associate degree

4.2 3.7 3.8 3.6 -0.2

Bachelor’s degree and higher

2.5 2.4 2.4 2.3 -0.1

Reason for unemployment

Job losers and persons who completed temporary jobs

3,930 3,378 3,523 3,359 -164

Job leavers

900 757 804 738 -66

Reentrants

2,327 2,083 2,132 2,079 -53

New entrants

802 703 656 669 13

Duration of unemployment

Less than 5 weeks

2,584 2,133 2,222 2,226 4

5 to 14 weeks

2,220 2,017 2,015 1,874 -141

15 to 26 weeks

1,164 957 1,055 963 -92

27 weeks and over

1,963 1,785 1,740 1,733 -7

Employed persons at work part time

Part time for economic reasons

5,874 5,282 5,255 5,122 -133

Slack work or business conditions

3,587 3,161 3,266 3,121 -145

Could only find part-time work

1,972 1,754 1,645 1,733 88

Part time for noneconomic reasons

20,742 21,260 21,447 21,011 -436

Persons not in the labor force (not seasonally adjusted)

Marginally attached to the labor force

1,844 1,629 1,548 1,569

Discouraged workers

553 536 448 421

– Over-the-month changes are not displayed for not seasonally adjusted data.
NOTE: Persons whose ethnicity is identified as Hispanic or Latino may be of any race. Detail for the seasonally adjusted data shown in this table will not necessarily add to totals because of the independent seasonal adjustment of the various series. Updated population controls are introduced annually with the release of January data.

Employment Situation Summary Table B. Establishment data, seasonally adjusted

ESTABLISHMENT DATA
Summary table B. Establishment data, seasonally adjusted
Category Sept.
2016
July
2017
Aug.
2017(P)
Sept.
2017(P)

EMPLOYMENT BY SELECTED INDUSTRY
(Over-the-month change, in thousands)

Total nonfarm

249 138 169 -33

Total private

223 133 164 -40

Goods-producing

11 -20 66 9

Mining and logging

0 0 6 2

Construction

23 -9 19 8

Manufacturing

-12 -11 41 -1

Durable goods(1)

-10 -18 33 4

Motor vehicles and parts

-5.2 -27.1 23.9 -3.2

Nondurable goods

-2 7 8 -5

Private service-providing

212 153 98 -49

Wholesale trade

13.3 4.3 1.8 6.7

Retail trade

27.3 -10.8 -7.3 -2.9

Transportation and warehousing

-1.7 7.7 8.0 21.8

Utilities

0.5 -0.7 -0.3 0.0

Information

8 -3 -4 -9

Financial activities

9 11 8 10

Professional and business services(1)

83 43 43 13

Temporary help services

29.5 12.9 7.5 5.9

Education and health services(1)

48 51 45 27

Health care and social assistance

23.6 38.2 20.9 13.1

Leisure and hospitality

11 50 0 -111

Other services

13 1 4 -5

Government

26 5 5 7

(3-month average change, in thousands)

Total nonfarm

239 164 172 91

Total private

205 164 168 86

WOMEN AND PRODUCTION AND NONSUPERVISORY EMPLOYEES
AS A PERCENT OF ALL EMPLOYEES(2)

Total nonfarm women employees

49.6 49.5 49.5 49.5

Total private women employees

48.2 48.1 48.1 48.1

Total private production and nonsupervisory employees

82.3 82.4 82.4 82.4

HOURS AND EARNINGS
ALL EMPLOYEES

Total private

Average weekly hours

34.4 34.4 34.4 34.4

Average hourly earnings

$25.81 $26.39 $26.43 $26.55

Average weekly earnings

$887.86 $907.82 $909.19 $913.32

Index of aggregate weekly hours (2007=100)(3)

105.8 107.2 107.4 107.3

Over-the-month percent change

0.5 -0.2 0.2 -0.1

Index of aggregate weekly payrolls (2007=100)(4)

130.6 135.3 135.7 136.2

Over-the-month percent change

0.8 0.3 0.3 0.4

DIFFUSION INDEX
(Over 1-month span)(5)

Total private (261 industries)

57.9 63.2 60.2 55.7

Manufacturing (78 industries)

39.7 60.9 66.0 50.0

Footnotes
(1) Includes other industries, not shown separately.
(2) Data relate to production employees in mining and logging and manufacturing, construction employees in construction, and nonsupervisory employees in the service-providing industries.
(3) The indexes of aggregate weekly hours are calculated by dividing the current month’s estimates of aggregate hours by the corresponding annual average aggregate hours.
(4) The indexes of aggregate weekly payrolls are calculated by dividing the current month’s estimates of aggregate weekly payrolls by the corresponding annual average aggregate weekly payrolls.
(5) Figures are the percent of industries with employment increasing plus one-half of the industries with unchanged employment, where 50 percent indicates an equal balance between industries with increasing and decreasing employment.
(P) Preliminary

NOTE: Data have been revised to reflect March 2016 benchmark levels and updated seasonal adjustment factors.

 

The Tax Reform Tipping Point

Breitbart’s Steve Bannon is lighting up media coverage by championing primaries, but GOP operatives are more concerned with snagging a legislative win to calm the growing strife.

By David Catanese, Senior Politics Writer |Oct. 11, 2017, at 5:32 p.m.

The Tax Reform Tipping Point

What Bannon’s Civil War on the GOP Means for Tax Reform
Bloomberg
 Republican strategists and activists increasingly fear that a failure to deliver on tax reformin the coming months will intensify primary challenges to sitting incumbents next year and imperil the party’s already precarious standing in the midterm elections.

Angry GOP donors, a restless conservative base, a standstill Congress and a uniquely impetuous president are raising the stakes for a fourth-quarter legislative agenda that will be largely defined by an attempt at revamping the tax code that has languished for months.

An outside insurrection by Breitbart News head and former White House chief strategist Steve Bannon already is ominously fanning the flames of internecine warfare. But many top Republican minds believe the most powerful tipping point for the GOP is whether it can deliver on Trump’s key campaign promise of producing tax relief for Americans.

“If Congress passes the key elements of the conservative agenda, including repealing Obamacare and cutting taxes, some of the anger at the grass roots will dissipate,” says Ralph Reed, founder and chairman of the Faith & Freedom Coalition. “But if Congress fails to do so, I think there will be a lot of primaries in 2018 and 2020, and I think there will be a lot of vulnerable incumbents.”

Saddled by multiple failed attempts to repeal former President Barack Obama’s health care law, President Donald Trump and congressional Republicans are now turning their concerted attention to pitching lower tax rates and a simplification of the filing system. But there’s a growing realization they are now up against a calendar that leaves only two and a half months until an election year – and some of the most fiery activists already have lost their patience.

President Trump To Advance Tax Reform Plan
CBS New York
 The latest evidence of intraparty unrest came Wednesday in the form of a blistering letter from leading conservative groups asking Senate Majority Leader Mitch McConnell and members of his leadership team to step aside, citing their failure to act on an array of issues from illegal immigration and deficit spending to Planned Parenthood funding and a repeal of the Affordable Care Act.

“Republicans were given full control of the federal government. They – you – have done nothing,” the letter reads. “Worse, it is painfully clear that you intend to do nothing because, as is most apparent, you had no intention of honoring your solemn commitments to the American people. You were not going to drain the swamp. You are the swamp.”

The searing missive was signed by Ken Cuccinelli, president of the Senate Conservatives Fund; Jenny Beth Martin, co-founder of Tea Party Patriots; Adam Brandon, president of FreedomWorks; David Bozell, president of ForAmerica; Brent Bozell, chairman of ForAmerica; and conservative activist Richard Viguerie.

The cadre also questioned McConnell’s “commitment to real reform” on taxes – and a key GOP member of the House Ways and Means Committee on Wednesday acknowledged lawmakers will have to settle for at least some changes that won’t be permanent. “We’re not going to do as well as we had hoped in terms of permanence. It’s obvious,” said Rep. Pete Roskam of Illinois.

Meanwhile, even as Bannon’s clarion call for primary challengers to half a dozen GOP Senate incumbents has shaken the political media establishment as he intended, many GOP campaign veterans privately contend his influence has been widely overblown.

Plenty of anti-establishment candidates and would-be contenders mulling 2018 bids were stirring the pot long before Bannon came along. Alabama’s Roy Moore, for example, was beating Sen. Luther Strange ahead of Bannon’s blessing. Arizona’s Kelli Ward had run in 2016 against Sen. John McCain, and shortly after that defeat switched her focus to Sen. Jeff Flake.

 Mississippi’s Chris McDaniel, who is inching closer to a challenge of GOP Sen. Roger Wicker, gained national notoriety in 2014 for falling barely short in his bid to unseat Sen. Thad Cochran.

Bannon is also in talks with potential challengers to Sen. John Barrasso in Wyoming and Sen. Orrin Hatch in Utah, but so far neither has drawn a formal primary opponent, and Hatch hasn’t even formally decided to run again. In Nebraska, one key GOP player mocked any Bannon effort to draft a candidate to run against first-term Sen. Deb Fischer. “There’s really not any anti-Deb sentiment in Nebraska,” says Mike Kennedy, a 25-year GOP activist from Omaha. “I don’t see any traction for Bannon at all. They’re going to have to look under a lot of rocks.”

“Let’s be honest: Steve’s a drum major desperately running in front of a parade,” says a prominent conservative activist, speaking anonymously because he counts Bannon as a friend. “He’s good copy. He’s a good story. The issue is not Bannon. The issue is what these people were told for eight years: That when we got the White House, the Senate and the House, this stuff was going to happen. The grass roots feel like they’ve been played.”

“If we don’t pass the tax cut, I think all bets are off,” the activist adds, referring to the number of ferocious primaries that could multiply across the map.

Strategists working to preserve and expand the 52-member Republican Senate majority are also pinning their hopes on tax reform to hand their incumbents a tangible accomplishment that will land in voters’ pocketbooks. At the same time, they know it stands to impact their own bottom lines.

 A Senate GOP source acknowledges fundraising has begun to lag since June and that the National Republican Senatorial Committee – the entity tasked with electing GOP senators – has spent more than it’s raised over the preceding two months.

“Donors are so pissed off,” the source says. “If we don’t get tax reform, we won’t have the money to fund all our races. They just don’t understand why nothing’s been done.”

Terry Schilling, executive director of conservative think tank the American Principles Project, agrees that Republicans need an accomplishment on tax reform that they can hold in front of voters next year.

But unlike others, he doesn’t view Bannon’s efforts as necessarily counterproductive. Instead, Schilling says, Bannon’s looming threat of outside fire provides a constant incentive for even the most dependable incumbents to make good on Trump’s agenda.

“It’s probably not fair to target Barrasso, but then Barrasso gets to go to [John] McCain and [Lisa] Murkowski and [Susan] Collins and say, ‘I’m your friend and I’m getting heartburn for this.’ It’s pressure; it’s just politics,” he says. “These incumbents better be able to point to how they’ve been supportive of Trump. Otherwise, they’re going to be Luther Strange.”

https://www.usnews.com/news/the-run/articles/2017-10-11/tax-reform-key-to-republicans-fate-in-2018-midterms

Story 2: How Obama Destroyed The Democratic and Damaged The U.S. Economy — Will Trump Reform The Republican Party and Revive The U.S. Economy? — Videos

Victor D. Hanson: How the Obama Presidency Destroyed Todays Democratic Party

Taking Stock of Trumpism: Where It Came From, What It Has Accomplished, and Where It Is Going

Victor D. Hanson: The Media Hysteria over Trump | and the Reality

Victor D. Hanson on Obama’s Last Year & the Problem w/ Elites in Society

VICTOR DAVIS HANSON FULL ONE-ON-ONE EXPLOSIVE INTERVIEW WITH TUCKER CARLSON (6/9/2017)

Victor Davis Hanson on Obama and the current administartion.

‘Two-States of California’- Victor Davis Hanson at American Freedom Alliance

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The Pronk Pops Show 931, July 19, 2017, Story 1: “Obamacare Failed” Says President Trump — Wants Obamacare Completely  Repealed and Replaced Sooner or Later — Obama Lied To American People — Does President Trump Understand The Relationship Between Pre-existing Conditions, Guaranteed Issue, Community Rating and Adverse Selection — Many Doubt Trump Really Understands The Relationship That Is The Real Reason Obamacare Was Designed To Fail From The Beginning So It Could Be Replaced By Single Payer Government Health Care — Videos

Posted on July 20, 2017. Filed under: Abortion, Addiction, American History, Barack H. Obama, Biology, Blogroll, Breaking News, Bribery, Budgetary Policy, Business, Cartoons, Chemistry, Communications, Congress, Constitutional Law, Corruption, Countries, Crime, Culture, Diet, Diets, Disasters, Donald J. Trump, Donald J. Trump, Donald Trump, Donald Trump, Drugs, Economics, Education, Elections, Empires, Employment, Energy, Eugenics, Exercise, Fiscal Policy, Food, Food, Former President Barack Obama, Freedom of Speech, Government, Government Dependency, Government Spending, Health, Health Care, Health Care Insurance, Hillary Clinton, Hillary Clinton, Hillary Clinton, History, House of Representatives, Human, Human Behavior, Illegal Drugs, Immigration, Independence, Insurance, Investments, Labor Economics, Language, Law, Legal Drugs, Life, Lying, Media, Medical, Medicare, Medicine, Monetary Policy, National Interest, Networking, News, Obama, People, Philosophy, Photos, Politics, Polls, President Trump, Pro Abortion, Pro Life, Progressives, Radio, Rand Paul, Raymond Thomas Pronk, Regulation, Religion, Resources, Rule of Law, Scandals, Science, Security, Senate, Social Science, Social Security, Success, Tax Policy, Taxation, Taxes, Ted Cruz, United States Constitution, United States of America, Videos, Violence, Wealth, Welfare Spending, Wisdom | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

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The Pronk Pops Show Podcasts

Pronk Pops Show 931,  July 19, 2017

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Pronk Pops Show 929,  July 17, 2017

Pronk Pops Show 928,  July 13, 2017

Pronk Pops Show 927,  July 12, 2017

Pronk Pops Show 926,  July 11, 2017

Pronk Pops Show 925,  July 10, 2017

Pronk Pops Show 924,  July 6, 2017

Pronk Pops Show 923,  July 5, 2017

Pronk Pops Show 922,  July 3, 2017 

Pronk Pops Show 921,  June 29, 2017

Pronk Pops Show 920,  June 28, 2017

Pronk Pops Show 919,  June 27, 2017

Pronk Pops Show 918,  June 26, 2017 

Pronk Pops Show 917,  June 22, 2017

Pronk Pops Show 916,  June 21, 2017

Pronk Pops Show 915,  June 20, 2017

Pronk Pops Show 914,  June 19, 2017

Pronk Pops Show 913,  June 16, 2017

Pronk Pops Show 912,  June 15, 2017

Pronk Pops Show 911,  June 14, 2017

Pronk Pops Show 910,  June 13, 2017

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Pronk Pops Show 888,  May 8, 2017

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Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

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Pronk Pops Show 878: April 21, 2017

Pronk Pops Show 877: April 20, 2017

Pronk Pops Show 876: April 19, 2017

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Pronk Pops Show 874: April 17, 2017

Pronk Pops Show 873: April 13, 2017

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Pronk Pops Show 866: April 3, 2017

Image result for cartoons trump on obamacare failure

Image result for cartoons trump on obamacare failure

Image result for cartoons Obamacare has failed

Image result for cartoons trump on obamacare failure

Image result for cartoons trump on obamacare failure

Image result for branco cartoons obamacare failed

Image result for cartoons trump on obamacare failure

 

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Story 1: “Obamacare Failed” Says President Trump — Wants Obamacare Completely  Repealed and Replaced Sooner or Later — Obama Lied To American People — Does President Trump Understand The Relationship Between Pre-existing Conditions, Guaranteed Issue, Community Rating and Adverse Selection — Many Doubt Trump Really Understands The Relationship That Is The Real Reason Obamacare Was Designed To Fail From The Beginning So It Could Be Replaced By Single Payer Government Health Care — Videos

Trump Warns GOP Senators; 7-19-2017

MUST WATCH: President Trump Reacts to GOP Healthcare Bill Collapse – “Let ObamaCare Fail” (FNN)

LIMBAUGH: If We REPEAL Obamacare, “It’s The WILD WEST”

Rand Paul on Failed Healthcare Bill | Repealing Obamacare

Sen. Rand Paul Still Wants a Clean Repeal of Obamacare

Senator Mike Lee: Trump is right. repeal Obamacare now, replace later

Richard Epstein: Obamacare’s Collapse, the 2016 Election, & More

Richard Epstein – Obama Explained

Health Care 2: Can Congress Force Individuals to Buy Insurance?

Richard Epstein on Health Care Reform

The Truth Behind the Affordable Care Act – Learn Liberty

Is Obamacare Working? The Affordable Care Act Five Years Later

Why Is Healthcare So Expensive?

Why Is U.S. Health Care So Expensive?

Milton Friedman on universal health care

Milton Friedman on Medical Care (Full Lecture)

Professor Richard Epstein tribute to Milton Friedman

Does Trump Even Know What A Pre-Existing Conditions Is??

Here’s Why the Epic Health Care Reform Disaster Occurred

Here’s Why the Epic Health Care Reform Disaster Occurred

Will I pay more for insurance if I have a pre-existing condition under Obamacare?

Hume: Trump’s scenario for ObamaCare ‘politically nuts’

Obama’s Health Plan In 4 Minutes

How ObamaCare has been a financial failure

We Now Have Proof Obamacare Was Designed to Fail… and Here’s Why

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The Pronk Pops Show 925, Story 1: Republicans Rush To Pass Repeal and Replace Obamacare Before August Recess with Pence, Cruz and McConnell Leading The Way — Videos — Story 2: Total Repeal of Obamacare Requires Total Repeal of All Obamacare Regulations Including Requiring Guaranteed Issue In Individual Health Insurance Market For Those With Preexisting Conditions, Community Rating Premiums and 10 Essential Health Care Benefits as Well As Repeal of The Individual and Employer Mandates and All Obamacare-Related Taxes– Address Individuals With Preexisting Conditions by State Special Risk Pools Insurance Coverage With State Subsidies Only and No Federal Subsidies — Otherwise Guaranteed Failure Just Like Obamacare Due To Adverse Selection — Leading To Single Government Payer Health Care System — Total Repeal of Obamacare Now Or Replace Your Representative and Senators Both Democrat and Republican Next November — It’s Now Or Never (O Sole Mio) — Videos

Posted on July 10, 2017. Filed under: American History, Biology, Blogroll, Breaking News, Communications, Computer, Congress, Countries, Donald J. Trump, Donald J. Trump, Donald J. Trump, Donald Trump, Donald Trump, Education, Elections, Employment, Freedom of Speech, Government, Government Spending, Health Care, Health Care Insurance, History, House of Representatives, Human, Insurance, Investments, Language, Law, Life, Media, Medical, Medicine, Mike Pence, National Interest, News, People, Philosophy, Photos, Politics, Polls, President Barack Obama, President Trump, Progressives, Rand Paul, Rand Paul, Raymond Thomas Pronk, Rule of Law, Science, Security, Senate, Success, Taxation, Taxes, Ted Cruz, Ted Cruz, United States of America, Videos, Wealth, Wisdom | Tags: , , , , , , , , , , , |

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The Pronk Pops Show Podcasts

Pronk Pops Show 925,  July 10, 2017

Pronk Pops Show 924,  July 6, 2017

Pronk Pops Show 923,  July 5, 2017

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Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

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Pronk Pops Show 866: April 3, 2017

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Story 1: Republicans Rush To Pass Repeal and Replace Obamacare Before August Recess with Pence, Cruz and McConnell Leading The Way — Videos —

Ronald Reagan speaks out on Socialized Medicine – Audio

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Vice President Pence ‘s Obamacare Listening Session with Ohio Small Business Owners

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Sen. Cruz on ‘Face the Nation’ – July 9, 2017

Sen Mike Lee on the push to repeal ObamaCare

Lawmakers respond to Senate health care proposal

Sen. Rand Paul: Senate health care bill needs more Obamacare ‘repeal’

Sen. Rand Paul: We shouldn’t try to fix government intervention with more intervention. – 6/22/17

I won’t vote to keep ObamaCare: Rand Paul

Coolidge: The Best President You Don’t Know

Amity Shlaes on Coolidge’s life, ideas, and success in bringing about low taxes and small government

Uncommon Knowledge: The Great Depression with Amity Shlaes

Amity Shlaes: Calvin Coolidge, Better Than Reagan?

Archie Bunker on Democrats

 

Trump prods Congress to pass stalled healthcare overhaul

By Susan Cornwell and Ian Simpson | WASHINGTON

President Donald Trump on Monday prodded the Republican-led U.S. Congress to pass major healthcare legislation but huge obstacles remained, with a senior lawmaker saying the Senate was unlikely to take up the stalled bill until next week.

The House of Representatives approved its healthcare bill in May but the Senate’s version appeared to be in growing trouble as lawmakers returned to Washington from a week-long recess.

“I cannot imagine that Congress would dare to leave Washington without a beautiful new HealthCare bill fully approved and ready to go!” Trump wrote on Twitter, referring to the seven-year Republican quest to dismantle Democratic former President Barack Obama’s signature legislative achievement.

Lawmakers are set to take another recess from the end of July until Sept. 5.

Repealing and replacing the Affordable Care Act, dubbed Obamacare, was a central campaign pledge for the Republican president. But Senate Republican leaders have faced a revolt within their ranks, with moderate senators uneasy about the millions of Americans forecast to lose their medical insurance under the legislation and hard-line conservatives saying it leaves too much of Obamacare intact.

They were struggling to find a compromise that could attract the 50 votes needed for passage in a chamber Republicans control by a 52-48 margin, with Vice President Mike Pence casting a potential tie-breaking vote in the face of unified Democratic opposition.

No. 2 Senate Republican John Cornyn said Republicans could release an updated draft of their bill by the end of the week and told Fox News that senators could vote as early as Tuesday or Wednesday of next week.

 
U.S. President Donald Trump waves as walks on the South Lawn of the White House upon his return to Washington, U.S., from the G20 Summit in Hamburg, July 8, 2017. REUTERS/Yuri Gripas
“We’re going to continue to talk and listen and exchange ideas on how we can continue to make improvements,” Cornyn said on the Senate floor.

Also speaking on the Senate floor, Majority Leader Mitch McConnell gave no timetable for the bill. McConnell signaled his determination to keep working and said mere legislative “band-aids” would not suffice.

Senate Democratic leader Chuck Schumer said he had written to McConnell urging a bipartisan effort to stabilize the health insurance market, noting that McConnell had been quoted recently as saying Congress would need to shore up that market if lawmakers fail to repeal Obamacare.

The U.S. Centers for Medicare and Medicaid Services issued data on Monday showing a 38 percent decrease in applications by insurers to sell health plans in the Obamacare individual market in 2018 compared to this year. The agency said insurers continue to flee the exchanges, the online marketplace for health insurance set up under Obamacare.

MORE AMERICANS UNINSURED

With uncertainty hanging over the healthcare system, the percentage of U.S. adults without health insurance grew in the April-May-June period to 11.7 percent, up from 11.3 percent in the first quarter of 2017, according to Gallup-Sharecare Well-Being Index figures released on Monday. That translates into nearly 2 million more Americans who have become uninsured.

Scores of protesters voiced opposition to the legislation outside the Republican National Committee headquarters and at the offices of some Republican lawmakers including House of Representatives Speaker Paul Ryan, chanting slogans including “Trumpcare kills” and “Healthcare is a human right.”

U.S. Capitol Police said in a statement 80 people were arrested at 13 locations in House and Senate office buildings after they refused “to cease and desist with their unlawful demonstration activities.”

Republicans criticize Obamacare as a costly government intrusion into the healthcare system. Democrats call the Republican legislation a giveaway to the rich that would hurt millions of the most vulnerable Americans.

The Senate legislation would phase out the Obamacare expansion of the Medicaid health insurance program for the poor and disabled, sharply cut federal Medicaid spending beginning in 2025, repeal most of Obamacare’s taxes, end a penalty on Americans who do not obtain insurance and overhaul Obamacare’s subsidies to help people buy insurance with tax credits.

Leerink Partners analyst Ana Gupte said investors remained in a “wait-and-see” mode regarding the Senate legislation.

(For a graphic on who’s covered under Medicaid, click bit.ly/2u3O2Mu)

(Additional reporting by Susan Heavey, Eric Beech and Doina Chiacu; Writing by Will Dunham; Editing by Tom Brown)

http://www.reuters.com/article/us-usa-politics-healthcare-idUSKBN19V0YP

 

The Health 202: Cruz picks government health care subsidies as lesser of two evils

 July 10 at 9:03 AM
THE PROGNOSIS

Even conservatives acknowledge that the sickest Americans need help in paying their own steep insurance costs. In an ironic twist, some would rather have the government make up the difference rather than spreading expenses among the healthy.

Health insurance markets are so complicated, and the policy around them is so complex and intertwined, that politicians don’t always land ideologically on the issue where you’d think. Just look at how GOP Sen. Ted Cruz of Texas is trying to change the Obamacare overhaul that Senate Republicans will try to pass in the next three weeks before August recess. The former presidential candidate last week touted his ideas and on the Sunday shows yesterday, my colleague Sean Sullivan reports.

Cruz’s so-called “Consumer Freedom Amendment” — which conservatives have been rallying around as the revision they most want — would essentially free the healthiest Americans from covering the costs of the sickest Americans. But the sick would be even more heavily reliant on federal assistance as a result.

“You would likely see some market segmentation” Cruz told Vox last month. “But the exchanges have very significant federal subsidies, whether under the tax credits or under the stabilization funds.”

The Cruz amendment, which is being scored by the Congressional Budget Office as one of several potential changes to the Senate health-care bill, would result in segmenting the individual insurance market into two groups, experts say. Under it, insurers could sell cheaper, stripped-down plans free of Obamacare coverage requirements like essential health benefits or even a guarantee of coverage. These sparser plans would appeal to the healthiest Americans, who would gladly exchange fewer benefits for lower monthly premiums.

But insurers would also have to sell one ACA-compliant plan. The sickest patients would flock to these more expansive and expensive plans because they need more care and medications covered on a day-to-day basis. As a result, premiums for people with expensive and serious medical conditions like diabetes or cancer would skyrocket because all those with such serious conditions would be pooled together.

“The question is, would there be a premium spiral on the ACA-complaint market?” said Cori Uccello, a senior health fellow with the American Academy of Actuaries. “Can they ever price those premiums adequately if it’s just going to be the sickest people in there?”

It’s true that government subsidies — which under the Senate plan would be available to those earning up to 350 percent of the federal poverty level — would be even more crucial in order for these sicker Americans to afford the cost of their coverage, as would an extra infusion of federal “stabilization” money for states to cover their steep expenses.

Cruz hasn’t laid out all the details of how his amendment would work, nor is it even certain Senate Majority Leader Mitch McConnell (R-Ky.) will accept it as part of his health-care bill. But should it be adopted, and the Senate bill ultimately made law, the Cruz amendment would significantly shift how the individual insurance market operates.

But in Cruz’s mind, it would solve one of the biggest problems with Obamacare: that it robs the healthy to pay for the sick. He’s spent the last week pitching it as the legislative solution for passing the Senate bill.

“I think really the consumer freedom option is the key to bringing Republicans together and getting this repeal passed,” Cruz said on ABC yesterday.

Of course, everyone paying into the system for those who most need care is the way insurance is fundamentally supposed to work. The ACA requires insurers to offer a wider ranger of benefits in plans sold to everyone regardless of their health status. But to Cruz and his compatriots, requiring healthier people to buy cushier plans than they want or need is an abridgment of personal freedom and oversteps federal regulatory authority. So they’re more worried at the moment about rolling back more ACA regulations and less worried about federal spending.

“I think for conservatives it’s become a question of picking their poison,” Larry Levitt, president of the Kaiser Family Foundation, told me. “Is it government spending, or regulation? It’s almost like with this amendment, Sen. Cruz is acknowledging the need for a government entitlement program.”

Conservative groups that want a much fuller Obamacare repeal than the Senate bill provides have been jumping on the Cruz bandwagon, including Club for Growth, FreedomWorks and Tea Party Patriots.

.@SenTedCruz@SenMikeLee ‘Consumer Choice’ amendment, aka individual Obamacare Opt Out, is real step toward . We Support it!

From Tea Party Patriots founder Jenny Beth Martin:

If the Senate adopts the Cruz-Lee Amdt to the health care bill, @TPPatriots will be more likely to support the bill http://www.teapartypatriots.org/news/tea-party-patriots-signals-support-for-cruz-lee-amendment-to-senate-health-care-bill/ 

Photo published for Tea Party Patriots Signals Support for Cruz-Lee Amendment to Senate Health Care Bill

Tea Party Patriots Signals Support for Cruz-Lee Amendment to Senate Health Care Bill

Atlanta, GA – Tea Party Patriots President and co-founder Jenny Beth Martin released the following statement today regarding the amendment to the Senate health care bill offered by Senators Ted Cruz…

teapartypatriots.org

On the flip side, the Cruz amendment could help kill the Senate health-care bill in the end because it’s prompting fears among moderates (whose votes are also needed to pass the legislation) that patients with preexisting conditions could be harmed.

“I think that reopens an issue that I can’t support, that it would make it too difficult for people with preexisting conditions to get coverage,” Sen. Shelley Moore Capito (R-W.Va.) told the Charleston Gazette-Mail.

Cruz has said the Senate bill’s $100 billion stabilization fund for states could help cover costs for the resulting pricier coverage for those with preexisting conditions under his amendment. And to parry concerns about the increased federal spending, which to some is more than ironic coming from Cruz? The  talking point Capitol Hill aides and conservative wonks are adopting: Directly subsidizing costs for those with preexisting conditions is a more “honest” approach by the government than forcing healthy people to indirectly pay for their care by buying comprehensive coverage.

“If you’re going to have a subsidy, have it come directly from the taxpayer and call it a subsidy rather than try to dragoon people to do the government’s work,” said Chris Jacobs, a former GOP Hill staffer and founder of Juniper Research Group.

“It’s more honest and fair to have the government than to have healthy, middle-class families pay for it,” Conn Carroll, a spokesman for Sen. Mike Lee (R-Utah) said.

A co-sponsor of Cruz’s amendment, Lee is insisting it be added to the Senate bill before he’ll vote for it. Sens. Rand Paul of Kentucky and Ron Johnson of Wisconsin have sent similar signals. And remember — if more than two Republicans defect, the measure would be sunk in the Senate and the GOP effort to repeal-and-replace Obamacare would most likely meet a bitter end.

Some exciting news over at The Daily 202 from my colleague James Hohmann, whose newsletter makes its debut on Amazon Echo devices and Google Home as a flash briefing called “The Daily 202’s Big Idea.” Every morning, you can listen to James analyze one of the day’s most important political stories, along with three headlines you need to know. To learn how to add The Daily 202’s Big Idea to your flash briefings on your Echo device or Google Home, visit this page. You can also get the briefing on Apple Podcasts or wherever you get your podcasts.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/07/10/the-health-202-cruz-picks-government-health-care-subsidies-as-lesser-of-two-evils/59611958e9b69b7071abcae4/?utm_term=.7137a797b4cf

GOP, White House Plot ‘Urgent Blitz’ For Repeal Votes | The Last Word | MSNBC

Story 2: Total Repeal of Obamacare Requires Total Repeal of All Obamacare Regulations Including Requiring Guaranteed Issue In Individual Health Insurance Market For Those With Preexisting Conditions, Community Rating Premiums and 10 Essential Health Care Benefits as Well As Repeal of The Individual and Employer Mandates and All Obamacare-Related Taxes– Address Individuals With Preexisting Conditions by State Special Risk Pools Insurance Coverage With State Subsidies Only and No Federal Subsidies — Otherwise Guaranteed Failure Just Like Obamacare Due To Adverse Selection — Leading To Single Government Payer Health Care System — Total Repeal of Obamacare Now Or Replace Your Representative and Senators Both Democrat and Republican Next November — It’s Now Or Never (O Sole Mio) — Videos

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Socialism Makes People Selfish

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Elvis – It’s Now Or Never (O Sole Mio)

 

 

It’s Now or Never
It’s now or never,
Come hold me tight
Kiss me my darling,
Be mine tonight
Tomorrow will be too late,
It’s now or never
My love won’t wait.
When I first saw you
With your smile so tender
My heart was captured,
My soul surrendered
I’d spend a lifetime
Waiting for the right time
Now that your near
The time is here at last.
It’s now or never,
Come hold me tight
Kiss me my darling,
Be mine tonight
Tomorrow will be too late,
It’s now or never
My love won’t wait.
Just like a willow,
We would cry an ocean
If we lost true love
And sweet

 

FACT VERSUS FEAR: THE AHCA AND PRE-EXISTING CONDITIONS

On May 4, 2017, the House of Representatives passed the American Health Care Act (AHCA), a bill to repeal and replace many provisions of the Affordable Care Act (ACA). Immediately following the vote, misinformation about the bill began spreading like wildfire, stoking fears and outrage. The issue which seems to be getting the most attention is the potential impact this legislation could have on people with pre-existing conditions. However, as the legislation now moves to the Senate for further consideration and amendment, it is important that all stakeholders be well informed, and understand what the legislation actually says and who may realistically be impacted by any possible changes to current law.

  • The number of people in the U.S. with a condition that would likely qualify as pre-existing is not easily known, primarily because there is not a specific, pre-determined list of conditions. Estimates vary depending on how one defines “pre-existing.”
  • Even the range included in a recent report from the Department of Health and Human Services varied by a margin of more than 2:1, from between 61 million to 133 million people.[1] That said, it is likely that approximately as many as a quarter of Americans, and possibly more, have a pre-existing health condition, making it understandable why some are concerned.
  • As the AHCA is currently written, the only people who could be charged a premium based on their health status are those with a pre-existing condition who are not enrolled in a large group health plan, are also living in a state that obtains a waiver, and have let their insurance lapse in the past year for 63 days or more. In this case, the increased premium would only be allowed for one year. Further, no one may be denied insurance because of a pre-existing condition.

Background

Before passage of the ACA, most laws pertaining to the regulation of the individual health insurance market were passed at the state level and could vary widely from one state to another. The McCarran-Ferguson Act of 1945 provided states primary responsibility for regulating the business of insurance.

The Employee Retirement Income Security Act of 1974 (ERISA) imposed federal standards on certain types and with respect to certain provisions of large group (employer-sponsored) health plans, some of which supersede state law.[2] Among the provisions included in ERISA is a requirement that plans be offered on a guaranteed-issue basis, meaning that insurers are prohibited from denying coverage to the group based on medical claims history; though, the policy may be medically underwritten, meaning the premiums are based on the insured’s health status.

In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was passed and imposed additional federal health insurance standards across the individual, small group, and large group markets. In response to concerns of “job-lock”—the fear that leaving a job could result in the inability to regain health insurance if an individual had a pre-existing condition—HIPAA required all states to guarantee renewability of health insurance coverage to anyone who had creditable coverage for the past 18 months, with no more than a 63-day gap in coverage during that time.[3] However, while insurers were required to renew an individual’s policy from one year to the next, they were still not prohibited from medically underwriting individuals. Thus, some individuals found that while a plan was still technically available to them, the premium may have effectively priced them out of the market. Even those without a pre-existing condition may have found the cost of insurance to be significantly higher without the added employer contribution and tax advantage that such plans receive, which could make maintaining coverage, and HIPAA eligibility, more difficult.

Very few states previously had guarantee issue or renewability requirements or other protections for individuals not covered by HIPAA.[4] Most states permitted insurers to impose pre-existing condition exclusions, in which a pre-existing condition could be used to deny coverage altogether, or would not be covered by an individual’s new insurance policy for at least a certain amount of time, if not indefinitely. Varying “look-back” periods were also prevalent, which regulated the amount of time during which the insurer may check an individual’s claims history to make such a determination.

Current Law

The ACA attempted to mitigate these issues by imposing federal guaranteed issue requirements paired with community rating, which prohibits medical underwriting, across all health insurance markets. For many, these protections became the most important provisions of the ACA. However, there are economic consequences associated with such protections; primarily, higher average premiums in the individual market and increased spending by federal taxpayers. Multiple risk mitigation programs were included in order to help subsidize the cost of insuring high-risk, high-cost individuals, but the funding has not been sufficient. Insurers continue to lose money in the individual market, despite tens of billions of dollars in federal payments each year. In fact, many insurers have found the markets to be so unprofitable due to the many enhanced regulations, that they have decided they can no longer participate in the individual market in many states.[5]

The AHCA

The AHCA, passed by the House of Representatives on May 4, would repeal and replace many provisions of the ACA. One of the ACA’s most well-known provisions, the individual mandate which requires everyone to obtain health insurance, would be repealed (practically speaking, though not technically) and replaced with a continuous coverage provision.[6] These two policies are similar. The individual mandate imposes an annual penalty for not being insured equal to the greater of $695 per adult or 2.5 percent of household income.[7] The continuous coverage provision in this legislation would, instead of federally mandating that everyone buy insurance, incentivize individuals to remain insured by allowing for the imposition of a 30 percent premium surcharge for one year on individuals who signed up for coverage if they were uninsured for more than two months in the previous year.[8] After paying the surcharge for one year, individuals would return to paying regular community-rated premiums.

One provision that would not be repealed is the federal guaranteed issue requirement; insurers in every state would still be prohibited from denying insurance coverage to anyone on the basis of a pre-existing condition. In no circumstance would this protection be denied, though it seems much confusion surrounding this protection has stemmed from the adoption of several amendments to the underlying legislation.

The first relevant amendment is one that was negotiated by Rep. Mark Meadows (R-NC), on behalf of the Freedom Caucus. This amendment includes a provision pertaining to the “essential health benefits” established by the ACA—ten categories of care which are now required to be covered under every health insurance plan. The amendment would permit states, rather than the federal government, to define the EHB standards for themselves beginning in 2018.[9] However, this provision was ultimately struck.

A second amendment was offered by Rep. Tom MacArthur (R-NJ) to address concerns that states would drastically reduce benefit requirements. The MacArthur amendment reinstates the federal EHB standards, but would allow states to apply for waivers to a number of provisions, under certain conditions. Waivers would be permitted for the following: beginning in 2018, a change in age-rating restrictions (which determine how much more an insurer may charge an older person relative to a younger person); beginning in 2019, changes to the community rating provisions, which prohibit insurers from medically underwriting individuals; and, beginning in 2020, changes to the federal EHB standards, permitting states to set their own.

Any state seeking to obtain a community rating waiver must first have in place a program to help high-risk individuals enroll in coverage or a program providing incentives to insurers to enter the market and stabilize premiums, or an invisible risk-sharing program, as defined by the Schweikert/Palmer amendment.[10] All of these programs would be at least partially funded by the $138 billion provided over the next ten years by the Patient and State Stability Fund created by AHCA. The state must also specify how the waiver it is requesting would assist in: reducing average premiums in the state, increasing the number insured, stabilizing the health insurance market, stabilizing premiums for people with pre-existing conditions, or increasing plan choice in the state. If a state demonstrates it has met these conditions and obtains such a waiver, then it may permit insurers to waive the community rating protections, though only for individuals who have not maintained continuous coverage (save for the 63-day allowance) seeking to enroll in coverage in the individual and small group markets. In other words, individuals who would otherwise face a 30 percent surcharge as a result of not maintaining continuous coverage, would instead be medically underwritten for one year. However, under no circumstance may the gender rating protections be waived; insurers would continue to be prohibited from charging different rates based on whether an individual is a male or female.

Thus, the only people who could be charged a premium based on their health status are those with a pre-existing condition, not enrolled in a large group health plan, living in a state that obtains a waiver, who have let their insurance lapse in the past year for 63 days or more, and then only for one year. All others would continue to be protected by the community rating provisions currently in place under the ACA. Further, no one could be denied coverage because of the existence of a pre-existing condition, or even face a lock-out period.

Conclusion

The AHCA would not provide for the return to the status quo prior to the ACA. It is unlikely that many Americans will be impacted by the provisions of the MacArthur amendment. Finally, the AHCA must still be passed by the Senate and is likely to undergo significant reforms before it does, in which case, the legislation would again have to be passed by the House.

 

[1] https://aspe.hhs.gov/system/files/pdf/255396/Pre-ExistingConditions.pdf

[2] https://www.nahu.org/consumer/GroupInsurance.cfm

[3] There are some exceptions to the guaranteed renewability requirements.

[4] http://www.ncsl.org/research/health/individual-health-insurance-in-the-states.aspx

[5] http://kff.org/health-reform/issue-brief/2017-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/

[6] Technically, the mandate would not be repealed because legislative rules prohibit such a change through the reconciliation process, but the applicable penalty would be set to $0, rendering the mandate moot.

[7] https://www.healthcare.gov/fees/fee-for-not-being-covered/

[8] The continuous coverage provisions which match the 63-day rule of the HIPAA requirements.

[9] https://rules.house.gov/sites/republicans.rules.house.gov/files/115/policymngr-amdt.pdf

[10] https://rules.house.gov/sites/republicans.rules.house.gov/files/115/AHCA/Palmer-Schweikert%20Amendment.pdf

Read more: https://www.americanactionforum.org/insight/fact-versus-fear-ahca-pre-existing-conditions/#ixzz4mSiu1KRn
Follow us: @AAF on Twitter

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The Pronk Pops Show 920, June 28, 2017, Part 2 — Story 1: Breaking BIG — Big Interventionist Government — Obamacare and Obamacare Lite — The Progressive Two-Party Tyranny of The Democratic and Republican Parties — Fake Repeal and Fake Replace Is Not Real Repeal of Obamacare and All Obamacare Regulations and Replace With Free Enterprise Individual Health Insurance Markets Not Centralized Federal Control and Regulation with Massive Subsidies Of Health Insurance Industry — Collectivists vs Individualists — Replace The C, D, F BIG Progressive Republican Senators and Representatives — The Party’s Over — Videos

Posted on June 28, 2017. Filed under: American History, Banking System, Blogroll, Breaking News, Budgetary Policy, Communications, Congress, Constitutional Law, Corruption, Countries, Defense Spending, Donald J. Trump, Donald Trump, Economics, Elections, Employment, Federal Government, Fiscal Policy, Freedom of Speech, Government, Government Dependency, Government Spending, Health, Health Care, Health Care Insurance, History, House of Representatives, Human, Human Behavior, Independence, Labor Economics, Law, Life, Media, Medicare, Monetary Policy, National Interest, News, People, Philosophy, Photos, Politics, Progressives, Radio, Rand Paul, Raymond Thomas Pronk, Regulation, Rule of Law, Scandals, Senate, Social Security, Tax Policy, Taxation, Taxes, Ted Cruz, Trade Policy, United States of America, Videos, Wealth, Welfare Spending, Wisdom | Tags: , , , , , , , , , , , , , , |

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The Pronk Pops Show Podcasts

Pronk Pops Show 920,  June 28, 2017

Pronk Pops Show 919,  June 27, 2017

Pronk Pops Show 918,  June 26, 2017 

Pronk Pops Show 917,  June 22, 2017

Pronk Pops Show 916,  June 21, 2017

Pronk Pops Show 915,  June 20, 2017

Pronk Pops Show 914,  June 19, 2017

Pronk Pops Show 913,  June 16, 2017

Pronk Pops Show 912,  June 15, 2017

Pronk Pops Show 911,  June 14, 2017

Pronk Pops Show 910,  June 13, 2017

Pronk Pops Show 909,  June 12, 2017

Pronk Pops Show 908,  June 9, 2017

Pronk Pops Show 907,  June 8, 2017

Pronk Pops Show 906,  June 7, 2017

Pronk Pops Show 905,  June 6, 2017

Pronk Pops Show 904,  June 5, 2017

Pronk Pops Show 903,  June 1, 2017

Pronk Pops Show 902,  May 31, 2017

Pronk Pops Show 901,  May 30, 2017

Pronk Pops Show 900,  May 25, 2017

Pronk Pops Show 899,  May 24, 2017

Pronk Pops Show 898,  May 23, 2017

Pronk Pops Show 897,  May 22, 2017

Pronk Pops Show 896,  May 18, 2017

Pronk Pops Show 895,  May 17, 2017

Pronk Pops Show 894,  May 16, 2017

Pronk Pops Show 893,  May 15, 2017

Pronk Pops Show 892,  May 12, 2017

Pronk Pops Show 891,  May 11, 2017

Pronk Pops Show 890,  May 10, 2017

Pronk Pops Show 889,  May 9, 2017

Pronk Pops Show 888,  May 8, 2017

Pronk Pops Show 887,  May 5, 2017

Pronk Pops Show 886,  May 4, 2017

Pronk Pops Show 885,  May 3, 2017

Pronk Pops Show 884,  May 1, 2017

Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

Pronk Pops Show 881: April 26, 2017

Pronk Pops Show 880: April 25, 2017

Pronk Pops Show 879: April 24, 2017

Pronk Pops Show 878: April 21, 2017

Pronk Pops Show 877: April 20, 2017

Pronk Pops Show 876: April 19, 2017

Pronk Pops Show 875: April 18, 2017

Pronk Pops Show 874: April 17, 2017

Pronk Pops Show 873: April 13, 2017

Pronk Pops Show 872: April 12, 2017

Pronk Pops Show 871: April 11, 2017

Pronk Pops Show 870: April 10, 2017

Pronk Pops Show 869: April 7, 2017

Pronk Pops Show 868: April 6, 2017

Pronk Pops Show 867: April 5, 2017

Pronk Pops Show 866: April 3, 2017

Pronk Pops Show 865: March 31, 2017

Pronk Pops Show 864: March 30, 2017

Pronk Pops Show 863: March 29, 2017

Pronk Pops Show 862: March 28, 2017

Pronk Pops Show 861: March 27, 2017

Pronk Pops Show 860: March 24, 2017

Pronk Pops Show 859: March 23, 2017

Pronk Pops Show 858: March 22, 2017

Pronk Pops Show 857: March 21, 2017

Pronk Pops Show 856: March 20, 2017

Pronk Pops Show 855: March 10, 2017

Pronk Pops Show 854: March 9, 2017

Pronk Pops Show 853: March 8, 2017

Pronk Pops Show 852: March 6, 2017

Pronk Pops Show 851: March 3, 2017

Pronk Pops Show 850: March 2, 2017

Pronk Pops Show 849: March 1, 2017

Image result for repeal and replace obamacareImage result for branco cartoon repeal and replace obamacare

Image result for repeal and replace obamacareImage result for american on group plans, individual plans, Medicare, MedicaidImage result for repeal and replace obamacare

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Image result for Progressive republicans and democrats the two party tyrannyImage result for cartoons on repeal and replace of obamacareImage result for Progressive republicans and democrats the two party tyranny

National Debt Clock 

http://www.usdebtclock.org/

Image result for Progressive republicans and democrats the two party tyranny

Part 2 — Story 1: Breaking BIG — Big Interventionist Government — Obamacare and Obamacare Lite — The Progressive Two-Party Tyranny of The Democratic and Republican Parties — Fake Repeal and Fake Replace Is Not Real Repeal of Obamacare and All Obamacare Regulations and Replace With Free Enterprise Individual Health Insurance Markets Not Centralized Federal Control and Regulation with Massive Subsidies Of Health Insurance Industry — Collectivists vs Individualists — Replace The C, D, F BIG Progressive Republican Senators, and Representatives — The Party’s Over — Videos

 

Image result for Per capita health care expenditures by country 2015

Image result for Per capita health care expenditures by country 2015

 

Image result for Per capita health care expenditures by country 2015

Image result for Per capita health care expenditures by country 2015

Image result for Per capita health care expenditures by country 2015

Image result for how many americans are in employer paid health insurance v. individual health insurance

Judy Holliday – The Party’s Over

Judy Holliday The Party’s Over Lyrics

The party’s over
It’s time to call it a day
They’ve burst your pretty balloon
And taken the moon away.

It’s time to wind up

The masquerade
Just make your mind up
The piper must be paid.

The party’s over
The candles flicker and dim
You danced and dreamed

Through the night
It seemed to be right
Just being with him.

Now you must wake up
All dreams must end
Take off your makeup

The party’s over
It’s all over, my friend.

Now you must wake up
All dreams must end
Take off your makeup
The party’s over
It’s all over, my friend.

Should Republicans Punt On Health Care Reform?

Poll: Only 17% approve of Senate health care bill | Trump polls 6/28/2017

President Trump Holds Meeting with GOP Senators After Delayed Healthcare Vote 6/27/17

I won’t vote to keep ObamaCare: Rand Paul

Sen. Rand Paul: Our Bill May Cost More In First 2 Years Than Obamacare Did | TODAY

Republicans delay Senate health care vote

Heller says he will not support the GOP Senate health-care bill

Senator Ron Johnson: ‘We Should Not Be Voting’ on Healthcare This Week | Meet The Press | MSNBC

Milton Friedman – Collectivism

Milton Friedman on universal health care

Milton Friedman – The Social Security Myth

Milton Friedman – The Welfare Establishment

Milton Friedman – Tyranny of the Status Quo – Part 1 – Beneficiaries

Milton Friedman – Tyranny of the Status Quo – Part 2 – Bureaucrats

Milton Friedman – Tyranny of the Status Quo – Part 3 – Politicians

Milton Friedman – Why Tax Reform Is Impossible

Milton Friedman – Health Care Reform (1992) pt 1/4

Milton Friedman – Health Care Reform (1992) pt 2/4

Milton Friedman – Health Care Reform (1992) pt 3/4

Milton Friedman – Health Care Reform (1992) pt 3/4

Milton Friedman – Health Care Reform (1992) pt 4/4

Milton Friedman – Morality & Capitalism

Lacking enough GOP votes, Senate pushes back health bill

Sen. Rand Paul: Senate health care bill needs more Obamacare ‘repeal’

Hardball with Chris Matthews 6/27/17 Republicans can’t repeal and replace Obamacare

Hume on GOP Health Care Fight: Either Way, Republicans Have a ‘Problem’

Rand Paul: Let’s Repeal Obamacare And Don’t Replace It

Rush Limbaugh Talks Obamacare With VP Mike Pence: “We Take The Teeth Out Of The Tiger”

Republicans have one major problem on Obamacare

Why Can’t America Have a Grown-Up Healthcare Conversation?

Is Obamacare Working? The Affordable Care Act Five Years Later

Why Are American Health Care Costs So High?

How Health Insurance Works

Senate postpones health care bill vote

Individual Health Insurance VS. Group Health Insurance

Published on Aug 14, 2009

Ok so lets contrast individual vs. group health insurance. One thing that a lot of people get wrong is individual health insurance, number one isn’t as good coverage and number two, cost more than a group coverage. Well, these two things are wrong. The first one, lets talk about cost. We find that individual health insurance is about 40% less than any group plan. You can load it up with all the features and benefits you are looking for in a group

Group vs. Individual Health Insurance: Health Insurance Facts & More

Published on Aug 16, 2012

‘We’re Amending Obamacare. We’re Not Killing It’

The Senate bill coming out Thursday would do many things to health care in the U.S., but it won’t get rid of the Affordable Care Act, and Mitch McConnell won’t claim that it does.

The health-care bill Senate Republicans plan to unveil on Thursday likely will make substantial changes to Medicaid and cut taxes for wealthy Americans and businesses. It will eliminate mandates and relax regulations on insurance plans, and it will reduce the federal government’s role in health care.

What it won’t do, however, is actually repeal the Affordable Care Act.

Lost in the roiling debate over health care over the last several weeks is that Republicans have all but given up on their longstanding repeal-and-replace pledge. The slogan lives on in the rhetoric used by many GOP lawmakers and the Trump White House but not in the legislation the party is advancing. That was true when House Republicans passed the American Health Care Act last month, which rolled back key parts of Obamacare but was not a full repeal. And it is even more true of the bill the Senate has drafted in secret, which reportedly will stick closer to the underlying structure of the law.

“We’re amending Obamacare. We’re not killing it,” a frustrated Jason Pye of the conservative group FreedomWorks told me earlier this month as the murky outlines of the Senate proposal were beginning to emerge.

Like the House bill, the Senate plan is expected to repeal the ACA’s employer and individual insurance mandates and most if not all of the tax increases Democrats levied to pay for new programs and benefits. But the Senate bill likely will only begin a years-long phase-out of the ACA’s Medicaid expansion in 2020 rather than end it as the House measure does.

The Senate also is expected to include more generous tax credits than the House bill that more closely resemble the system already in place under Obamacare. But the funding levels would still be lower than the current law. And according to Axios, the bill would allow states to opt out of some ACA insurance regulations, but it would do so by loosening existing waivers within the current law rather than follow the House in creating a new waiver system. And the Senate proposal would require that states adhere to more of Obamacare’s regulations than the House bill.Senate Majority Leader McConnell has quietly abandoned the language of “repeal-and-replace” that his office originated seven years ago in the immediate aftermath of the ACA’s enactment. In more than a dozen speeches on health care that McConnell has delivered on the Senate floor since the House passed its bill in early May, he hasn’t uttered the word “repeal” a single time, according to transcripts provided by the majority leader’s office. Nor has he repeated his own pledge to rip out Obamacare “root and branch.” “We’re going to make every effort to pass a bill that dramatically changes the current health care law,” McConnell told reporters on Tuesday, setting a new standard for the bill Republicans plan to release on Thursday.

When the year started, legislation leaving Obamacare substantially in place would have been dead on arrival with hardliners in the House and Senate, who demanded that party leaders expand on a bill that former President Barack Obama vetoed in 2015. That measure did not fully repeal the ACA either, bowing to Senate budget rules limiting how much of the law Republicans could scrap without a filibuster-proof 60 votes. But it eliminated the tax credits and subsidies undergirding the law’s insurance exchanges along with its tax increases and mandates. And with Republicans now in control of both Congress and the White House, conservatives in the House Freedom Caucus this spring began pushing the leadership to go further by repealing Obamacare’s core consumer protections guaranteeing the coverage of essential health benefits and prohibiting insurers from charging higher rates to people with preexisting conditions.

The deal that ultimately allowed the AHCA to pass the House was an under-appreciated turning point in the health-care debate. The concession that Speaker Paul Ryan and a few key moderates made to the Freedom Caucus was to allow states to opt out of some of Obamacare’s insurance regulations, most crucially on equal treatment for pre-existing conditions. But the concession that conservative lawmakers and outside groups made in return was just as significant: They agreed to back off their demand for full repeal and endorse—or at least not fight—a bill that fell far short of that goal.“While this legislation does not fully repeal Obamacare, it’s an important step in keeping that promise to lower healthcare costs,” the Freedom Caucus said in its statement upon passage of the AHCA. It was a message echoed by outside groups like FreedomWorks, Heritage Action, and the Club for Growth, who agreed to drop their opposition to the bill, a move that gave Republicans additional cover to vote for it. Conservatives had embraced an incrementalist approach to Obamacare. The new standard they adopted for health-care legislation was not whether it eliminated the Affordable Care Act but whether it would lower premiums for most consumers.One key question for McConnell is whether the most outspoken conservatives in his caucus—Senators Rand Paul of Kentucky, Ted Cruz of Texas, and Mike Lee of Utah—will judge the Senate bill by that more modest baseline. Republicans can lose no more than two votes to secure passage, and a group of moderate senators is proving just as difficult for party leaders to nail down. To this point, Paul has been the most critical of the GOP approach and the most likely to oppose the proposal from the right. The House bill, he complained, already kept 90 percent of Obamacare’s subsidies. “If this gets any more subsidies in it, it may well be equal to what we have in Obamacare. So it really wouldn’t be repeal,” Paul said on Tuesday, according to Bloomberg. Even so, the Kentucky conservative wouldn’t rule out supporting the bill until he read the text.Cruz and Lee have participated in the Senate process as members of the 13-man working group, and aides have said both have bought into McConnell’s incremental approach. But the two have each complained about the emerging draft in recent days, either on the substance or the top-down, secretive process used to write the bill. “We’re not there yet,” Cruz said Tuesday on Fox News. “The current draft doesn’t do nearly enough to lower premiums.”The Congressional Budget Office projected that in states that opted out of Obamacare’s insurance requirements under the waivers allowed in the House bill, average premiums would drop significantly. But the tradeoff is that people with preexisting conditions would face sharply higher costs or be priced out of insurance entirely. Conservatives have argued that the high cost of adhering to the ACA’s minimum coverage requirements has forced insurers to raise premiums in order to make a profit.Conservative activists briefly held out hope that the health-care bill would move further to the right in the Senate, buoyed by efforts by Cruz and Lee to have Republicans override parliamentary rulings limiting how much of Obamacare they could repeal through the budget reconciliation process. But party leaders never seriously considered that option, which moderate Republicans were likely to oppose.In recent weeks, conservatives have instead focused on demanding that the Senate preserve—or deepen—the reforms to Medicaid in the House bill while still repealing all of Obamacare’s tax hikes. “It is clear that significant portions of the Republican Party have no intention of actually repealing Obamacare despite campaigning on that objective for years,” Mike Needham, CEO of Heritage Action, said in a statement on Wednesday.

“Conservatives will evaluate legislative language when it becomes available, looking particularly at whether the legislation empowers states to get out of the onerous insurance mandates imposed by Obamacare, maintains and improves the House’s Medicaid reforms, and repeals Obamacare’s stifling taxes.”

Make no mistake, Republicans aren’t merely tinkering around the edges of the health-care system, or Obamacare. The Senate proposal that will come out on Thursday will significantly alter the federal funding of Medicaid and, in all likelihood, would result in millions fewer Americans having health insurance over the next decade, as projected by the CBO. And while they won’t be excited by the bill, conservative senators and activists might well come around to support it. They’d vote for the plan as a step in the right direction, a weakening of Obamacare. But like McConnell, they won’t be calling it something that it’s not: repeal.

https://www.theatlantic.com/politics/archive/2017/06/senate-republican-bill-obamacare-repeal/531108/

What’s in the Senate Republican Health-Care Bill

Like the House version, Mitch McConnell’s proposal would slash taxes, cut Medicaid, and eliminate Obamacare’s insurance mandates for individuals and employers.

The Senate Republican health-care bill is finally out in the open.

After weeks of secretive deliberations, party leaders on Thursday released a 142-page proposal that would slash taxes on the wealthy and businesses; reduce federal funding for Medicaid and phase out its expansion under the Affordable Care Act; and limit the tax credits available to help people purchase insurance on the individual market. The legislation, titled the Better Care Reconciliation Act of 2017, is officially labeled a “discussion draft,” but Senate Majority Leader Mitch McConnell wants Republicans to debate and vote on the bill by the end of next week.

Like the American Health Care Act that passed the House in May, the Senate bill is a substantial revision to Obamacare but not a wholesale repeal. And while Senate Republicans had vowed to start over rather than work off the unpopular House proposal, their version is structured the same way. The Senate measure mirrors the House bill in eliminating the ACA’s employer and individual insurance mandates and most of the tax increases it imposed to pay for new programs. Both proposals call for an overhaul of Medicaid funding that would allow states to institute work requirements and end the program’s status as an open-ended entitlement. The Senate bill would go further than the House’s $800 billion in cuts by reducing its growth rate beginning in 2025, but unlike the House version, it would begin a three-year phase-out of the program’s expansion in 2020. The AHCA would cut off the expansion entirely that year.

As expected, Democrats assailed the proposal as a draconian measure that would strip health insurance from millions all for the goal of providing tax cuts for the rich. They seized on comments that President Trump reportedly made to Republican senators in which he called the House proposal “mean.”
“Simply put: This bill will result in higher costs, less care, and millions of Americans will lose their health insurance, particularly through Medicaid,” Senate Minority Leader Charles Schumer said. “It’s every bit as bad as the House bill; in some ways, it’s even worse.”

But the McConnell was never intended to appeal to Democrats. Instead, the majority leader and the Senate policy staffers who wrote the bill were trying to strike a delicate balance between conservatives bent on ripping up Obamacare and moderate Republican senators who, though they campaigned on repeal, now want to preserve its central benefits. Whether McConnell achieved that middle ground is unclear, as few Republican senators leapt to embrace his proposal in the immediate aftermath of its release. The first official holdouts to emerge were a group of four conservatives: Senators Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah, and Ron Johnson of Wisconsin.“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor,” they said in a joint statement. “There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.”Their statement was significant because together, their opposition alone could sink the bill given the GOP’s narrow, 52-48 majority in the Senate. But its careful wording left a lot of room for any or all of the conservatives to come around by the time the bill hits the floor next week. Paul, who has been a critic of the GOP approach for months, was more harsh in a pair of tweets he sent on his own. “The current bill does not repeal Obamacare. It does not keep our promises to the American people,” he wrote. Paul had long been considered a likely no vote, as it is unlikely McConnell could move the bill far enough to the right to get his support without losing moderates.
The draft will also face the test of whether its provisions pass muster under the Senate’s complex rules for budget reconciliation, which would allow Republican to circumvent a Democratic filibuster. Aides on Thursday acknowledged that “there will be ongoing discussions with the Parliamentarian” in the Senate about certain parts of the bill.The Senate proposal targets abortion coverage by prohibiting the use of tax credits to buy insurance plans that cover the procedure, and it would ban funds from going to Planned Parenthood. Those provisions could jeopardize the support of two moderate Republicans, Senators Susan Collins of Maine and Lisa Murkowski of Alaska, who have said they oppose restricting federal funding to Planned Parenthood. A spokeswoman for Collins, Annie Clark, said Thursday she would be reviewing the bill into the weekend. “She has a number of concerns and will be particularly interested in examining the forthcoming CBO analysis on the impact on insurance coverage, the effect on insurance premiums, and the changes in the Medicaid program,” Clark said.The Senate bill also allows states to opt out of some of Obamacare’s insurance regulations, but it does not allow waivers that would let insurance companies charge higher rates to people with preexisting conditions. “We’re not touching preexisting conditions,” one top GOP staffer told reporters on a Thursday conference call. While the House bill created a new waiver system aimed at allowing states to get around Obamacare requirements, the Senate expands an existing waiver in the current law to make it easier for states to apply. The provision, aides said, would allow insurance companies in states that obtain waivers to sell plans that do not provide essential health benefits, including maternity care, hospitalization, and mental-health treatment.Unlike the House bill, the Senate proposal contains funding for cost-sharing payments for insurers to help stabilize the faltering individual insurance market under Obamacare. They would continue through 2019 before being repealed entirely. The payments are the subject of a lawsuit that House Republicans filed against the Obama administration three years ago, and while the Trump administration has continued the subsidies, its refusal to guarantee them over the long term has prompted more insurers to exit the ACA exchanges.McConnell has drawn criticism from senators in both parties for writing the bill behind closed doors without public hearings, though it’s unclear if the mounting frustration among some Republican senators about the process will threaten the legislation’s passage. In a floor speech on Thursday morning, the majority leader said senators would have “ample time” to review and amend the bill before a final vote. The Congressional Budget Office said it would release its analysis of the Senate bill’s cost and impact on insurance early next week. It found that the House bill would leave 23 million more people uninsured over the next decade while reducing average premiums depending on whether states opted out of Obamacare’s insurance regulations.“We debated many policy proposals. We considered many different viewpoints,” McConnell said. “In the end, we found that we share many ideas about what needs to be achieved and how we can achieve it. These shared policy objectives and the solutions to help achieve them are what make up the health care discussion draft that we talked through this morning.”Senate budget rules call for what’s known as a “vote-a-rama” where members of either party offer amendments in a single session. And in many ways, it appears McConnell’s draft is designed to be amended. The bill, for example, does not include funding for the opioid crisis that Senators Rob Portman of Ohio, Shelley Moore Capito of West Virginia, and others were demanding. Nor does it adopt their proposal for a longer, seven-year phase-out of the Medicaid expansion. But by omitting those provisions at the front end, McConnell could be inviting Portman, Capito, and other wavering senators to add them by amendment so they can claim credit for improving the bill when it comes to the floor. Similarly, the statement Paul, Cruz, Lee, and Johnson appeared to be a play for changes that could win their ultimate support.Republicans have a razor-thin majority of 52 seats, and McConnell can lose no more than two votes to pass the bill with a tie-breaker from Vice President Mike Pence. The majority leader will also face difficulty securing support from conservatives who feel the proposal doesn’t go far enough in dismantling Obamacare.https://www.theatlantic.com/politics/archive/2017/06/whats-in-the-senate-republican-health-care-bill/531258/
Mark Levin’s new book, “Rediscovering Americanism,” an assault on the media and progressives and a call for Americans to take back their country, debuts today at No. 1 on Amazon.

Showing the draw of the New York Times bestselling author and top syndicated radio host, his book is already on the way to becoming another big seller.

“My new book covers a lot of territory — philosophy, history, economics, law, culture, etc. And I look deeply into what is meant by Americanism, republicanism, individualism, capitalism. What do we mean by natural law, unalienable rights, liberty, and property rights? From where do these principles come? Why are they important?” he told Secrets.

It follows in the path of his other books and the nation: Liberty and Tyranny: A Conservative Manifesto; Ameritopia: The Unmaking of America; The Liberty Amendments; and Plunder and Deceit.

Secrets reviewed “Rediscovering Americanism”last week and wrote:

In the book, Levin attacks the embrace by the media, politicians, and academia of progressive promises of a “utopia” defined by the end of personal freedom and individuality.

He has a grim name for it: “The Final Outcome.” Levin wrote, “They reject history’s lessons and instead are absorbed with their own conceit and aggrandizement in the relentless pursuit of a diabolical project, the final outcome of which is an oppression of mind and soul.”

Levin added, “the equality they envision but dare not honestly proclaim, is life on the hamster wheel, where one individual is indistinguishable from the next.”

Paul Bedard, the Washington Examiner’s “Washington Secrets” columnist, can be contacted at pbedard@washingtonexaminer.com

http://www.washingtonexaminer.com/mark-levin-book-condemning-media-progressives-debuts-no-1-amazon/article/2627178

Dems face identity crisis

Democrats are grappling with how to keep their progressive base happy while winning over white working-class voters who left the party in the 2016 elections.

Defections by blue-collar voters cost Democrat Hillary Clinton the states of Michigan, Pennsylvania and Wisconsin, all of which went to President Trump. It was the first time since 1988 that a GOP presidential candidate had won Michigan or Pennsylvania, and the first time since 1984 in Wisconsin.

The fallout has created an identity crisis for a Democratic Party seeking to find its way forward in the post-Obama era.

A string of House special election losses culminating in Democrat Jon Ossoff’s disappointing defeat in Georgia last week has only intensified the scrutiny and second-guessing of Democratic strategy, to say nothing of the hand-wringing by party activists craving a victory.

“I’m not convinced we know what the best thing is for the party right now,” said Democratic strategist Jim Manley. “I’m not convinced we have the answers.”

Democrats trying to figure out what they’re doing wrong are focused on how they’ve seemingly lost a significant part of the Democratic base all while failing to turn out enough progressives.

There are different views about what to do across the party, with some questioning whether the white working-class voters can be won back by a party that seems to be tilting leftward with the rise of Sen. Bernie Sanders(I-Vt.) and other liberal voices.

“I’ve spoken to some folks who think we have to only choose one or the other,” said one former senior aide to President Barack Obama. “And after this election cycle, I think there are some who believe there may be some truth to that.”

A lot depends on whether the party can find the right candidate with the right message, particularly in 2020.

“Democrats need a reason for showing up. Give them a reason to believe, and we won’t be having this discussion,” the former Obama aide said.

Democrats say there is a way to appeal to both progressives and white working-class voters.

“Everybody is being too simplistic,” Democratic strategist Jamal Simmons said. “Voters are much more complex.”

Simmons said it’s not a matter of choosing to talk about police violence and climate change or the minimum wage and creating jobs.

Progressives, he said, want Democrats to talk about all of that.

They “want politicians to say something about Black Lives Matter and equality — they also want to know how they’re going to get their kids through college, pay off their house and get a better job,” he said. “The thing that’s most frustrating to me is this either-or dichotomy.”

Obama’s victories in 2008 and 2012 show Democrats can win over both groups, say some Democrats.

“This crisis is Democrats not realizing their own strengths, or being scared of articulating their core principles, rather than a crisis of having no agenda,” said Julian Zelizer, a professor of history and public affairs at Princeton University.

He said a focus on economics, climate change and being anti-Trump would animate the party.

“These are the places that 2018 candidates need to focus on, because they are ways to distinguish themselves from the GOP and its agenda,” he added. “Then they should continue to use Trump as a unifying theme. Often experts downplay this, but Republicans were very effective at using Obama that way.”

In recent days, particularly since the Ossoff loss, Democrats have been doing a lot of finger-pointing.

There’s been a movement to stop blaming the 2016 presidential election loss on Russia. And there have been calls to cut ties with current Democratic leaders like House Minority Leader Nancy Pelosi (D-Calif.). Some of those calls, within the House, come from lawmakers such as Rep. Tim Ryan (D-Ohio), who is worried about losing the white working class.

On the other end of the spectrum, some say Sanders’s bashing of Democrats has only deepened wounds.

“A lot of people are sick of it,” said Manley, a former adviser to then-Senate Majority Leader Harry Reid (D-Nev.). “The mainstream part of the party has had it up to here with what he’s been saying.”

Some Democrats are seeking to build a bridge between the two groups.

In an interview Sunday on ABC’s “This Week,” Senate Minority Leader Charles Schumer (D-N.Y.) said the party will unveil a “strong, bold, sharp-edged and commonsense economic agenda” in the coming weeks.

Addressing both wings of his party, he added, “I’m talking to Bernie Sanders. I’m talking to Joe Manchin. This is going to be really something that Democrats can be proud of, and I’m excited about it.”

Manchin, a Democratic senator from West Virginia, is among the most centrist members of Schumer’s conference.

Michael Tyler, a spokesman for the Democratic National Committee, said Democrats will look to expand their support across the party.

He acknowledged in an email to The Hill that in order to win elections, Democrats “have to focus on broadening and turning out our base and on reaching out to Americans who cast ballots for Donald Trump or didn’t vote at all.”

Tyler said Democrats are in the process of rebuilding a party “from an organization whose mission was solely to elect the president of the United States to one that organizes to elect Democrats up and down the ballot, from school board to Senate.”

But it may not be as easy as that, some strategists say.

Asked how the party rebounds and lures both working-class and progressive Democrats, Manley admitted: “I don’t have the faintest idea in this point in time. I’m still trying to digest what happened.”

http://thehill.com/homenews/campaign/339577-dems-face-identity-crisis

Replacing Obamacare is a make-or-break moment for Republicans

 June 25

Sen. Dean Heller (R-Nev.) threw himself off a political cliff last week when he declared full-throated opposition to the Senate version of the Obamacare repeal bill, and it remains to be seen if Heller is hanging by a limb out of sight and can climb back to electoral sanity or has hit rock bottom in his public career.Individual Senate Republicans face different political realities, but the caucus must somehow get the votes necessary to return the revised Obamacare “repeal and replace” bill to the House. To fail to do so is to condemn not only Heller and Arizona’s Sen. Jeff Flake to certain doom but probably others among the eight GOP senators up for reelection. The grass roots’ disgust with this betrayal will be so deep as to endanger every senator, even in deep red states such as Mississippi, Texas and Utah.The political crosswinds and upheavals in the country are already beyond predicting anything, so to add even more cause for grievance by betraying the central promise of the congressional GOP is beyond irresponsible. It is political insanity. Shut the door to the consultants, and throw out the polling senators. If the GOP defaults on its core promise, it is doomed as a party to minority status, probably as early as 2018 and certainly in 2020.

To fail this week almost certainly forfeits the House majority in next year’s midterm elections but perhaps also the Senate’s, and with the latter, the ability to confirm Supreme Court justices and lower court judges, pass budgets under reconciliation, have any chance at serious tax reform and of course approve the crucial repeal of the Defense Department sequestration.

This is of course an imperative vote on saving American health care. Next year, for example, there potentially will be at least 18 counties in Ohio without even a single option for an individuals seeking coverage. The swaths of America where there is only one provider are large and growing. “Choice for consumers” is a delusion, and soaring deductibles have made health care an illusion to millions more.

Obamacare is a catastrophe on its own terms, but the consequences of not passing its repeal are worse even beyond those awful health-care outcomes. It will forfeit every other Republican goal because failing to deliver on the central promise of eight years of debates and campaigns will shatter the credibility every Republican, not just those who block the bill. The party as a whole will be gravely wounded, perhaps beyond healing for a generation or more.

I don’t have to guess about this. I have been talking to the center-right of the country for three hours a day Monday through Friday for the past 17 years. I know the central argument of the conservative activists everywhere in the United States is that Beltway Republicans cannot be trusted to do anything hard. That argument was dented by the discipline with which the GOP put up with the mainstream media and Democrats’ slings and arrows in the fight over replacing Justice Antonin Scalia. Majority Leader Mitch McConnell (Ky.) rightly calculated that to surrender that hill would be to lose not just a political battle but the political war stretching long into the future. It was that big of a deal to the base.

The same is true of Obamacare. To vote “no” on whatever compromise arrives is to express contempt for the Republican Party as a whole – and its grass-roots activists and base voters — and for those ideas it stands for on all major matters, from a strong defense to low taxes to an originalist Supreme Court.

Thus Heller seemed to declare himself a hollow man when he said he could not vote for it, a man without any core beliefs because with his rambling statement he endangered all alleged core GOP beliefs, and thus the GOP will not support him. It isn’t about primaries; primary opponents need not materialize. It is about millions of conservatives who will simply give up on politics.

This is a make-or-break moment for Senate Republicans and the party itself. Sadly, for this conservative, the tone-deafness of Heller may not be unique. It may not even turn out to be particularly rare. We will know in a week. And not one GOP senator will be able to say he or she wasn’t warned.

https://www.washingtonpost.com/opinions/replacing-obamacare-is-a-make-or-break-moment-for-republicans/2017/06/25/c5f7775a-59c9-11e7-9fc6-c7ef4bc58d13_story.html?utm_term=.602544feab43

Patient Protection and Affordable Care Act

From Wikipedia, the free encyclopedia
Patient Protection and Affordable Care Act
Great Seal of the United States
Long title The Patient Protection and Affordable Care Act
Acronyms(colloquial) PPACA, ACA
Nicknames Affordable Care Act, Health Insurance Reform, Healthcare Reform, Obamacare
Enacted by the 111th United States Congress
Effective March 23, 2010; 7 years ago
Most major provisions phased in by January 2014; remaining provisions phased in by 2020
Citations
Public law 111–148
Statutes at Large 124 Stat.119through 124 Stat.1025(906 pages)
Legislative history
  • Introduced in the Houseasthe “Service Members Home Ownership Tax Act of 2009” (H.R. 3590byCharles Rangel (DNYon September 17, 2009
  • Committee consideration byWays and Means
  • Passed the House on October 8, 2009 (416–0)
  • Passed the Senate as the “Patient Protection and Affordable Care Act” on December 24, 2009 (60–39with amendment
  • House agreed to Senate amendment on March 21, 2010 (219–212)
  • Signed into law by PresidentBarack Obamaon March 23, 2010
Major amendments
Health Care and Education Reconciliation Act of 2010
Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011
United States Supreme Court cases
National Federation of Independent Business v. Sebelius
Burwell v. Hobby Lobby
King v. Burwell

The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) and nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by PresidentBarack Obama on March 23, 2010. Under the act, hospitals and primary physicians would transform their practices financially, technologically, and clinically to drive better health outcomes, lower costs, and improve their methods of distribution and accessibility.

The Affordable Care Act was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage and reduce the costs of healthcare. It introduced mechanisms including mandates, subsidies, and insurance exchanges.[1][2] The law requires insurers to accept all applicants, cover a specific list of conditions and charge the same rates regardless of pre-existing conditions or sex.[3]

The ACA has caused a significant reduction in the number of people without health insurance, with estimates ranging from 20–24 million additional people covered during 2016.[4][5] Increases in overall healthcare spending have slowed since the law was implemented, including premiums for employer-based insurance plans.[6] The Congressional Budget Office reported in several studies that the ACA would reduce the budget deficit, and that repealing it would increase the deficit.[7][8]

As implementation began, first opponents, then others, and finally the president himself adopted the term “Obamacare” to refer to the ACA.[9]

The law and its implementation faced challenges in Congress and federal courts, and from some state governmentsconservativeadvocacy groupslabor unions, and small business organizations. The United States Supreme Court upheld the constitutionality of the ACA’s individual mandate as an exercise of Congress’s taxing power,[10] found that states cannot be forced to participate in the ACA’s Medicaid expansion,[11][12][13] and found that the law’s subsidies to help individuals pay for health insurance are available in all states, not just in those that have set up state exchanges.[14]

Together with the Health Care and Education Reconciliation Act amendment, it represents the U.S. healthcare system‘s most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965.[15][16][17][18]

Provisions

The President and White House Staff react to the House of Representatives passing the bill on March 21, 2010.

The ACA includes provisions to take effect between 2010 and 2020, although most took effect on January 1, 2014. Few areas of the US health care system were left untouched, making it the most sweeping health care reform since the enactment of Medicare and Medicaid in 1965.[15][16][17][19][18] However, some areas were more affected than others. The individual insurance market was radically overhauled, and many of the law’s regulations applied specifically to this market,[15] while the structure of Medicare, Medicaid, and the employer market were largely retained.[16] Most of the coverage gains were made through the expansion of Medicaid,[20] and the biggest cost savings were made in Medicare.[16] Some regulations applied to the employer market, and the law also made delivery system changes that affected most of the health care system.[16] Not all provisions took full effect. Some were made discretionary, some were deferred, and others were repealed before implementation.

Individual insurance

Guaranteed issue prohibits insurers from denying coverage to individuals due to pre-existing conditions. States were required to ensure the availability of insurance for individual children who did not have coverage via their families.

States were required to expand Medicaid eligibility to include individuals and families with incomes up to 133% of the federal poverty level, including adults without disabilities or dependent children.[21] The law provides a 5% “income disregard”, making the effective income eligibility limit for Medicaid 138% of the poverty level.[22]

The State Children’s Health Insurance Program (CHIP) enrollment process was simplified.[21]

Dependents were permitted to remain on their parents’ insurance plan until their 26th birthday, including dependents that no longer live with their parents, are not a dependent on a parent’s tax return, are no longer a student, or are married.[23][24]

Among the groups who remained uninsured were:

  • Illegal immigrants, estimated at around 8 million—or roughly a third of the 23 million projection—are ineligible for insurance subsidies and Medicaid.[25][26] They remain eligible for emergency services.
  • Eligible citizens not enrolled in Medicaid.[27]
  • Citizens who pay the annual penalty instead of purchasing insurance, mostly younger and single.[27]
  • Citizens whose insurance coverage would cost more than 8% of household income and are exempt from the penalty.[27]
  • Citizens who live in states that opt out of the Medicaid expansion and who qualify for neither existing Medicaid coverage nor subsidized coverage through the states’ new insurance exchanges.[28]

Subsidies

Households with incomes between 100% and 400% of the federal poverty level were eligible to receive federal subsidies for policies purchased via an exchange.[29][30] Subsidies are provided as an advanceable, refundable tax credits.[31][32] Additionally, small businesses are eligible for a tax credit provided that they enroll in the SHOP Marketplace.[33] Under the law, workers whose employers offer affordable coverage will not be eligible for subsidies via the exchanges. To be eligible the cost of employer-based health insurance must exceed 9.5% of the worker’s household income.

Subsidies (2014) for Family of 4[34][35][36][37][38]
Income % of federal poverty level Premium Cap as a Share of Income Incomea Max Annual Out-of-Pocket Premium Premium Savingsb Additional Cost-Sharing Subsidy
133% 3% of income $31,900 $992 $10,345 $5,040
150% 4% of income $33,075 $1,323 $9,918 $5,040
200% 6.3% of income $44,100 $2,778 $8,366 $4,000
250% 8.05% of income $55,125 $4,438 $6,597 $1,930
300% 9.5% of income $66,150 $6,284 $4,628 $1,480
350% 9.5% of income $77,175 $7,332 $3,512 $1,480
400% 9.5% of income $88,200 $8,379 $2,395 $1,480
a.^ Note: In 2014, the FPL was $11,800 for a single person and $24,000 for family of four.[39][40] See Subsidy Calculator for specific dollar amount.[41] b.^ DHHS and CBO estimate the average annual premium cost in 2014 would have been $11,328 for a family of 4 without the reform.[36]

Premiums were the same for everyone of a given age, regardless of preexisting conditions. Premiums were allowed to vary by enrollee age, but those for the oldest enrollees (age 45-64 average expenses $5,542) could only be three times as large as those for adults (18-24 $1,836).[42]

Mandates

Individual

The individual mandate[43] is the requirement to buy insurance or pay a penalty for everyone not covered by an employer sponsored health planMedicaidMedicare or other public insurance programs (such as Tricare). Also exempt were those facing a financial hardship or who were members in a recognized religious sect exempted by the Internal Revenue Service.[44]

The mandate and the limits on open enrollment[45][46] were designed to avoid the insurance death spiral in which healthy people delay insuring themselves until they get sick. In such a situation, insurers would have to raise their premiums to cover the relatively sicker and thus more expensive policies,[43][47][48] which could create a vicious cycle in which more and more people drop their coverage.[49]

The purpose of the mandate was to prevent the healthcare system from succumbing to adverse selection, which would result in high premiums for the insured and little coverage (and thus more illness and medical bankruptcy) for the uninsured.[47][50][51] Studies by the CBOGruber and Rand Health concluded that a mandate was required.[52][53][54] The mandate increased the size and diversity of the insured population, including more young and healthy participants to broaden the risk pool, spreading costs.[55] Experience in New Jersey and Massachusetts offered divergent outcomes.[50][53][56]

Business

Businesses that employ 50 or more people but do not offer health insurance to their full-time employees pay a tax penalty if the government has subsidized a full-time employee’s healthcare through tax deductions or other means. This is commonly known as the employer mandate.[57][58] This provision was included to encourage employers to continue providing insurance once the exchanges began operating.[59] Approximately 44% of the population was covered directly or indirectly through an employer.[60][61]

Excise taxes

Excise taxes for the Affordable Care Act raised $16.3 billion in fiscal year 2015 (17% of all excise taxes collected by the Federal Government). $11.3 billion was an excise tax placed directly on health insurers based on their market share. The ACA was going to impose a 40% “Cadillac tax” on expensive employer sponsored health insurance but that was postponed until 2018. Annual excise taxes totaling $3 billion were levied on importers and manufacturers of prescription drugs. An excise tax of 2.3% on medical devices and a 10% excise tax on indoor tanning services were applied as well.[62]

Insurance standards

Essential health benefits

The National Academy of Medicine defined the law’s “essential health benefits” as “ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care”[63][64][65][66][67][68][69] and others[70] rated Level A or B by the U.S. Preventive Services Task Force.[71] In determining what would qualify as an essential benefit, the law required that standard benefits should offer at least that of a “typical employer plan”.[68] States may require additional services.[72]

Contraceptives

One provision in the law mandates that health insurance cover “additional preventive care and screenings” for women.[73] The guidelines issued by the Health Resources and Services Administration to implement this provision mandate “[a]ll Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity”.[74] This mandate applies to all employers and educational institutions except for religious organizations.[75][76] These regulations were included on the recommendations of the Institute of Medicine.[77][78]

Risk management

ACA provided three ways to control risk for insurers in the individual and business markets: temporary reinsurance, temporary risk corridors, and permanent risk adjustment.

Risk corridor program

The risk-corridor program was a temporary risk management device defined under the PPACA section 1342[79]:1 to encourage reluctant insurers into the “new and untested” ACA insurance market during the first three years that ACA was implemented (2014–2016). For those years the Department of Health and Human Services (HHS) “would cover some of the losses for insurers whose plans performed worse than they expected. Insurers that were especially profitable, for their part, would have to return to HHS some of the money they earned on the exchanges”[80][81]

According to an article in Forbes, risk corridors “had been a successful part of the Medicare prescription drug benefit, and the ACA’s risk corridors were modeled after Medicare’s Plan D.”[82] They operated on the principle that “more participation would mean more competition, which would drive down premiums and make health insurance more affordable” and “[w]hen insurers signed up to sell health plans on the exchanges, they did so with the expectation that the risk-corridor program would limit their downside losses.”[80] The risk corridors succeeded in attracting ACA insurers. The program did not pay for itself as planned with “accumulated losses” up to $8.3 billion for 2014 and 2015 alone. Authorization had to be given so that HHS could pay insurers from “general government revenues”. Congressional Republicans “railed against” the program as a ‘bailout’ for insurers. Then-Rep. Jack Kingston (R-Ga.), on the Appropriations Committee that funds the Department of Health and Human Services and the Labor Department “[slipped] in a sentence” — Section 227 — in the “massive” appropriationsConsolidated Appropriations Act, 2014 (H.R. 3547) that said that no funds in the discretionary spending bill “could be used for risk-corridor payments.” This effectively “blocked the administration from obtaining the necessary funds from other programs”[83] and placed Congress in a potential breach of contract with insurers who offered qualified health plans, under the Tucker Act[79] as it did not pay the insurers.[84][84]

On February 10, 2017, in the Moda Health v the US Government, Moda, one of the insurers that struggled financially because of the elimination of the risk corridor program, won a “$214-million judgment against the federal government”. Justice Thomas C. Wheeler stated, “the Government “made a promise in the risk corridors program that it has yet to fulfill. Today, the court directs the Government to fulfill that promise. After all, ‘to say to [Moda], ‘The joke is on you. You shouldn’t have trusted us,’ is hardly worthy of our great government.”[85]

Temporary reinsurance

Temporary reinsurance for insurance for insurers against unexpectedly high claims was a program that ran from 2014 through 2016. It was intended to limit insurer losses.[citation needed]

Risk adjustment

Of the three risk management programs, only risk adjustment was permanent. Risk adjustment attempts to spread risk among insurers to prevent purchasers with good knowledge of their medical needs from using insurance to cover their costs (adverse selection). Plans with low actuarial risk compensate plans with high actuarial risk.[citation needed]

Other provisions

In 2012 Senator Sheldon Whitehouse created this summary to explain his view on the act.

The ACA has several other provisions:

  • Annual and lifetime coverage caps on essential benefits were banned.[86][87]
  • Prohibits insurers from dropping policyholders when they get sick.[88]
  • All health policies sold in the United States must provide an annual maximum out of pocket (MOOP) payment cap for an individual’s or family’s medical expenses (excluding premiums). After the MOOP payment cap is reached, all remaining costs must be paid by the insurer.[89]
  • A partial community rating requires insurers to offer the same premium to all applicants of the same age and location without regard to gender or most pre-existing conditions (excluding tobacco use).[90][91][92] Premiums for older applicants can be no more than three times those for the youngest.[93]
  • Preventive care, vaccinations and medical screenings cannot be subject to co-paymentsco-insurance or deductibles.[94][95][96] Specific examples of covered services include: mammograms and colonoscopies, wellness visits, gestational diabetes screening, HPV testing, STI counseling, HIV screening and counseling, contraceptive methods, breastfeeding support/supplies and domestic violence screening and counseling.[97]
  • The law established four tiers of coverage: bronze, silver, gold and platinum. All categories offer the essential health benefits. The categories vary in their division of premiums and out-of-pocket costs: bronze plans have the lowest monthly premiums and highest out-of-pocket costs, while platinum plans are the reverse.[68][98] The percentages of health care costs that plans are expected to cover through premiums (as opposed to out-of-pocket costs) are, on average: 60% (bronze), 70% (silver), 80% (gold), and 90% (platinum).[99]
  • Insurers are required to implement an appeals process for coverage determination and claims on all new plans.[88]
  • Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued to policyholders if this is violated.[100][101]

Exchanges

Established the creation of health insurance exchanges in all fifty states. The exchanges are regulated, largely online marketplaces, administered by either federal or state government, where individuals and small business can purchase private insurance plans.[102][103][104]

Setting up an exchange gives a state partial discretion on standards and prices of insurance.[105][106] For example, states approve plans for sale, and influence (through limits on and negotiations with private insurers) the prices on offer. They can impose higher or state-specific coverage requirements—including whether plans offered in the state can cover abortion.[107] States without an exchange do not have that discretion. The responsibility for operating their exchanges moves to the federal government.[105]

State waivers

From 2017 onwards, states can apply for a “waiver for state innovation” that allows them to conduct experiments that meet certain criteria.[108] To obtain a waiver, a state must pass legislation setting up an alternative health system that provides insurance at least as comprehensive and as affordable as ACA, covers at least as many residents and does not increase the federal deficit.[109] These states can be exempt from some of ACA’s central requirements, including the individual and employer mandates and the provision of an insurance exchange.[110] The state would receive compensation equal to the aggregate amount of any federal subsidies and tax credits for which its residents and employers would have been eligible under ACA plan, if they cannot be paid under the state plan.[108]

In May 2011, Vermont enacted Green Mountain Care, a state-based single-payer system for which they intended to pursue a waiver to implement.[111][112][113] In December 2014, Vermont decided not to continue due to high expected costs.[114]

Accountable Care Organizations

The Act allowed the creation of Accountable Care Organizations (ACOs), which are groups of doctors, hospitals and other providers that commit to give coordinated, high quality care to Medicare patients. ACOs were allowed to continue using a fee for service billing approach. They receive bonus payments from the government for minimizing costs while achieving quality benchmarks that emphasize prevention and mitigation of chronic disease. If they fail to do so, they are subject to penalties.[115]

Unlike Health Maintenance Organizations, ACO patients are not required to obtain all care from the ACO. Also, unlike HMOs, ACOs must achieve quality of care goals.[115]

Others

Legislative history

President Obama signing the Patient Protection and Affordable Care Act on March 23, 2010

Background

An individual mandate coupled with subsidies for private insurance as a means for universal healthcare was considered the best way to win the support of the Senate because it had been included in prior bipartisan reform proposals. The concept goes back to at least 1989, when the conservativeThe Heritage Foundation proposed an individual mandate as an alternative to single-payer health care.[125] It was championed for a time by conservative economists and Republican senators as a market-based approach to healthcare reform on the basis of individual responsibility and avoidance of free rider problems. Specifically, because the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) requires any hospital participating in Medicare (nearly all do) to provide emergency care to anyone who needs it, the government often indirectly bore the cost of those without the ability to pay.[126][127][128]

President Bill Clintonproposed a healthcare reform bill in 1993 that included a mandate for employers to provide health insurance to all employees through a regulated marketplace of health maintenance organizations. Republican Senators proposed an alternative that would have required individuals, but not employers, to buy insurance.[127]Ultimately the Clinton plan failed amid an unprecedented barrage of negative advertising funded by politically conservative groups and the health insurance industry and due to concerns that it was overly complex.[129] Clinton negotiated a compromise with the 105th Congress to instead enact the State Children’s Health Insurance Program (SCHIP) in 1997.[130]

John Chafee

The 1993 Republican alternative, introduced by Senator John Chafee as the Health Equity and Access Reform Today Act, contained a “universal coverage” requirement with a penalty for noncompliance—an individual mandate—as well as subsidies to be used in state-based ‘purchasing groups’.[131] Advocates for the 1993 bill included prominent Republicans such as Senators Orrin HatchChuck GrassleyBob Bennett and Kit Bond.[132][133] Of 1993’s 43 Republican Senators, 20 supported the HEART Act.[125][134] Another Republican proposal, introduced in 1994 by Senator Don Nickles (R-OK), the Consumer Choice Health Security Act, contained an individual mandate with a penalty provision;[135] however, Nickles subsequently removed the mandate from the bill, stating he had decided “that government should not compel people to buy health insurance”.[136] At the time of these proposals, Republicans did not raise constitutional issues with the mandate; Mark Pauly, who helped develop a proposal that included an individual mandate for George H. W. Bush, remarked, “I don’t remember that being raised at all. The way it was viewed by the Congressional Budget Office in 1994 was, effectively, as a tax.”[125]

Mitt Romney’s Massachusetts went from 90% of its residents insured to 98%, the highest rate in the nation.[137]

In 2006, an insurance expansion bill was enacted at the state level in Massachusetts. The bill contained both an individual mandate and an insurance exchange. Republican Governor Mitt Romney vetoed the mandate, but after Democrats overrode his veto, he signed it into law.[138] Romney’s implementation of the ‘Health Connector’ exchange and individual mandate in Massachusetts was at first lauded by Republicans. During Romney’s 2008 presidential campaign, Senator Jim DeMint praised Romney’s ability to “take some good conservative ideas, like private health insurance, and apply them to the need to have everyone insured”. Romney said of the individual mandate: “I’m proud of what we’ve done. If Massachusetts succeeds in implementing it, then that will be the model for the nation.”[139]

In 2007, a year after the Massachusetts reform, Republican Senator Bob Bennett and Democratic Senator Ron Wyden introduced the Healthy Americans Act, which featured an individual mandate and state-based, regulated insurance markets called “State Health Help Agencies”.[128][139] The bill initially attracted bipartisan support, but died in committee. Many of the sponsors and co-sponsors remained in Congress during the 2008 healthcare debate.[140]

By 2008 many Democrats were considering this approach as the basis for healthcare reform. Experts said that the legislation that eventually emerged from Congress in 2009 and 2010 bore similarities to the 2007 bill[131] and that it was deliberately patterned after Romney’s state healthcare plan.[141]

Healthcare debate, 2008–10

Healthcare reform was a major topic during the 2008 Democratic presidential primaries. As the race narrowed, attention focused on the plans presented by the two leading candidates, Hillary Clinton and the eventual nominee, Barack Obama. Each candidate proposed a plan to cover the approximately 45 million Americans estimated to not have health insurance at some point each year. Clinton’s proposal would have required all Americans to obtain coverage (in effect, an individual mandate), while Obama’s proposal provided a subsidy but rejected the use of an individual mandate.[142][143]

During the general election, Obama said that fixing healthcare would be one of his top four priorities as president.[144] Obama and his opponent, Sen. John McCain, proposed health insurance reforms though they differed greatly. Senator John McCain proposed tax credits for health insurance purchased in the individual market, which was estimated to reduce the number of uninsured people by about 2 million by 2018. Obama proposed private and public group insurance, income-based subsidies, consumer protections, and expansions of Medicaid and SCHIP, which was estimated at the time to reduce the number of uninsured people by 33.9 million by 2018.[145]

President Obama addressing Congress regarding healthcare reform, September 9, 2009

After his inauguration, Obama announced to a joint session of Congress in February 2009 his intent to work with Congress to construct a plan for healthcare reform.[146][147] By July, a series of bills were approved by committees within the House of Representatives.[148] On the Senate side, from June to September, the Senate Finance Committee held a series of 31 meetings to develop a healthcare reform bill. This group — in particular, Democrats Max BaucusJeff Bingaman and Kent Conrad, along with Republicans Mike EnziChuck Grassley and Olympia Snowe— met for more than 60 hours, and the principles that they discussed, in conjunction with the other committees, became the foundation of the Senate healthcare reform bill.[149][150][151]

Congressional Democrats and health policy experts like MIT economics professor Jonathan Gruber[152] and David Cutler argued that guaranteed issue would require both community ratingand an individual mandate to ensure that adverse selection and/or “free riding” would not result in an insurance “death spiral”.[153] This approach was taken because the president and congressional leaders had concluded that more progressive plans, such as the (single-payer)Medicare for All act, could not obtain filibuster-proof support in the Senate. By deliberately drawing on bipartisan ideas — the same basic outline was supported by former Senate majority leaders Howard BakerBob DoleTom Daschle and George J. Mitchell—the bill’s drafters hoped to garner the votes necessary for passage.[154][155]

However, following the adoption of an individual mandate, Republicans came to oppose the mandate and threatened to filibuster any bills that contained it.[125] Senate minority leader Mitch McConnell, who led the Republican congressional strategy in responding to the bill, calculated that Republicans should not support the bill, and worked to prevent defections:[156]

It was absolutely critical that everybody be together because if the proponents of the bill were able to say it was bipartisan, it tended to convey to the public that this is O.K., they must have figured it out.[157]

Republican Senators, including those who had supported previous bills with a similar mandate, began to describe the mandate as “unconstitutional”. Journalist Ezra Klein wrote in The New Yorker that “a policy that once enjoyed broad support within the Republican Party suddenly faced unified opposition.”[128] Reporter Michael Cooper of The New York Times wrote that: “the provision … requiring all Americans to buy health insurance has its roots in conservative thinking.”[127][134]

Tea Party protesters at the Taxpayer March on Washington, September 12, 2009

The reform negotiations also attracted attention from lobbyists,[158] including deals between certain lobby groups and the advocates of the law to win the support of groups that had opposed past reforms, as in 1993.[159][160] The Sunlight Foundation documented many of the reported ties between “the healthcare lobbyist complex” and politicians in both parties.[161]

During the August 2009 summer congressional recess, many members went back to their districts and held town hall meetings on the proposals. The nascent Tea Party movement organized protests and many conservative groups and individuals attended the meetings to oppose the proposed reforms.[147] Many threats were made against members of Congress over the course of the debate.[162][163]

When Congress returned from recess, in September 2009 President Obama delivered a speech to a joint session of Congress supporting the ongoing Congressional negotiations.[164] He acknowledged the polarization of the debate, and quoted a letter from the late Senator Edward “Ted” Kennedy urging on reform: “what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”[165] On November 7, the House of Representatives passed the Affordable Health Care for America Act on a 220–215 vote and forwarded it to the Senate for passage.[147]

Senate

The Senate began work on its own proposals while the House was still working. The United States Constitution requires all revenue-related bills to originate in the House.[166] To formally comply with this requirement, the Senate used H.R. 3590, a bill regarding housing tax changes for service members.[167] It had been passed by the House as a revenue-related modification to the Internal Revenue Code. The bill became the Senate’s vehicle for its healthcare reform proposal, discarding the bill’s original content.[168] The bill ultimately incorporated elements of proposals that were reported favorably by the Senate Health and Financecommittees. With the Republican Senate minority vowing to filibuster, 60 votes would be necessary to pass the Senate.[169] At the start of the 111th Congress, Democrats had only 58 votes; the Senate seat in Minnesota ultimately won by Al Franken was still undergoing a recount, while Arlen Specter was still a Republican (he became a Democrat in April, 2009).

Negotiations were undertaken attempting to satisfy moderate Democrats and to bring Republican senators aboard; particular attention was given to Republicans Bennett, Enzi, Grassley and Snowe. On July 7 Franken was sworn into office, providing a potential 60th vote. On August 25 Ted Kennedy—a longtime healthcare reform advocate—died. Paul Kirk was appointed as Senator Kennedy’s temporary replacement on September 24.

After the Finance Committee vote on October 15, negotiations turned to moderate Democrats. Majority leaderHarry Reid focused on satisfying centrists. The holdouts came down to Joe Lieberman of Connecticut, an independent who caucused with Democrats, and conservative Nebraska Democrat Ben Nelson. Lieberman’s demand that the bill not include a public option[153][170] was met,[171] although supporters won various concessions, including allowing state-based public options such as Vermont’s Green Mountain Care.[171][172]

Senate vote by state.

  Democratic yes (58)
  Independent yes (2)
  Republican no (39)
 Republican not voting (1)

The White House and Reid addressed Nelson’s concerns[173] during a 13-hour negotiation with two concessions: a compromise on abortion, modifying the language of the bill “to give states the right to prohibit coverage of abortion within their own insurance exchanges”, which would require consumers to pay for the procedure out of pocket if the state so decided; and an amendment to offer a higher rate of Medicaid reimbursement for Nebraska.[147][174] The latter half of the compromise was derisively termed the “Cornhusker Kickback”[175] and was repealed in the subsequent reconciliation amendment bill.

On December 23, the Senate voted 60–39 to end debate on the bill: a cloture vote to end the filibuster. The bill then passed, also 60–39, on December 24, 2009, with all Democrats and two independents voting for it, and all Republicans against (except Jim Bunning, who did not vote).[176] The bill was endorsed by the AMA and AARP.[177]

On January 19, 2010, Massachusetts Republican Scott Brown was elected to the Senate in a special election to replace Kennedy, having campaigned on giving the Republican minority the 41st vote needed to sustain Republican filibusters.[147][178][179] His victory had become significant because of its effects on the legislative process. The first was psychological: the symbolic importance of losing Kennedy’s traditionally Democratic Massachusetts seat made many Congressional Democrats concerned about the political cost of passing a bill.[180][181]

House

House vote by congressional district.

  Democratic yes (219)
  Democratic no (34)
  Republican no (178)
  No representative seated (4)

Brown’s election meant Democrats could no longer break a filibuster in the Senate. In response, White House Chief of StaffRahm Emanuel argued that Democrats should scale back to a less ambitious bill; House SpeakerNancy Pelosi pushed back, dismissing Emanuel’s scaled-down approach as “Kiddie Care”.[182][183]

Obama remained insistent on comprehensive reform. The news that Anthem Blue Cross in California intended to raise premium rates for its patients by as much as 39% gave him new evidence of the need for reform.[182][183] On February 22, he laid out a “Senate-leaning” proposal to consolidate the bills.[184] He held a meeting with both parties’ leaders on February 25. The Democrats decided that the House would pass the Senate’s bill, to avoid another Senate vote.

House Democrats had expected to be able to negotiate changes in a House-Senate conference before passing a final bill. Since any bill that emerged from conference that differed from the Senate bill would have to pass the Senate over another Republican filibuster, most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.[181] They drafted the Health Care and Education Reconciliation Act, which could be passed by the reconciliation process.[182][185][186]

As per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. But reconciliation is limited to budget changes, which is why the procedure was not used to pass ACA in the first place; the bill had inherently non-budgetary regulations.[187][188] Although the already-passed Senate bill could not have been passed by reconciliation, most of House Democrats’ demands were budgetary: “these changes—higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal—mainly involve taxes and spending. In other words, they’re exactly the kinds of policies that are well-suited for reconciliation.”[185]

Jim Clyburn and Nancy Pelosi celebrating after the House passes the amended bill on March 21

The remaining obstacle was a pivotal group of pro-life Democrats led by Bart Stupak who were initially reluctant to support the bill. The group found the possibility of federal funding for abortion significant enough to warrant opposition. The Senate bill had not included language that satisfied their concerns, but they could not address abortion in the reconciliation bill as it would be non-budgetary. Instead, Obama issued Executive Order 13535, reaffirming the principles in the Hyde Amendment.[189] This won the support of Stupak and members of his group and assured the bill’s passage.[186][190] The House passed the Senate bill with a 219–212 vote on March 21, 2010, with 34 Democrats and all 178 Republicans voting against it.[191] The next day, Republicans introduced legislation to repeal the bill.[192] Obama signed ACA into law on March 23, 2010.[193] Since passage, Republicans have voted to repeal all or parts of the Affordable Care Act over sixty times; no such attempt by Republicans has been successful.[194] The amendment bill, The Health Care and Education Reconciliation Act, cleared the House on March 21; the Senate passed it by reconciliation on March 25, and Obama signed it on March 30.

Impact

Coverage rate, employer market cost trends, budgetary impact, and income inequality aspects of the Affordable Care Act.

This chart illustrates several aspects of the Affordable Care Act, including number of persons covered, cost before and after subsidies, and public opinion.

Coverage

Affordable Care Act (ObamaCare). County By County Projected Insurer Participation in Health Insurance Exchanges.

The law has caused a significant reduction in the number and percentage of people without health insurance. The CDC reported that the percentage of people without health insurance fell from 16.0% in 2010 to 8.9% during the January–June 2016 period.[195] The uninsured rate dropped in every congressional district in the U.S. between 2013 and 2015.[196] The Congressional Budget Office reported in March 2016 that there were approximately 12 million people covered by the exchanges (10 million of whom received subsidies to help pay for insurance) and 11 million made eligible for Medicaid by the law, a subtotal of 23 million people. An additional 1 million were covered by the ACA’s “Basic Health Program,” for a total of 24 million.[4] CBO also estimated that the ACA would reduce the net number of uninsured by 22 million in 2016, using a slightly different computation for the above figures totaling ACA coverage of 26 million, less 4 million for reductions in “employment-based coverage” and “non-group and other coverage.”[4]

The Department of Health and Human Services (HHS) estimated that 20.0 million adults (aged 18–64) gained healthcare coverage via ACA as of February 2016, a 2.4 million increase over September 2015. HHS estimated that this 20.0 million included: a) 17.7 million from the start of open enrollment in 2013-2016; and b) 2.3 million young adults aged 19–25 who initially gained insurance from 2010-2013, as they were allowed to remain on their parent’s plans until age 26. Of the 20.0 million, an estimated 6.1 million were aged 19–25.[5] Similarly, the Urban Institute issued a report in in December 2016 that said that about 19.2 million non-elderly Americans had gained health insurance coverage from 2010 to 2015.[197] In March 2016, the CBO reported that there were approximately 27 million people without insurance in 2016, a figure they expected would range from 26-28 million through 2026. CBO also estimated the percentage of insured among all U.S. residents would remain at 90% through that period, 92-93% excluding unauthorized immigrants.[4]

Those states that expanded Medicaid had a 7.3% uninsured rate on average in the first quarter of 2016, while those that did not expand Medicaid had a 14.1% uninsured rate, among adults aged 18 to 64.[198] As of December 2016 there were 32 states (including Washington DC) that had adopted the Medicaid extension, while 19 states had not.[199]

By 2017, nearly 70% of those on the exchanges could purchase insurance for less than $75/month after subsidies, which rose to offset significant pre-subsidy price increases in the exchange markets.[200] Healthcare premium cost increases in the employer market continued to moderate. For example, healthcare premiums for those covered by employers rose by 69% from 2000-2005, but only 27% from 2010 to 2015,[6] with only a 3% increase from 2015 to 2016.[201]

The ACA also helps reduce income inequality measured after taxes, due to higher taxes on the top 5% of income earners and both subsidies and Medicaid expansion for lower-income persons.[202] CBO estimated that subsidies paid under the law in 2016 averaged $4,240 per person for 10 million individuals receiving them, roughly $42 billion. For scale, the subsidy for the employer market, in the form of exempting from taxation those health insurance premiums paid on behalf of employees by employers, was approximately $1,700 per person in 2016, or $266 billion total in the employer market. The employer market subsidy was not changed by the law.[4]

Insurance exchanges

As of August 2016, 15 states operated their own exchanges. Other states either used the federal exchange, or operated in partnership with or supported by the federal government.[203]

Medicaid expansion

Medicaid expansion by state, as of September 1, 2015.[204]

  Adopted the Medicaid expansion
  Medicaid expansion under discussion
  Not adopting Medicaid expansion

As of December 2016 there were 32 states (including Washington DC) that had adopted the Medicaid extension, while 19 states had not.[199] Those states that expanded Medicaid had a 7.3% uninsured rate on average in the first quarter of 2016, while those that did not expand Medicaid had a 14.1% uninsured rate, among adults aged 18 to 64.[198] Following the Supreme Court ruling in 2012, which held that states would not lose Medicaid funding if they didn’t expand Medicaid under the ACA, several states rejected expanded Medicaid coverage. Over half of the national uninsured population lived in those states.[205] In a report to Congress, the Centers for Medicare and Medicaid Services (CMS) estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 million to 10 million people had gained Medicaid coverage, mostly low-income adults.[206] The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered because of states that rejected the Medicaid expansion.[207]

States that rejected the Medicaid expansion could maintain their Medicaid eligibility thresholds, which in many states were significantly below 133% of the poverty line.[208] Many states did not make Medicaid available to childless adults at any income level.[209] Because subsidies on exchange insurance plans were not available to those below the poverty line, such individuals had no new options.[210][211] For example, in Kansas, where only able-bodied adults with children and with an income below 32% of the poverty line were eligible for Medicaid, those with incomes from 32% to 100% of the poverty level ($6,250 to $19,530 for a family of three) were ineligible for both Medicaid and federal subsidies to buy insurance. Absent children, able-bodied adults were not eligible for Medicaid in Kansas.[205]

Studies of the impact of state decisions to reject the Medicaid expansion calculated that up to 6.4 million people could fall into this status.[212] The federal government initially paid for 100% of the expansion (through 2016). The subsidy tapered to 90% by 2020 and continued to shrink thereafter.[213] Several states argued that they could not afford their 10% contribution.[213][214] Studies suggested that rejecting the expansion would cost more than expanding Medicaid due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage,[215]

A 2016 study led by Harvard University health economics professor Benjamin Sommers found that residents of Kentucky and Arkansas, which both accepted the Medicaid expansion, were more likely to receive health care services and less likely to incur emergency room costs or have trouble paying their medical bills than before the expansion. Residents of Texas, which did not accept the Medicaid expansion, did not see a similar improvement during the same period.[216] Kentucky opted for increased managed care, while Arkansas subsidized private insurance. The new Arkansas and Kentucky governors have proposed reducing or modifying their programs. Between 2013 and 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with 39% to 32% in Texas. Specific improvements included additional primary and preventive care, fewer emergency departments visits, reported higher quality care, improved health, improved drug affordability, reduced out-of-pocket spending and increased outpatient visits, increased diabetes screening, glucose testing among diabetes patients and regular care for chronic conditions.[217]

A 2016 DHHS study found that states that expanded Medicaid had lower premiums on exchange policies, because they had fewer low-income enrollees, whose health on is worse than that of those with higher income.[218]

Healthcare insurance costs

U.S. healthcare cost information, including rate of change, per-capita, and percent of GDP. (Data source: Centers for Medicare and Medicaid Services[219])

The law is designed to pay subsidies in the form of tax credits to the individuals or families purchasing the insurance, based on income levels. Higher income consumers receive lower subsidies. While pre-subsidy prices rose considerably from 2016 to 2017, so did the subsidies, to reduce the after-subsidy cost to the consumer. For example, a study published in 2016 found that the average requested 2017 premium increase among 40-year-old non-smokers was about 9 percent, according to an analysis of 17 cities, although Blue Cross Blue Shield proposed increases of 40 percent in Alabama and 60 percent in Texas.[220] However, some or all of these costs are offset by subsidies, paid as tax credits. For example, the Kaiser Foundation reported that for the second-lowest cost “Silver plan” (a plan often selected and used as the benchmark for determining financial assistance), a 40-year old non-smoker making $30,000 per year would pay effectively the same amount in 2017 as they did in 2016 (about $208/month) after the subsidy/tax credit, despite large increases in the pre-subsidy price. This was consistent nationally. In other words, the subsidies increased along with the pre-subsidy price, fully offsetting the price increases.[221]

Healthcare premium cost increases in the employer market continued to moderate after the implementation of the law. For example, healthcare premiums for those covered by employers rose by 69% from 2000-2005, but only 27% from 2010 to 2015,[6] with only a 3% increase from 2015 to 2016.[201] From 2008-2010 (before passage of the ACA) health insurance premiums rose by an average of 10% per year.[222]

Several studies found that the financial crisis and accompanying recession could not account for the entirety of the slowdown and that structural changes likely share at least partial credit.[223][224][225][226] A 2013 study estimated that changes to the health system had been responsible for about a quarter of the recent reduction in inflation.[227] Paul Krawzak claimed that even if cost controls succeed in reducing the amount spent on healthcare, such efforts on their own may be insufficient to outweigh the long-term burden placed by demographic changes, particularly the growth of the population on Medicare.[228]

In a 2016 review of the ACA published in JAMA, Barack Obama himself wrote that from 2010 through 2014 mean annual growth in real per-enrollee Medicare spending was negative, down from a mean of 4.7% per year from 2000 through 2005 and 2.4% per year from 2006 to 2010; similarly, mean real per-enrollee growth in private insurance spending was 1.1% per year over the period, compared with a mean of 6.5% from 2000 through 2005 and 3.4% from 2005 to 2010.[229]

Effect on deductibles and co-payments

While health insurance premium costs have moderated, some of this is because of insurance policies that have a higher deductibleco-payments and out-of-pocket maximums that shift costs from insurers to patients. In addition, many employees are choosing to combine a health savings account with higher deductible plans, making the impact of the ACA difficult to determine precisely.

For those who obtain their insurance through their employer (“group market”), a 2016 survey found that:

  • Deductibles grew by 63% from 2011 to 2016, while premiums increased 19% and worker earnings grew by 11%.
  • In 2016, 4 in 5 workers had an insurance deductible, which averaged $1,478. For firms with less than 200 employees, the deductible averaged $2,069.
  • The percentage of workers with a deductible of at least $1,000 grew from 10% in 2006 to 51% in 2016. The 2016 figure drops to 38% after taking employer contributions into account.[230]

For the “non-group” market, of which two-thirds are covered by the ACA exchanges, a survey of 2015 data found that:

  • 49% had individual deductibles of at least $1,500 ($3,000 for family), up from 36% in 2014.
  • Many marketplace enrollees qualify for cost-sharing subsidies that reduce their net deductible.
  • While about 75% of enrollees were “very satisfied” or “somewhat satisfied” with their choice of doctors and hospitals, only 50% had such satisfaction with their annual deductible.
  • While 52% of those covered by the ACA exchanges felt “well protected” by their insurance, in the group market 63% felt that way.[231]

Health outcomes

Insurance coverage helps save lives, by encouraging early detection and prevention of dangerous medical conditions. According to a 2014 study, the ACA likely prevented an estimated 50,000 preventable patient deaths from 2010 to 2013.[232]City University public health professors David Himmelstein and Steffie Woolhandler wrote in January 2017 that a rollback of the ACA’s Medicaid expansion alone would cause an estimated 43,956 deaths annually.[233]

Federal deficit

CBO estimates of revenue and impact on deficit

The CBO reported in several studies that the ACA would reduce the deficit, and that repealing it would increase the deficit.[7][8][234][235] The 2011 comprehensive CBO estimate projected a net deficit reduction of more than $200 billion during the 2012–2021 period:[8][236] it calculated the law would result in $604 billion in total outlays offset by $813 billion in total receipts, resulting in a $210 billion net deficit reduction.[8] The CBO separately predicted that while most of the spending provisions do not begin until 2014,[237][238] revenue would exceed spending in those subsequent years.[239] The CBO claimed that the bill would “substantially reduce the growth of Medicare’s payment rates for most services; impose an excise tax on insurance plans with relatively high premiums; and make various other changes to the federal tax code, Medicare, Medicaid, and other programs”[240]—ultimately extending the solvency of the Medicare trust fund by 8 years.[241]

This estimate was made prior to the Supreme Court’s ruling that enabled states to opt out of the Medicaid expansion, thereby forgoing the related federal funding. The CBO and JCT subsequently updated the budget projection, estimating the impact of the ruling would reduce the cost estimate of the insurance coverage provisions by $84 billion.[242][243][244]

The CBO in June 2015 forecasted that repeal of ACA would increase the deficit between $137 billion and $353 billion over the 2016–2025 period, depending on the impact of macroeconomic feedback effects. The CBO also forecasted that repeal of ACA would likely cause an increase in GDP by an average of 0.7% in the period from 2021 to 2015, mainly by boosting the supply of labor.[7]

Major new sources of increased tax receipts include:[95] higher Medicare taxes; annual fees on insurance providers; fees on the healthcare industry such as manufacturers and importers of brand-name pharmaceutical drugs and certain medical devices; limits on tax deductions of medical expenses and flexible spending accounts; a 40% excise tax on plans with annual insurance premiums in excess of $10,200 for an individual or $27,500 for a family; revenue from mandate penalty payments; a 10% federal sales tax on indoor tanning services. Predicted spending reductions included a reduction in Medicare reimbursements to insurers and drug companies for private Medicare Advantagepolicies that the Government Accountability Office and Medicare Payment Advisory Commission found to be excessively costly relative to government Medicare;[245][246] and reductions in Medicare reimbursements to hospitals that failed standards of efficiency and care.[245]

Although the CBO generally does not provide cost estimates beyond the 10-year budget projection period because of the degree of uncertainty involved in the projection, it decided to do so in this case at the request of lawmakers, and estimated a second decade deficit reduction of $1.2 trillion.[240][247] CBO predicted deficit reduction around a broad range of one-half percent of GDP over the 2020s while cautioning that “a wide range of changes could occur”.[248]

Opinions on CBO projections

The CBO cost estimates were criticized because they excluded the effects of potential legislation that would increase Medicare payments by more than $200 billion from 2010 to 2019.[249][250][251] However, the so-called “doc fix” is a separate issue that would have existed whether or not ACA became law – omitting its cost from ACA was no different from omitting the cost of other tax cuts.[252][253][254]

Uwe Reinhardt, a Princeton health economist, wrote. “The rigid, artificial rules under which the Congressional Budget Office must score proposed legislation unfortunately cannot produce the best unbiased forecasts of the likely fiscal impact of any legislation”, but went on to say “But even if the budget office errs significantly in its conclusion that the bill would actually help reduce the future federal deficit, I doubt that the financing of this bill will be anywhere near as fiscally irresponsible as was the financing of the Medicare Modernization Act of 2003.”[255]Douglas Holtz-Eakin, CBO director during the George W. Bush administration, who later served as the chief economic policy adviser to U.S. Senator John McCain‘s 2008 presidential campaign, alleged that the bill would increase the deficit by $562 billion because, he argued, it front-loaded revenue and back-loaded benefits.[256]

Scheiber and Cohn rejected critical assessments of the law’s deficit impact, arguing that predictions were biased towards underestimating deficit reduction. They noted that for example, it is easier to account for the cost of definite levels of subsidies to specified numbers of people than account for savings from preventive healthcare, and that the CBO had a track record of overestimating costs and underestimating savings of health legislation;[257][258] stating, “innovations in the delivery of medical care, like greater use of electronic medical records[259] and financial incentives for more coordination of care among doctors, would produce substantial savings while also slowing the relentless climb of medical expenses… But the CBO would not consider such savings in its calculations, because the innovations hadn’t really been tried on such large scale or in concert with one another—and that meant there wasn’t much hard data to prove the savings would materialize.”[257]

In 2010 David Walker, former U.S. Comptroller General then working for The Peter G. Peterson Foundation, stated that the CBO estimates are not likely to be accurate, because they were based on the assumption that the law would not change.[260] The Center on Budget and Policy Priorities objected that Congress had a good record of implementing Medicare savings. According to their study, Congress followed through on the implementation of the vast majority of provisions enacted in the past 20 years to produce Medicare savings, although not the payment reductions addressed by the annual “doc fix”.[261][262]

Economic consequences

CBO estimated in June 2015 that repealing the ACA would:

  • Decrease aggregate demand (GDP) in the short-term, as low-income persons who tend to spend a large fraction of their additional resources would have fewer resources (e.g., ACA subsidies would be eliminated). This effect would be offset in the long-run by the labor supply factors below.
  • Increase the supply of labor and aggregate compensation by about 0.8 and 0.9 percent over the 2021-2025 period. CBO cited the ACA’s expanded eligibility for Medicaid and subsidies and tax credits that rise with income as disincentives to work, so repealing the ACA would remove those disincentives, encouraging workers to supply more hours of labor.
  • Increase the total number of hours worked by about 1.5% over the 2021-2025 period.
  • Remove the higher tax rates on capital income, thereby encouraging additional investment, raising the capital stock and output in the long-run.[7]

In 2015 the Center for Economic and Policy Research found no evidence that companies were reducing worker hours to avoid ACA requirements[263] for employees working over 30 hours per week.[264]

The CBO estimated that the ACA would slightly reduce the size of the labor force and number of hours worked, as some would no longer be tethered to employers for their insurance. Cohn, citing CBO’s projections, claimed that ACA’s primary employment effect was to alleviate job lock: “People who are only working because they desperately need employer-sponsored health insurance will no longer do so.”[265] He concluded that the “reform’s only significant employment impact was a reduction in the labor force, primarily because people holding onto jobs just to keep insurance could finally retire”, because they have health insurance outside of their jobs.[266]

Employer mandate and part-time work

The employer mandate requires employers meeting certain criteria to provide health insurance to their workers. The mandate applies to employers with more than 50 employees that do not offer health insurance to their full-time workers.[267] Critics claimed that the mandate created a perverse incentive for business to keep their full-time headcount below 50 and to hire part-time workers instead.[268][269] Between March 2010 and 2014 the number of part-time jobs declined by 230,000, while the number of full-time jobs increased by 2 million.[270][271] In the public sector full-time jobs turned into part-time jobs much more than in the private sector.[270][272] A 2016 study found only limited evidence that ACA had increased part-time employment.[273]

Several businesses and the state of Virginia added a 29-hour-a-week cap for their part-time employees,[274][unreliable source?][275][unreliable source?] to reflect the 30-hour-or-more definition for full-time worker.[267] As of yet, however, only a small percent of companies have shifted their workforce towards more part-time hours (4% in a survey from the Federal Reserve Bank of Minneapolis).[269] Trends in working hours[276] and the effects of the Great Recessioncorrelate with part-time working hour patterns.[277][278] The impact of this provision may have been offset by other factors, including that health insurance helps attract and retain employees, increases productivity and reduces absenteeism; and the lower training and administration costs of a smaller full-time workforce over a larger part-time work force.[269][276][279] Relatively few firms employ over 50 employees[269] and more than 90% of them offered insurance.[280] Workers without employer insurance could purchase insurance on the exchanges.[281]

Most policy analysts (on both right and left) were critical of the employer mandate provision.[268][280] They argued that the perverse incentives regarding part-time hours, even if they did not change existing plans, were real and harmful;[282][283] that the raised marginal cost of the 50th worker for businesses could limit companies’ growth;[284] that the costs of reporting and administration were not worth the costs of maintaining employer plans;[282][283] and noted that the employer mandate was not essential to maintain adequate risk pools.[285][286] The effects of the provision generated vocal opposition from business interests and some unions not granted exemptions.[283][287]

A 2013/4 survey by the National Association for Business Economics found that about 75 percent of those surveyed said ACA hadn’t influenced their planning or expectations for 2014, and 85 percent said the law wouldn’t prompt a change in their hiring practices. Some 21 percent of 64 businesses surveyed said that the act would have a harmful effect and 5 percent said it would be beneficial.[288]

Hospitals

From the start of 2010 to November 2014, 43 hospitals in rural areas closed. Critics claimed that the new law caused these hospitals to close. Many of these rural hospitals were built using funds from the 1946 Hill–Burton Act, to increase access to medical care in rural areas. Some of these hospitals reopened as other medical facilities, but only a small number operated emergency rooms (ER) or urgent care centers.[289]

Between January 2010 and 2015, a quarter of emergency room doctors said they had seen a major surge in patients, while nearly half had seen a smaller increase. Seven in ten ER doctors claimed that they lacked the resources to deal with large increases in the number of patients. The biggest factor in the increased number of ER patients was insufficient primary care providers to handle the larger number of insured patients.[290]

Insurers claimed that because they have access to and collect patient data that allow evaluations of interventions, they are essential to ACO success. Large insurers formed their own ACOs. Many hospitals merged and purchased physician practices. The increased market share gave them more leverage in negotiations with insurers over costs and reduced patient care options.[115]

Public opinion

Prior to the law’s passage, polling indicated the public’s views became increasingly negative in reaction to specific plans discussed during the legislative debate over 2009 and 2010. Polling statistics showed a general negative opinion of the law; with those in favor at approximately 40% and those against at 51%, as of October 2013.[291][292] About 29% of whites approve of the law, compared with 61% of Hispanics and 91% of African Americans.[293]Opinions were divided by age of the person at the law’s inception, with a solid majority of seniors opposing the bill and a solid majority of those younger than forty years old in favor.[294]

Congressional Democrats celebrating the 6th anniversary of the Affordable Care Act in March 2016 on the steps of the U.S. Capitol.

Congressional Democrats celebrating the 6th anniversary of the Affordable Care Act in March 2016 on the steps of the U.S. Capitol.

Specific elements were popular across the political spectrum, while others, such as the mandate to purchase insurance, were widely disliked. In a 2012 poll 44% supported the law, with 56% against. By party affiliation, 75% of Democrats, 27% of Independents and 14% of Republicans favored the law overall. 82% favored banning insurance companies from denying coverage to people with pre-existing conditions, 61% favored allowing children to stay on their parents’ insurance until age 26, 72% supported requiring companies with more than 50 employees to provide insurance for their employees, and 39% supported the individual mandate to own insurance or pay a penalty. By party affiliation, 19% of Republicans, 27% of Independents, and 59% of Democrats favored the mandate.[295] Other polls showed additional provisions receiving majority support, including the creation of insurance exchanges, pooling small businesses and the uninsured with other consumers so that more people can take advantage of large group pricing benefits and providing subsidies to individuals and families to make health insurance more affordable.[296][297]

In a 2010 poll, 62% of respondents said they thought ACA would “increase the amount of money they personally spend on health care”, 56% said the bill “gives the government too much involvement in health care”, and 19% said they thought they and their families would be better off with the legislation.[298] Other polls found that people were concerned that the law would cost more than projected and would not do enough to control costs.[299]

Some opponents believed that the reform did not go far enough: a 2012 poll indicated that 71% of Republican opponents rejected it overall, while 29% believed it did not go far enough; independent opponents were divided 67% to 33%; and among the much smaller group of Democratic opponents, 49% rejected it overall and 51% wanted more.[295] In June 2013, a majority of the public (52–34%) indicated a desire for “Congress to implement or tinker with the law rather than repeal it”.[300] After the Supreme Court upheld the individual mandate, a 2012 poll held that “most Americans (56%) want to see critics of President Obama’s health care law drop efforts to block it and move on to other national issues”.[301]A 2014 poll reported that 48.9% of respondents had an unfavorable view of ACA vs. 38.3% who had a favorable view (of more than 5,500 individuals).[302]

A 2014 poll reported that 26% of Americans support ACA.[303] Another held that 8% of respondents say that the Affordable Care Act “is working well the way it is”.[304] In late 2014, a Rasmussen poll reported Repeal: 30%, Leave as is: 13%, Improve: 52%.[305]

In 2015, a CBS News / New York Times poll reported that 47% of Americans approved the health care law. This was the first time that a major poll indicated that more respondents approved ACA than disapproved of it.[306] The recurring Kaiser Health Tracking Poll from December 2016 reported that: a) 30% wanted to expand what the law does; b) 26% wanted to repeal the entire law; c) 19% wanted to move forward with implementing the law as it is; and d) 17% wanted to scale back what the law does, with the remainder undecided.[307]

Separate polls from Fox News and NBC/WSJ both taken during January 2017 indicated more people viewed the law favorably than did not for the first time. One of the reasons for the improving popularity of the law is that Democrats who opposed it in the past (many prefer a “Medicare for All” approach) have shifted their positions since the ACA is under threat of repeal.[308]

A January 2017 Morning Consult poll showed that 35% of respondents either believed that “Obamacare” and the “Affordable Care Act” were different or did not know.[309] Approximately 45% were unsure whether the “repeal of Obamacare” also meant the “repeal of the Affordable Care Act.”[309] 39% did not know that “many people would lose coverage through Medicaid or subsidies for private health insurance if the A.C.A. were repealed and no replacement enacted,” with Democrats far more likely (79%) to know that fact than Republicans (47%).[309]

A 2017 study found that personal experience with public health insurance programs leads to greater support for the Affordable Care Act, and the effects appear to be most pronounced among Republicans and low-information voters.[310]

Political aspects

“Obamacare”

The term “Obamacare” was originally coined by opponents as a pejorative. The term emerged in March 2007 when healthcare lobbyist Jeanne Schulte Scott used it in a health industry journal, writing “We will soon see a ‘Giuliani-care’ and ‘Obama-care’ to go along with ‘McCain-care’, ‘Edwards-care’, and a totally revamped and remodeled ‘Hillary-care‘ from the 1990s”.[9][311] According to research by Elspeth Reeve, the expression was used in early 2007, generally by writers describing the candidate’s proposal for expanding coverage for the uninsured.[312] It first appeared in a political campaign by Mitt Romney in May 2007 in Des Moines, Iowa. Romney said, “In my state, I worked on healthcare for some time. We had half a million people without insurance, and I said, ‘How can we get those people insured without raising taxes and without having government take over healthcare?’ And let me tell you, if we don’t do it, the Democrats will. If the Democrats do it, it will be socialized medicine; it’ll be government-managed care. It’ll be what’s known as Hillarycare or Barack Obamacare, or whatever you want to call it.”[9]

By mid-2012, Obamacare had become the colloquial term used by both supporters and opponents. In contrast, the use of “Patient Protection and Affordable Care Act” or “Affordable Care Act” became limited to more formal and official use.[312] Use of the term in a positive sense was suggested by Democrat John Conyers.[313] Obama endorsed the nickname, saying, “I have no problem with people saying Obama cares. I do care.”[314]

In March 2012, the Obama reelection campaign embraced the term “Obamacare”, urging Obama’s supporters to post Twitter messages that begin, “I like #Obamacare because…”.[315]

In October 2013 the Associated Press and NPR began cutting back on use of the term.[316] Stuart Seidel, NPR’s managing editor, said that the term “seems to be straddling somewhere between being a politically-charged term and an accepted part of the vernacular”.[317]

Common misconceptions

“Death panels”

On August 7, 2009, Sarah Palin pioneered the term “death panels” to describe groups that would decide whether sick patients were “worthy” of medical care.[318] “Death panel” referred to two claims about early drafts.

One was that under the law, seniors could be denied care due to their age[319] and the other that the government would advise seniors to end their lives instead of receiving care. The ostensible basis of these claims was the provision for an Independent Payment Advisory Board (IPAB).[320] IPAB was given the authority to recommend cost-saving changes to Medicare by facilitating the adoption of cost-effective treatments and cost-recovering measures when the statutory levels set for Medicare were exceeded within any given 3-year period. In fact, the Board was prohibited from recommending changes that would reduce payments to certain providers before 2020, and was prohibited from recommending changes in premiums, benefits, eligibility and taxes, or other changes that would result in rationing.[321][322]

The other related issue concerned advance-care planning consultation: a section of the House reform proposal would have reimbursed physicians for providing patient-requested consultations for Medicare recipients on end-of-life health planning (which is covered by many private plans), enabling patients to specify, on request, the kind of care they wished to receive.[323] The provision was not included in ACA.[324]

In 2010, the Pew Research Center reported that 85% of Americans were familiar with the claim, and 30% believed it was true, backed by three contemporaneous polls.[325] A poll in August 2012 found that 39% of Americans believed the claim.[326] The allegation was named PolitiFact‘s “Lie of the Year”,[318][327] one of FactCheck.org‘s “whoppers”[328][329] and the most outrageous term by the American Dialect Society.[330]AARP described such rumors as “rife with gross—and even cruel—distortions”.[331]

Members of Congress

ACA requires members of Congress and their staffs to obtain health insurance either through an exchange or some other program approved by the law (such as Medicare), instead of using the insurance offered to federal employees (the Federal Employees Health Benefits Program).[332][333][334][335][336]

Illegal immigrants

ACA does not provide benefits to illegal immigrants.[337] It explicitly denies insurance subsidies to “unauthorized (illegal) aliens”.[25][26][338]

Exchange “death spiral”

One argument against the ACA is that the insurers are leaving the marketplaces, as they cannot profitably cover the available pool of customers, which contains too many unhealthy participants relative to healthy participants. A scenario where prices rise, due to an unfavorable mix of customers from the insurer’s perspective, resulting in fewer customers and fewer insurers in the marketplace, further raising prices, has been called a “Death Spiral.”[339]During 2017, the median number of insurers offering plans on the ACA exchanges in each state was 3.0, meaning half the states had more and half had fewer insurers. There were five states with one insurer in 2017; 13 states with two; 11 states with three; and the remainder had four insurers or more. Wisconsin had the most, with 15 insurers in the marketplace. The median number of insurers was 4.0 in 2016, 5.0 in 2015, and 4.0 in 2014.[340]

Further, the CBO reported in January 2017 that it expected enrollment in the exchanges to rise from 10 million during 2017 to 13 million by 2027, assuming laws in place at the end of the Obama administration were continued.[341]Following a 2015 CBO report that reached a similar conclusion, Paul Krugman wrote: “But the truth is that this report is much, much closer to what supporters of reform have said than it is to the scare stories of the critics–no death spirals, no job-killing, major gains in coverage at relatively low cost.”[342]

Opposition

Opposition and efforts to repeal the legislation have drawn support from sources that include labor unions,[343][344]conservative advocacy groups,[345][346] Republicans, small business organizations and the Tea Party movement.[347]These groups claimed that the law would disrupt existing health plans, increase costs from new insurance standards, and increase the deficit.[348] Some opposed the idea of universal healthcare, viewing insurance as similar to other unsubsidized goods.[349][350] President Donald Trump has repeatedly promised to “repeal and replace” it.[351][352]

As of 2013 unions that expressed concerns about ACA included the AFL-CIO,[353] which called ACA “highly disruptive” to union health care plans, claiming it would drive up costs of union-sponsored plans; the International Brotherhood of TeamstersUnited Food and Commercial Workers International Union, and UNITE-HERE, whose leaders sent a letter to Reid and Pelosi arguing, ” ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40-hour work week that is the backbone of the American middle class.”[344] In January 2014, Terry O’Sullivan, president of the Laborers’ International Union of North America (LIUNA) and D. Taylor, president of Unite Here sent a letter to Reid and Pelosi stating, “ACA, as implemented, undermines fair marketplace competition in the health care industry.”[343]

In October 2016, Mark Dayton, the governor of Minnesota and a member of the Minnesota Democratic–Farmer–Labor Party, said that the ACA had “many good features” but that it was “no longer affordable for increasing numbers of people” and called on the Minnesota legislature to provide emergency relief to policyholders.[354] Dayton later said he regretted his remarks after they were seized on by Republicans seeking to repeal the law.[355]

Legal challenges

National Federation of Independent Business v. Sebelius

Opponents challenged ACA’s constitutionality in multiple lawsuits on multiple grounds.[356][357][not in citation given] In National Federation of Independent Business v. Sebelius, the Supreme Court ruled on a 5–4 vote that the individual mandate was constitutional when viewed as a tax, although not under the Commerce Clause.

The Court further determined that states could not be forced to participate in the Medicaid expansion. ACA withheld all Medicaid funding from states declining to participate in the expansion. The Court ruled that this withdrawal of funding was unconstitutionally coercive and that individual states had the right to opt out without losing preexisting Medicaid funding.[358]

Contraception mandate

In March 2012 the Roman Catholic Church, while supportive of ACA’s objectives, voiced concern through the United States Conference of Catholic Bishops that aspects of the mandate covering contraception and sterilization and HHS‘s narrow definition of a religious organization violated the First Amendment right to free exercise of religion and conscience. Various lawsuits addressed these concerns.[359][360]

On June 25, 2015, the U.S. Supreme Court ruled 6–3 that federal subsidies for health insurance premiums could be used in the 34 states that did not set up their own insurance exchanges.[361]

House v. Price

In United States House of Representatives v. Price (previously United States House of Representatives v. Burwell) the House sued the administration alleging that the money for premium subsidy payments to insurers had not been appropriated, as required for any federal government spending. The ACA subsidy that helps customers pay premiums was not part of the suit.

Without the cost-sharing subsidies, the government estimated that premiums would increase by 20 percent to 30 percent for silver plans.[362] In 2017, the uncertainty about whether the payments would continue caused Blue Cross Blue Shield of North Carolina to try to raise premiums by 22.9 percent the next year, as opposed to an increase of only 8.8 percent that it would have sought if the payments were assured.[363]

Non-cooperation

Officials in Texas, Florida, Alabama, Wyoming, Arizona, Oklahoma and Missouri opposed those elements of ACA over which they had discretion.[364][365] For example, Missouri declined to expand Medicaid or establish a health insurance marketplace engaging in active non-cooperation, enacting a statute forbidding any state or local official to render any aid not specifically required by federal law.[366] Other Republican politicians discouraged efforts to advertise the benefits of the law. Some conservative political groups launched ad campaigns to discourage enrollment.[367][368]

Repeal efforts

ACA was the subject of unsuccessful repeal efforts by Republicans in the 111th112th, and 113th Congresses: Representatives Steve King (R-IA) and Michele Bachmann (R-MN) introduced bills in the House to repeal ACA the day after it was signed, as did Senator Jim DeMint (R-SC) in the Senate.[369] In 2011, after Republicans gained control of the House of Representatives, one of the first votes held was on a bill titled “Repealing the Job-Killing Health Care Law Act” (H.R. 2), which the House passed 245–189.[370] All Republicans and 3 Democrats voted for repeal.[371] House Democrats proposed an amendment that repeal not take effect until a majority of the Senators and Representatives had opted out of the Federal Employees Health Benefits Program; Republicans voted down the measure.[372] In the Senate, the bill was offered as an amendment to an unrelated bill, but was voted down.[373]President Obama had stated that he would have vetoed the bill even if it had passed both chambers of Congress.[374]

2017 House Budget

Following the 2012 Supreme Court ruling upholding ACA as constitutional, Republicans held another vote to repeal the law on July 11;[375] the House of Representatives voted with all 244 Republicans and 5 Democrats in favor of repeal, which marked the 33rd, partial or whole, repeal attempt.[376][377] On February 3, 2015, the House of Representatives added its 67th repeal vote to the record (239 to 186). This attempt also failed.[378]

2013 federal government shutdown

Strong partisan disagreement in Congress prevented adjustments to the Act’s provisions.[379] However, at least one change, a proposed repeal of a tax on medical devices, has received bipartisan support.[380] Some Congressional Republicans argued against improvements to the law on the grounds they would weaken the arguments for repeal.[283][381]

Republicans attempted to defund its implementation,[365][382] and in October 2013, House Republicans refused to fund the federal government unless accompanied with a delay in ACA implementation, after the President unilaterally deferred the employer mandate by one year, which critics claimed he had no power to do. The House passed three versions of a bill funding the government while submitting various versions that would repeal or delay ACA, with the last version delaying enforcement of the individual mandate. The Democratic Senate leadership stated the Senate would only pass a “clean” funding bill without any restrictions on ACA. The government shutdown began on October 1.[383][384][385] Senate Republicans threatened to block appointments to relevant agencies, such as the Independent Payment Advisory Board[386] and Centers for Medicare and Medicaid Services.[387][388]

2017 repeal effort

During a midnight congressional session starting January 11, 2017, the Senate of the 115th Congress of the United States voted to approve a “budget blueprint” which would allow Republicansto repeal parts of the law “without threat of a Democraticfilibuster.”[389][390] The plan, which passed 51-48, is a budget blueprint named by Senate Republicans the “Obamacare ‘repeal resolution.'”[391] Democrats opposing the resolution staged a protest during the vote.[392]

House Republicans announced their replacement for the ACA, the American Health Care Act, on March 6, 2017.[393] On March 24, 2017 the effort, led by Paul Ryan and Donald Trump, to repeal and replace the ACA failed amid a revolt among Republican representatives.[394]

On May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act (and thereby repeal most of the Affordable Care Act) by a narrow margin of 217 to 213, sending the bill to the Senate for deliberation.[395] The Senate has indicated they will write their own version of the bill, instead of voting on the House version.[396]

Implementation history

Once the law was signed, provisions began taking effect, in a process that continued for years. Some provisions never took effect, while others were deferred for various periods.

Existing individual health plans

Plans purchased after the date of enactment, March 23, 2010, or old plans that changed in specified ways would eventually have to be replaced by ACA-compliant plans.[citation needed]

At various times during and after the ACA debate, Obama stated that “if you like your health care plan, you’ll be able to keep your health care plan”.[397][398] However, in fall 2013 millions of Americans with individual policies received notices that their insurance plans were terminated,[399] and several million more risked seeing their current plans cancelled.[400][401][402]

Obama’s previous unambiguous assurance that consumers’ could keep their own plans became a focal point for critics, who challenged his truthfulness.[403][404] On November 7, 2013, President Obama stated: “I am sorry that [people losing their plans] are finding themselves in this situation based on assurances they got from me.”[405] Various bills were introduced in Congress to allow people to keep their plans.[406]

In the fall of 2013, the Obama Administration announced a transitional relief program that would let states and carriers allow non-compliant individual and small group policies to renew at the end of 2013. In March 2014, HHS allowed renewals as late as October 1, 2016. In February 2016, these plans were allowed to renew up until October 1, 2017, but with a termination date no later than December 31, 2017.[citation needed]

2010

In June small business tax credits took effect. For certain small businesses, the credits reached up to 35% of premiums. At the same time uninsured people with pre-existing conditions could access the federal high-risk pool. Also, participating employment-based plans could obtain reimbursement for a portion of the cost of providing health insurance to early retirees.[407]

In July the Pre-Existing Condition Insurance Plan (PCIP) took effect to offer insurance to those that had been denied coverage by private insurance companies because of a pre-existing condition. Despite estimates of up to 700,000 enrollees, at a cost of approximately $13,000/enrollee, only 56,257 enrolled at a $28,994 cost per enrollee.[407]

2011

As of September 23, 2010, pre-existing conditions could no longer be denied coverage for children’s policies. HHS interpreted this rule as a mandate for “guaranteed issue“, requiring insurers to issue policies to such children.[citation needed] By 2011, insurers had stopped marketing child-only policies in 17 states, as they sought to escape this requirement.[408]

The average beneficiary in the prior coverage gap would have spent $1,504 in 2011 on prescriptions. Such recipients saved an average $603. The 50 percent discount on brand name drugs provided $581 and the increased Medicare share of generic drug costs provided the balance. Beneficiaries numbered 2 million[409]

2012

In National Federation of Independent Business v. Sebelius decided on June 28, 2012, the Supreme Court ruled that the individual mandate was constitutional when the associated penalties were construed as a tax. The decision allowed states to opt out of the Medicaid expansion. Several did so,[410] although some later accepted the expansion.[411][412]

2013

In January 2013 the Internal Revenue Service ruled that the cost of covering only the individual employee would be considered in determining whether the cost of coverage exceeded 9.5% of income. Family plans would not be considered even if the cost was above the 9.5% income threshold. This was estimated to leave 2–4 million Americans unable to afford family coverage under their employers’ plans and ineligible for subsidies.[413][414]

A June 2013 study found that the MLR provision had saved individual insurance consumers $1.2 billion in 2011 and $2.1 billion in 2012, reducing their 2012 costs by 7.5%.[415] The bulk of the savings were in reduced premiums, but some came from MLR rebates.

On July 2, 2013, the Obama Administration announced that it would delay the implementation of the employer mandate until 2015.[280][416][417]

The Community Living Assistance Services and Supports Act (or CLASS Act) was enacted as Title VIII of the ACA. It would have created a voluntary and public long-term care insurance option for employees.[121][123] In October 2011 the administration announced it was unworkable and would be dropped.[418] The CLASS Act was repealed January 1, 2013.[419]

The launch for both the state and federal exchanges was troubled due to management and technical failings. HealthCare.gov, the website that offers insurance through the exchanges operated by the federal government, crashed on opening and suffered endless problems.[420] Operations stabilized in 2014, although not all planned features were complete.[421][422]

CMS reported in 2013 that, while costs per capita continued to rise, the rate of increase in annual healthcare costs had fallen since 2002. Per capita cost increases averaged 5.4% annually between 2000 and 2013. Costs relative to GDP, which had been rising, had stagnated since 2009.[423] Several studies attempted to explain the reductions. Reasons included:

  • Higher unemployment due to the 2008-2010 recession, which limited the ability of consumers to purchase healthcare;
  • Out-of-pocket costs rose, reducing demand for healthcare services.[424] The proportion of workers with employer-sponsored health insurance requiring a deductible climbed to about three-quarters in 2012 from about half in 2006.[223]
  • ACA changes[223] that aim to shift the healthcare system from paying-for-quantity to paying-for-quality. Some changes occurred due to healthcare providers acting in anticipation of future implementation of reforms.[120][224]

2014

On July 30, 2014, the Government Accountability Office released a non-partisan study that concluded that the administration did not provide “effective planning or oversight practices” in developing the ACA website.[425]

In Burwell v. Hobby Lobby the Supreme Court exempted closely held corporations with religious convictions from the contraception rule.[426] In Wheaton College vs Burwell the Court issued an injunction allowing the evangelical college and other religiously affiliated nonprofit groups to completely ignore the contraceptive mandate.[427]

A study found that average premiums for the second-cheapest ( silver) plan were 10-21% less than average individual market premiums in 2013, while covering many more conditions. Credit for the reduced premiums was attributed to increased competition stimulated by the larger market, greater authority to review premium increases, the MLR and risk corridors.[citation needed]

Many of the initial plans featured narrow networks of doctors and hospitals.[428][not in citation given]

A 2016 analysis found that health care spending by the middle class was 8.9% of household spending in 2014.[429]

2015

By the beginning of the year, 11.7 million had signed up (ex-Medicaid).[430] On December 31, 2015, about 8.8 million consumers had stayed in the program. Some 84 percent, or about 7.4 million, were subsidized.[431]

Bronze plans were the second most popular in 2015, making up 22% of marketplace plan selections. Silver plans were the most popular, accounting for 67% of marketplace selections. Gold plans were 7%. Platinum plans accounted for 3%. On average across the four metal tiers, premiums were up 20% for HMOs and 18% for EPOs. Premiums for POS plans were up 15% from 2015 to 2016, while PPO premiums were up just 8%.[citation needed]

A 2015 study found 14% of privately insured consumers received a medical bill in the past two years from an out-of-network provider in the context of an overall in-network treatment event. Such out-of-network care is not subject to the lower negotiated rates of in-network care, increasing out-of-pocket costs. Another 2015 study found that the average out-of-network charges for the majority of 97 medical procedures examined “were 300% or higher compared to the corresponding Medicare fees” for those services.[citation needed]

Some 47% of the 2015 ACA plans sold on the Healthcare.gov exchange lacked standard out-of-network coverage. Enrollees in such plans, typically received no coverage for out-of-network costs (except for emergencies or with prior authorization). A 2016 study on Healthcare.gov health plans found a 24 percent increase in the percentage of ACA plans that lacked standard out-of-network coverage.[citation needed]

The December spending bill delayed the onset of the “Cadillac tax” on expensive insurance plans by two years, until 2020.[432]

The average price of non-generic drugs rose 16.2% in 2015 and 98.2% since 2011.[429]

2016

As of March 2016 11.1 million people had purchased exchange plans,[citation needed] while an estimated 9 million to 10 million people had gained Medicaid coverage, mostly low-income adults.[206] 11.1 million were still covered, a decline of nearly 13 percent.[433] 6.1 million uninsured 19-25 year olds gained coverage.[434]

Employers

A survey of New York businesses found an increase of 8.5 percent in health care costs, less than the prior year’s survey had expected. A 10 percent increase was expected for 2017. Factors included increased premiums, higher drug costs, ACA and aging workers. Some firms lowered costs by increasing cost-sharing (for higher employee contributions, deductibles and co-payments). 60% planned to further increase cost-sharing. Coverage and benefits were not expected to change. Approximately one fifth said ACA had pushed them to reduce their workforce. A larger number said they were raising prices.[435]

Insurers

The five major national insurers expected to lose money on ACA policies in 2016.[436] UnitedHealth withdrew from the Georgia and Arkansas exchanges for 2017, citing heavy losses.[203] Humana exited other markets, leaving it operating in 156 counties in 11 states for 2017.[437] 225 counties across the country had access to only a single ACA insurer. A study released in May estimated that 664 counties would have one insurer in 2017.[438][not in citation given]

Aetna cancelled planned expansion of its offerings and following an expected $300 million loss in 2016 and then withdrew from 11 of its 15 states.[439] In August 2016 Anthem said that its offerings were losing money, but also that it would expand its participation if a pending merger with Cigna was approved.[440] Aetna and Humana’s exit for 2017 left 8 rural Arizona counties with only Blue Cross/Blue Shield.[441]

Blue Cross/Blue Shield Minnesota announced that it would exit individual and family markets in Minnesota in 2017, due to financial losses of $500 million over three years.[442]

Another analysis found that 17 percent of eligibles may have a single insurer option in 2017. North Carolina, Oklahoma, Alaska, Alabama, South Carolina and Wyoming were expected to have a single insurer,[443] while only 2 percent of 2016 eligibles had only one choice.[444]

Aetna, Humana, UnitedHealth Group also exited various individual markets. Many local Blue Cross plans sharply narrowed their networks. In 2016 two thirds of individual plans were narrow-network HMO plans.[428]

One of the causes of insurer losses is the lower income, older and sicker enrollee population. One 2016 analysis reported that while 81% of the population with incomes from 100-150% of the federal poverty level signed up, only 45% of those from 150-200% did so. The percentage continued to decline as income rose: 2% of those above 400% enrolled.[445]

Costs

The law is designed to pay subsidies in the form of tax credits to the individuals or families purchasing the insurance, based on income levels. Higher income consumers receive lower subsidies. While pre-subsidy prices rose considerably from 2016 to 2017, so did the subsidies, to reduce the after-subsidy cost to the consumer. For example, a study published in 2016 found that the average requested 2017 premium increase among 40-year-old non-smokers was about 9 percent, according to an analysis of 17 cities, although Blue Cross Blue Shield proposed increases of 40 percent in Alabama and 60 percent in Texas.[220] However, some or all of these costs are offset by subsidies, paid as tax credits. For example, the Kaiser Foundation reported that for the second-lowest cost “Silver plan” (a plan often selected and used as the benchmark for determining financial assistance), a 40-year old non-smoker making $30,000 per year would pay effectively the same amount in 2017 as they did in 2016 (about $208/month) after the subsidy/tax credit, despite large increases in the pre-subsidy price. This was consistent nationally. In other words, the subsidies increased along with the pre-subsidy price, fully offsetting the price increases.[221]

Cooperatives

The number of ACA nonprofit insurance cooperatives for 2017 fell from 23 originally to 7 for 2017. The remaining 7 posted annual losses in 2015. A General Accountability Report found that co-ops’ 2015 premiums were generally below average. At the end of 2014, money co-ops and other ACA insurers had counted on risk corridor payments that didn’t materialize. Maryland’s Evergreen Health claims that ACA’s risk-adjustment system does not adequately measure risk.[citation needed]

Medicaid

Newly elected Louisiana Governor John Bel Edwards issued an executive order to accept the expansion, becoming the 32nd state to do so. The program was expected to enroll an additional 300,000 Louisianans.[446]

2017

More than 9.2 million people signed up for care on the national exchange (healthcare.gov) for 2017, down some 400,000 from 2016. This decline was due primarily to the election of President Trump, who pulled advertising encouraging people to sign up for coverage, issued an executive order that attempts to eliminate the mandate, and has created significant uncertainty about the future of the ACA. Enrollments had been running ahead of 2016 prior to President Obama leaving office, with 9.8 million expected to sign-up, so President Trump’s actions potentially cost about 600,000 national enrollments (i.e., 9.8 million expected − 9.2 million actual = 0.6 million impact).[447] Of the 9.2 million, 3.0 million were new customers and 6.2 million were returning. The 9.2 million excludes the 11 states that run their own exchanges, which have signed up around 3 million additional people.[447] These figures also exclude the additional coverage due to the Medicaid expansion, which covers another approximately 10 million persons, as described in the impact section above.

In February, Humana announced that it would withdraw from the individual insurance market in 2018, citing “further signs of an unbalanced risk pool.”[448] That month the IRS announced that it would not require that tax returns indicate that a person has health insurance, reducing the effectiveness of the individual mandate, in response to an executive order from President Donald Trump.[449]

Aetna CEO Mark Bertolini stated that ACA was in a “death spiral” of escalating premiums and shrinking, skewed enrollment.[450] However, a U.S. judge found that the Aetna CEO misrepresented why his company was leaving the exchanges; an important part of the reason was the Justice Department’s opposition to the intended merger between Aetna and Humana. Aetna announced that it would exit the exchange market in all remaining states.[451] It stated that its losses had grown from $100M in 2014 to $450M in 2016.[452]Wellmark withdrew from Iowa in April.[453] As of May, no insurer had indicated its intention to offer ACA insurance in Nebraska.[451] Also in May Blue Cross and Blue Shield of Kansas City announced it would withdraw from Missouri and Kansas’s individual markets in 2018, potentially leaving nearly 19,000 residents in Western Missouri without a coverage option.[454] Anthem announced plans to withdraw from Ohio[455] and later Wisconsin[456] and Indiana,[457] describing the market as “volatile” and referring to the difficulty in pricing its plans “due to the shrinking individual market as well as continual changes in federal operations, rules and guidance.”[455]

The CBO reported in March 2017 that the healthcare exchanges were expected to be stable; i.e., they were not in a “death spiral.”[458] In June, Centene announced that it intended to initiate coverage in Nevada, Kanasa and Missouri and expand coverage in Ohio and Florida.[459]

Molina Healthcare, a major Medicaid provider, said that it was considering exiting some markets in 2018, citing “too many unknowns with the marketplace program.” Molina lost $110 million in 2016 due to having to contribute $325 million more than expected to the ACA “risk transfer” fund that compensated insurers with unprofitable risk pools. These pools were established to help prevent insurers from artificially selecting lower-risk pools.[460]

In May the United States House of Representatives voted to repeal the ACA.[461][462]

See also

https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

Party Affiliation

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The Pronk Pops Show 917, June 22, 2017, Story 1: Senate Draft Bill To Repeal Obamacare Is Obamacare Lite! No Individual and Employer Mandates and Obamacare Taxes But Subsidies Remain — The Stupid Party Again Betrays Republican Voters By Not Repealing Obamacare Completely — Conservative and Libertarian Republicans Will Oppose Senate Draft Bill — Nothing For Trump To Sign Before Independence Day! — Videos — Story 2: More Republican Voters Will Be Leaving The Party and Become Independents — Waiting For A New Limited Government Party! — Obama Damaged Democratic Party and Trump Will Damage Republican Party — No Hope and No Change With Two Party Tyranny of Big Interventionist Government — BIG Parties — Videos

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Story 1: Senate Draft Bill To Repeal Obamacare Is Obamacare Lite! No Individual and Employer Mandates and Obamacare Taxes But Subsidies Remain — The Stupid Party Again Betrays Republican Voters By Not Repealing Obamacare Completely — Conservative and Libertarian Republicans Will Oppose Senate Draft Bill — Nothing For Trump To Sign Before Independence Day! — Videos

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“Once the principle is admitted that it is the duty of the government to protect the individual against his own foolishness, no serious objections can be advanced against further encroachments.”

“The champions of socialism call themselves progressives, but they recommend a system which is characterized by rigid observance of routine and by a resistance to every kind of improvement. They call themselves liberals, but they are intent upon abolishing liberty. They call themselves democrats, but they yearn for dictatorship. They call themselves revolutionaries, but they want to make the government omnipotent. They promise the blessings of the Garden of Eden, but they plan to transform the world into a gigantic post office. Every man but one a subordinate clerk in a bureau.”
~ Ludwig von Mises

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Senators Debate GOP Health Care Plan

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Here are the details of Senate Republican Obamacare replacement bill

  • The bill would significantly change how the federal government subsidizes individual health plans and funds Medicaid
  • GOP leaders want to have a vote on the bill before the Fourth of July recess.
  • The House’s own version of a health-care bill is deeply unpopular.
Dan Mangan | Kayla Tausche

Senate Minority Leader Sen. Mitch McConnell (R-KY)

Former Medicare administrator: Millions will still lose coverage under Senate health-care bill  6 Hours Ago | 03:20

Senate GOP leaders on Thursday finally released their secret health-care reform bill, which would repeal Obamacare taxes, restructure subsidies to insurance customers, and both phase out Medicaid’s expansion program and cap Medicaid spending.

Republicans plan to bring the controversial bill that was drafted in secret to a quick vote next week, but face potentially fatal opposition to it from several members of their own caucus.

The 142-page bill, if passed into law, would sharply reduce financial aid that currently helps millions of people obtain health coverage, while at the same time offering a tax break to primarily wealthy Americans to the tune of hundreds of billions of dollars. And it would loosen rules in a way that could lead to states allowing insurers to offer less-generous health plans.

The bill would repeal, retroactive to the beginning of 2016, the Obamacare rule requiring most Americans to have some form of health coverage or pay a tax penalty fine. That repeal is expected to sharply increase the number of people who don’t have insurance, which could in turn lead insurers to raise premiums.

And it would repeal, retroactively to the beginning of 2016, the “employer mandate,” which requires large employers to offer health insurance to workers or be fined.

Read the entire bill here

The bill also would continue for at least two years to offer reimbursements to health insurance companies for subsidies that reduce out-of-pocket costs for low income customers of Obamacare plans. But those subsidies would end in 2020, which would increase deductibles and other out-of-pocket health expenses for millions of customers.

The federal government’s share of funding for Medicaid, which is jointly run with individual states, would fall over the course of seven years to end up at around 57 percent of the cost of that program, which offers health coverage to the poor.

Under Obamacare, the federal government had guaranteed that its funding for adults newly eligible for Medicaid because of the Affordable Care Act would fall to no lower than 90 percent of their costs. That expansion program would begin being phased out in 2021, and fully repealed by three years later.

In another cost-cutting move, the bill would lower the maximum income level a household could have to still qualify for federal subsidies that help reduce the premiums people pay for enrollment for individual health plans. Obamacare currently bars subsidies to families that earn more than 400 percent of the federal poverty level. The new bill would reduce that cap to 350 percent of the poverty level.

Younger people, as a group, would end up paying less of a share of their income toward their individual health plans under the bill in comparison to what they pay now under Obamacare, while older people as a group would end up paying a larger share of their income.

Health plans that offer abortion services would not be eligible for the subsidies, according to the draft released Thursday.

The federal government also would end up spending less money subsidizing people’s insurance purchases by changing how the value of those subsidies are calculated. The bill would use a less-expensive type of individual health plan to calculate those subsidies, as opposed to the pricier plan used under Obamacare.

The bill also seeks to repeal, to the start of 2017, the 3.8 percent tax on net investment income.

The Trump administration is expected to back the bill, which most GOP senators were learning the details of during a meeting Thursday morning. The bill is named the “Better Care Reconciliation Act of 2017.”

“It’s going to be very good,” President Donald Trump said about an hour after the bill’s release. “A little negotiation, but it’s going to be very good.” Trump did not elaborate.

The House’s version of the bill, dubbed the American Health Care Act, is broadly unpopular among the public, and had been reportedly called “mean, mean, mean,” by Trump during a meeting with senators. Weeks earlier, Trump and House members who voted for the ACHA celebrated its passage in the Rose Garden of the White House.

A new NBC News/Wall Street Journal Poll released Thursday found that just 16 percent of Americans thought the House bill was a good idea, with 48 percent saying it is a bad idea.

“In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal heath spending, big increase in the uninsured,” tweeted Larry Levitt, an Obamacare expert at the Kaiser Family Foundation.

“Under the Senate bill, low-income people would pay higher premiums for bigger deductibles,” Levitt said.

He had noted on Twitter on Wednesday that “A 60 year-old at 351% of poverty currently gets a premium subsidy of $5,151 per year on average.” The Senate bill would eliminate all of that federal financial aid if it becomes law.

Senate GOP leaders want to have a vote on the bill by late next week, before Congress’ Fourth of July recess. They do not plan to hold any hearings on the legislation, infuriating Democrats, who were frozen out of the drafting process.

To pass, Republicans must get at least 50 GOP senators to vote for the bill, since no Democrat or independent is expected to vote for it. Vice President Mike Pence would break any tie, and would be expected to vote for the bill. There are 52 Republican senators.

On Thursday, about an hour after the bill was posted online, NBC’s Chuck Todd tweeted that a group of a conservative Republican senators were meeting, and that there are at least three GOP senators, and possibly more, who plan to announce later today that they will oppose the bill.

If that number proves to be accurate, it could be a death blow to the bill.

Sen. Rand Paul, R-Ky., told NBC that he and several other members of the GOP caucus would be making a statement on the bill later Thursday.

“It looks like we’re keeping Obamacare, not repealing it,” said Paul, who declined to say whether that meant he would vote against the bill.

Senate Majority Leader Mitch McConnell of Ky., center, followed by Majority Whip John Cornyn, R-Texas, leaves a Republican meeting on healthcare, Thursday, June 22, 2017, on Capitol Hill in Washington.

Jacquelyn Martin | AP
Senate Majority Leader Mitch McConnell of Ky., center, followed by Majority Whip John Cornyn, R-Texas, leaves a Republican meeting on healthcare, Thursday, June 22, 2017, on Capitol Hill in Washington.

Senate Majority Leader Mitch McConnell, R-Ky., said Thursday, “There will be ample time to analyze” and discuss the bill before the legislation is put to a vote.

While McConnell praised the bill on the floor of the Senate, many of his Republican caucus members avoided speaking with reporters staking them out in Congress, who wanted to ask about the legislation.

Democrats promptly blasted the bill, and castigated Republicans for planning to call a vote on it just a week after its details were released.

“The Republicans want to give a tax break to the wealthiest Americans,” said Senate Minority Leader Chuck Schumer, D-NY, on the floor of the Senate after release of the bill. “Simply put this bill will result in higher costs, less care, and millions of Americans will lose their health insurance.”

“It’s every bit as bad as the House bill. In many ways it’s even worse,” Schumer said. “The Senate bill is a wolf in sheep’s clothing, but this wolf has even sharper teeth than the House bill.”

House Speaker Paul Ryan, R-Wisc., during a press conference said, “From what I understand, their bill tracks along lines of House bill … [I] think that’s very good.”

Leslie Dach, director of the Obamacare-supporting group Protect Our Care Campaign, tore into the Senate’s bill, which, like Ryan, he compared to the House’s earlier bill.

“Senate Republicans promised to start over and write a plan that improves people’s health care,” Dach said. “Instead they doubled down on the failed House repeal approach that puts everyone’s health care last, and tax breaks for the wealthy first.”

“The heartless Senate health care repeal bill makes health care worse for everyone — it raises costs, cuts coverage, weakens protections and cuts even more from Medicaid than the mean House bill,” said Dach, who had served as senior counselor at the Department of Health and Human Services in the Obama administration.

“They wrote their plan in secret and are rushing forward with a vote next week because they know how much harm their bill does to millions of people.”

But Seema Verma, administrator for the federal Centers for Medicare and Medicaid Services, praised the Senate’s bill as she criticized Obamacare, a program that CMS oversees.

“I appreciate the work of the Senate as they continue to make progress fixing the crisis in health care that has resulted from Obamacare,” Verma said. “Skyrocketing premiums, rising costs and fewer choices have caused too many Americans to drop their insurance coverage.”

“Today, Obamacare is in a death spiral and millions ofAmericans are being negatively impacted as a result. They are trapped by mandates that force them to purchase insurance they don’t want and can’t afford,” she said. “The Senate proposal is built on putting patients first and in charge of their health-care decisions, bringing down the cost of coverage and expanding choices. Congress must act now to achieve the President’s goal to make sure all Americans have access to quality, affordable coverage.”

The Congressional Budget Office said it expects to release an analysis of the bill early next week Monday. The analysis will estimate how many people are likely to become uninsured in the next decade if the bill becomes law, as well as how premiums for individual health plans would be affected.

CBO aims to release estimate for Senate health care plan early next week https://www.cbo.gov/publication/52843 

CBO aims to release estimate for Senate health care plan early next week

CBO and the staff of the Joint Committee on Taxation are in the process of preparing an estimate for the Senate health care plan and aim to release it early next week.

cbo.gov

The CBO “score” would also include projections on the bill’s impact on federal spending.

The release of the draft comes more than six weeks after GOP leaders in the House barely managed to win passage for their own health-care legislation.

The House bill, the American Health Care Act, is widely unpopular, multiple polls have shown.

The nonpartisan CBO, in analyzing that bill, found that 23 million more Americans would become uninsured by 2026 if it became law than if Obamacare remained in place.

While many of those people would voluntarily cease buying insurance plans because of the elimination requirement that they have some form of health coverage or pay a fine, millions more would find their plans unaffordable because of either rising prices, the loss of government subsidies or both factors.

http://www.cnbc.com/2017/06/22/senate-republicans-finally-unveil-their-big-obamacare-replacement-bill.html

Track the Key Changes in the GOP’s Health Plan

By Hannah Recht, Zachary Tracer and Mira Rojanasakul

Published: March 22, 2017 | Last updated: June 22, 2017
Seven years after the Affordable Care Act was enacted, Republicans are trying to follow through on their promises to repeal and replace Obamacare. On March 6, Republican House leaders introduced their health plan, and Senate Republicans followed with their own bill on June 22. Congress will need to reconcile differences in the two proposals before a bill can reach President Donald Trump’s desk. We’ll track major policy changes and their impacts as Congress drafts and revises legislation to repeal Obamacare.
House bill introduced [March 6] ⟶ First House amendments [March 20] ⟶ First House vote canceled [March 24] ⟶ Passes House [May 4] ⟶ Senate bill introduced [June 22] ⟶ Passes Senate ⟶ House and Senate negotiate and revise bill ⟶ House and Senate pass final bill ⟶ President signs, becomes law
Medicaid Financing
House billCHANGE
House bill introduced  |  March 6, 2017

Currently, the federal government generally reimburses states for a fixed percentage of Medicaid expenditures, regardless of total spending or number of enrollees. The GOP bill would limit Medicaid reimbursement by a per-enrollee cost, based on 2016 average costs.

House amendment  |  March 20, 2017

Allows states to choose from two formulas for how they get federal Medicaid funding, and boosts the funding for elderly and disabled Medicaid enrollees, relative to the initial bill.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

Like the House bill, the Senate bill would allow states to choose between two formulas for federal Medicaid funding. But starting in 2025, the Senate bill would set a lower funding growth rate than the House bill would, meaning states would receive less money. Certain Medicaid enrollees would not be subject to these limits, including people with disabilities and children.

Budget impact: In the House bill, Federal Medicaid spending would decrease by $834 billion, from 2017 to 2026, relative to current law.

Decrease in Medicaid spending from current law, House bill
Source: Congressional Budget Office
Medicaid Expansion
House billREPEAL
House bill introduced  |  March 6, 2017

The ACA allowed states to expand Medicaid to individuals making as much as 138 percent of the federal poverty level, with federal funding. The GOP bill winds down Obamacare’s Medicaid expansion starting in 2020.

House amendment  |  March 20, 2017

Won’t provide extra funding to states that newly expand Medicaid.

Senate billREPEAL
Senate bill introduced  |  June 22, 2017

Medicaid expansion funding would be phased out between 2021 and 2024.

Human impact: In the House bill, Medicaid enrollment would decrease by 14 million people by 2026, about 17 percent.

Decrease in Medicaid enrollment from current law, House bill

0M

–3

–6

–9

–12

–15

Source: Congressional Budget Office
Premium Subsidies
House billCHANGE
House bill introduced  |  March 6, 2017

The ACA introduced subsidies based on income and the cost of health insurance, with some help available to people making up to 400 percent of the poverty level, or about $47,000 for an individual. The House bill would base subsidies mainly on age, phasing out funding beginning at an income of $75,000 for an individual.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

The Senate bill would maintain the ACA’s subsidies through 2019, but change how subsidies are allocated starting in 2020. The ACA calculates subsidies based on a mid-level coverage plan, while the Senate bill would use a cheaper type of plan. Subsidies would no longer be available to those above 350 percent of the poverty level, or about $42,000 for an individual.

Human impact: Many low-income subsidy recipients would lose thousands in premium subsidies, particularly older enrollees in higher-cost areas. In the House bill, some people who currently earn too much to qualify for subsidies would receive new assistance. The Senate bill does not offer similar assistance. Instead, it would place additional limits on who qualifies for subsidy assistance, making some middle-class recipients who currently receive subsidies ineligible.

Source: Congressional Budget Office
Essential Health Benefits
House billCHANGE
House amendment  |  March 23, 2017

The ACA requires health insurance plans to cover 10 broad categories of essential health benefits, as well as to provide preventive services at no cost. The bill initially left the requirement intact, but an amendment that would repeal that requirement was added. Instead, states will define their own list of benefits that are required for plans receiving premium subsidies beginning Jan. 1, 2018.

House amendment  |  May 3, 2017

An amendment was added that would leave essential health benefits intact—reinstating the federal standard. Instead, states could opt out of the requirement and apply for a waiver to define their own list of benefits that are required for plans receiving premium subsidies beginning Jan. 1, 2020.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: The Congressional Budget Office expects that half of the U.S. population live in states that would waive some required benefits. Plans in these states would likely have lower premiums, but they would cover less. For instance, maternity care premiums could cost an additional $1,000 per month or more. Customers seeking comprehensive coverage could face premiums and out-of-pocket charges that are significantly higher than under current law.

Budget impact: Insurers in some states could offer plans with such limited coverage that CBO does not consider them health insurance. Those plans would still be eligible for millions of dollars in federal subsidies.

Source: Congressional Budget Office
Pre-existing Conditions
House billCHANGE
House amendment  |  May 3, 2017

The ACA requires health insurers to sell plans to individuals who are sick with so-called pre-existing conditions and not charge them more than healthy customers. An amendment would allow states to apply for a waiver that would let insurers charge higher premiums to people with pre-existing conditions that had a gap in coverage of at least 63 days in the prior year. To do so, states would have to establish some method (a special “high-risk” insurance pool, or subsidies) to help sick people.

Senate billNO CHANGE
Senate bill introduced  |  June 22, 2017

Insurance companies would not be allowed to charge customers with pre-existing conditions more than healthy customers.

Human impact: In states that allow insurers to charge people with pre-existing conditions more than healthy people, those less healthy individuals would face increasingly prohibitive premiums under the House bill. Eventually, the CBO predicts, less-healthy people may not be able to afford any coverage.

Source: Congressional Budget Office
Age Rating
House billCHANGE
House bill introduced  |  March 6, 2017

Obamacare lets health insurers charge their oldest customers no more than three times as much as their youngest ones. The GOP bill introduced widens the ratio to 5 to 1.

House amendment  |  March 20, 2017

Adds a provision that would let the Senate decide whether to increase subsidies that go to older Americans.

House amendment  |  May 3, 2017

Adds a provision that would allow states to apply for a waiver to give insurers permission to charge older customers even more than the 5 to 1 ratio.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: Premiums would significantly rise for older people and decrease for younger people. Low-income older adults would face much higher premiums than under current law, even with federal subsidies.

Source: Congressional Budget Office
State Grants
House billNEW
House bill introduced  |  March 6, 2017

Includes a new $100 billion fund designed to help states stabilize their individual health insurance markets or help low-income people get health care.

House amendment  |  March 23, 2017

Adds $15 billion to the fund to be used for maternity, newborn, mental health and substance abuse coverage.

House amendment  |  April 6, 2017

Adds $15 billion for the Federal Invisible Risk Sharing Program, designed to help insurers cover the costs of sick and expensive patients.

House amendment  |  May 3, 2017

Adds $8 billion in funding from 2018 through 2023 to help individuals afford higher premiums in states that let insurers charge sick people more.

Senate billNEW
Senate bill introduced  |  June 22, 2017

The Senate bill would include $112 billion in state grant funds, primarily to stabilize state insurance markets and cover expensive patients. It would also allocate $2 billion in 2018 for substance abuse treatment.

Human impact: The grants would lead to slightly lower premiums in the individual market and encourage insurer participation. The new funding would not be enough to significantly lower costs for people with pre-existing conditions.

Budget impact: Both bills would require more than $100 billion in additional federal spending.

Source: Congressional Budget Office
Medicaid Work Requirements
House billNEW
House amendment  |  March 20, 2017

Gives states the option of requiring some Medicaid recipients to work or pursue job training.

Senate billNEW
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: According to the Kaiser Family Foundation, 10 million non-elderly adult Medicaid recipients who don’t receive Social Security are not working. Some of these adults would be excluded from work requirements due to disability, pregnancy or caretaker status, but many would be expected to complete job training or find employment in order to keep their insurance.

Source: Kaiser Family Foundation
Insurance Mandates
House billREPEAL
House bill introduced  |  March 6, 2017

The House bill ends Obamacare’s requirement that individuals have health coverage and that most employers offer it. Instead, when people who’ve gone uninsured decide to buy health insurance, they’ll have to pay a 30 percent surcharge on their premiums for one year.

Senate billREPEAL
Senate bill introduced  |  June 22, 2017

The Senate bill ends Obamacare’s requirement that individuals have health coverage and that most employers offer it.

Human impact: Though about 1 million people are expected to buy insurance in 2018 in order to avoid future surcharges, twice as many would choose not to purchase insurance long-term because of the House bill surcharge or insurance documentation requirements.

Budget impact: Revenue loss of $210 billion from 2017 to 2026 from repealing insurance penalties. The new premium surcharge would go to insurers directly, not the government.

Source: Congressional Budget Office
Planned Parenthood and Abortion Care
House billNEW
House bill introduced  |  March 6, 2017

Ends all federal funding for Planned Parenthood for one year. The bill also prohibits federal funds from going to insurance plans that cover abortions, other than those necessary to save the life of the woman, or in cases of rape or incest.

House amendment  |  March 20, 2017

Adds additional safeguards to prevent government funds from being used for some abortions.

Senate billNEW
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: Several thousand Medicaid-covered births would occur because of the loss of Planned Parenthood contraceptive and abortion care, particularly among women in areas without other providers that serve low-income patients.

Budget impact: Direct spending would decrease by $234 million between 2017 and 2026, but new births due to the Planned Parenthood provision would increase Medicaid spending by $77 million over the same period.

Source: Congressional Budget Office
Individual Taxes
House billREPEAL
House bill introduced  |  March 6, 2017

Repeals a 0.9 percent Medicare payroll surtax and a 3.8 percent investment-income tax on wealthy individuals that were introduced in the ACA, effective 2018.

House amendment  |  March 20, 2017

Ends the taxes in 2017, rather than 2018.

House amendment  |  March 23, 2017

Postpones repeal of the additional Medicare tax to 2023.

Senate billREPEAL
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: Wealthy individuals would get a tax break. In counties that backed Trump, taxpayers would save $6.6 billion, while taxpayers in Clinton counties would save $21.6 billion.

Budget impact: From 2017 to 2026, the repeal would lose $172 billion in Net Investment Tax revenue and about $64 billion in Medicare tax revenue from 2023 to 2026. Repealing the Medicare tax in 2017 would have resulted in an additional $63 billion loss.

Source: Congressional Budget Office
Industry Taxes
House billREPEAL
House bill introduced  |  March 6, 2017

Repeals ACA taxes imposed on health insurers, pharmaceutical companies, medical-device companies and tanning salons, effective 2018.

House amendment  |  March 20, 2017

Ends the taxes in 2017, rather than 2018.

Senate billREPEAL
Senate bill introduced  |  June 22, 2017

Repeals most taxes immediately. A tax on providers would be phased out in 2025.

Budget impact: Loss of $199 billion in tax revenue from 2017 to 2026.

Tax revenue lost, 2017–2026
Source: Congressional Budget Office
Cadillac Tax
House billCHANGE
House bill introduced  |  March 6, 2017

Obamacare imposes a tax on very generous health insurance benefits, which was delayed to 2020. The bill introduced further pushes the tax back to 2025.

House amendment  |  March 20, 2017

Delays the tax to 2026.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Budget impact: Loss of $66 billion in tax revenue through 2026.

Tax revenue lost

$0B

–3

–6

–9

–12

–15

Source: Congressional Budget Office
Dependent Coverage
No proposed change to current law

The ACA requires health insurers to allow children to remain on their parents’ plans, up to age 26.

https://www.bloomberg.com/graphics/2017-healthcare-bill-changes/

The C, D, and F Rollover Republicans Want To Keep Obamacare Subsidies

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The Pronk Pops Show 881, April 26, 2017, Story 1: District Court Judge in 9th Circuit Commits Judicial Fraud Makes Up A Violation of Law — Trump Executive Order Requires Existing Federal Laws Passed By Congress Be Enforced — Videos — Story 2: Senator Ted Cruz Great Idea For Paying For The Wall — Videos — Story 3: Trump’s Latest Tax Proposal — Good But Not Great — Missed Opportunity To Transition From An Income Tax Based System To A Broad Based Consumption Tax — FairTax or Fair Tax Less — Forget The Republican Establishment Border Adjustment Tax — Videos

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Image result for list of santuary citiesImage result for branco cartoons trump paying for the wallImage result for branco cartoons trump tax reform blueprint april 26, 2017

 

 

 

Story 1: District Court Judge in 9th Circuit Commits Judicial Fraud Makes Up A Violation of Law — Trump Executive Order Requires Existing Federal Laws Passed By Congress Be Enforced — Videos — 

Image result for list of santuary cities

Image result for Mexico Southern Border FenceImage result for list of santuary cities

Federal judge rules Trump cannot punish sanctuary cities by withholding funds

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A Ruling About Nothing

by ANDREW C. MCCARTHY April 26, 2017 1:45 PM

A federal judge suspends Trump’s unenforced ban on funding for sanctuary cities.

A federal judge suspends Trump’s unenforced ban on funding for sanctuary cities. A showboating federal judge in San Francisco has issued an injunction against President Trump’s executive order cutting off federal funds from so-called sanctuary cities. The ruling distorts the E.O. beyond recognition, accusing the president of usurping legislative authority despite the order’s express adherence to “existing law.” Moreover, undeterred by the inconvenience that the order has not been enforced, the activist court — better to say, the fantasist court — dreams up harms that might befall San Francisco and Santa Clara, the sanctuary jurisdictions behind the suit, if it were enforced. The court thus flouts the standing doctrine, which limits judicial authority to actual controversies involving concrete, non-speculative harms.

Although he vents for 49 pages, Judge William H. Orrick III gives away the game early, on page 4. There, the Obama appointee explains that his ruling is about . . . nothing. That is, Orrick acknowledges that he is adopting the construction of the E.O. urged by the Trump Justice Department, which maintains that the order does nothing more than call for the enforcement of already existing law. Although that construction is completely consistent with the E.O. as written, Judge Orrick implausibly describes it as “implausible.”

That is, Orrick acknowledges that he is adopting the construction of the E.O. urged by the Trump Justice Department, which maintains that the order does nothing more than call for the enforcement of already existing law. Although that construction is completely consistent with the E.O. as written, Judge Orrick implausibly describes it as “implausible.”

Since Orrick ultimately agrees with the Trump Justice Department, and since no enforcement action has been taken based on the E.O., why not just dismiss the case? Why the judicial theatrics?

There appear to be two reasons.

The first is Orrick’s patent desire to embarrass the White House, which rolled out the E.O. with great fanfare. The court wants it understood that Trump is a pretender: For all the hullaballoo, the E.O. effectively did nothing. Indeed, Orrick rationalizes his repeated misreadings of what the order actually says by feigning disbelief that what it says could possibly be what it means. Were that the case, he suggests, there would have been no reason to issue the order in the first place.

Thus, taking a page from the activist left-wing judges who invalidated Trump’s “travel ban” orders, Orrick harps on stump speeches by Trump and other administration officials. One wonders how well Barack “If you like your plan, you can keep your plan” Obama would have fared under the judiciary’s new Trump Doctrine: The extravagant political rhetoric by which the incumbent president customarily sells his policies relieves a court of the obligation to grapple with the inevitably more modest legal text of the directives that follow.

Of course, the peer branches of government are supposed to presume each other’s good faith in the absence of a patent violation of the law. But let’s put aside the unseemliness of Orrick’s barely concealed contempt for a moment, because he is also wrong. The proper purpose of an executive order is to direct the operations of the executive branch within the proper bounds of the law. There is, therefore, nothing untoward about an E.O. that directs the president’s subordinates to take enforcement action within the confines of congressional statutes.

In fact, it is welcome.

It is the president’s burden to set federal law-enforcement priorities. After years of Obama’s lax enforcement of immigration law and apathy regarding sanctuary jurisdictions, an E.O. openly manifesting an intent to execute the laws vigorously can have a salutary effect. And indeed, indications are that the cumulative effect of Trump’s more zealous approach to enforcement, of which the sanctuary-city E.O. is just one component, has been a significant reduction in the number of aliens seeking to enter the U.S. illegally.

In any event, eight years of Obama’s phone and pen have made it easy to forget that the president is not supposed to make law, and thus that we should celebrate, not condemn, an E.O. that does not break new legal ground. Orrick, by contrast, proceeds from the flawed premise that if a president is issuing an E.O., it simply must be his purpose to usurp congressional authority. Then he censures Trump for a purported usurpation that is nothing more than a figment of his own very active imagination.

Orrick’s second reason for issuing his Ruling About Nothing is to rationalize what is essentially an advisory opinion. It holds — I know you’ll be shocked to hear this — that if Trump ever did try to cut off funds from sanctuary cities, it would be an epic violation of the Constitution. Given that courts are supposed to refrain from issuing advisory opinions, the Constitution is actually more aggrieved by Orrick than by Trump. * * *

In a nutshell, the court claims that the E.O. is presidential legislation, an unconstitutional violation of the separation of powers. Orrick insists that the E.O. directs the attorney general and the secretary of homeland security to cut off any federal funds that would otherwise go to states and municipalities if they “willfully refuse to comply” with a federal law (Section 1373 of Title 8) that calls for state and local cooperation in enforcing immigration law.

According to Judge Orrick, Trump’s E.O. is heedless of whether Congress has approved any terminations of state funding from federal programs it has enacted. In one of the opinion’s most disingenuous passages, Orrick asserts that the E.O. “directs the Attorney General and the [Homeland Security] Secretary to ensure that ‘sanctuary jurisdictions’ are ‘not eligible to receive’ federal grants.” (Emphasis in original.)

But this is just not true; Orrick has omitted key context from the relevant passage, which actually states that “the Attorney General and the Secretary, in their discretion and to the extent consistent with law, shall ensure that jurisdictions that willfully refuse to comply with 8 U.S.C. 1373 (sanctuary jurisdictions) are not eligible to receive Federal grants.” (Emphasis added.) In plain English, the president has expressly restricted his subordinates to the limits that Congress has enacted. Under Trump’s order, there can be no suspension or denial of funding from a federal program unless congressional statutes authorize it. The president is not engaged in an Obama-

Of course, the peer branches of government are supposed to presume each other’s good faith in the absence of a patent violation of the law. But let’s put aside the unseemliness of Orrick’s barely concealed contempt for a moment, because he is also wrong. The proper purpose of an executive order is to direct the operations of the executive branch within the proper bounds of the law. There is, therefore, nothing untoward about an E.O. that directs the president’s subordinates to take enforcement action within the confines of congressional statutes. In fact, it is welcome.

It is the president’s burden to set federal law-enforcement priorities. After years of Obama’s lax enforcement of immigration law and apathy regarding sanctuary jurisdictions, an E.O. openly manifesting an intent to execute the laws vigorously can have a salutary effect. And indeed, indications are that the cumulative effect of Trump’s more zealous approach to enforcement, of which the sanctuary-city E.O. is just one component, has been a significant reduction in the number of aliens seeking to enter the U.S. illegally. In any event, eight years of Obama’s phone and pen have made it easy to forget that the president is not supposed to make law, and thus that we should celebrate, not condemn, an E.O. that does not break new legal ground. Orrick, by contrast, proceeds from the flawed premise that if a president is issuing an E.O., it simply must be his purpose to usurp congressional authority. Then he censures Trump for a purported usurpation that is nothing more than a figment of his own very active imagination.

Orrick’s second reason for issuing his Ruling About Nothing is to rationalize what is essentially an advisory opinion. It holds — I know you’ll be shocked to hear this — that if Trump ever did try to cut off funds from sanctuary cities, it would be an epic violation of the Constitution. Given that courts are supposed to refrain from issuing advisory opinions, the Constitution is actually more aggrieved by Orrick than by Trump. * * *

In a nutshell, the court claims that the E.O. is presidential legislation, an unconstitutional violation of the separation of powers. Orrick insists that the E.O. directs the attorney general and the secretary of homeland security to cut off any federal funds that would otherwise go to states and municipalities if they “willfully refuse to comply” with a federal law (Section 1373 of Title 8) that calls for state and local cooperation in enforcing immigration law. According to Judge Orrick, Trump’s E.O. is heedless of whether Congress has approved any terminations of state funding from federal programs it has enacted. In one of the opinion’s most disingenuous passages, Orrick asserts that the E.O. “directs the Attorney General and the [Homeland Security] Secretary to ensure that ‘sanctuary jurisdictions’ are ‘not eligible to receive’ federal grants.” (Emphasis in original.)

But this is just not true; Orrick has omitted key context from the relevant passage, which actually states that “the Attorney General and the Secretary, in their discretion and to the extent consistent with law, shall ensure that jurisdictions that willfully refuse to comply with 8 U.S.C. 1373 (sanctuary jurisdictions) are not eligible to receive Federal grants.” (Emphasis added.)

In plain English, the president has expressly restricted his subordinates to the limits that Congress has enacted. Under Trump’s order, there can be no suspension or denial of funding from a federal program unless congressional statutes authorize it. The president is not engaged in an Obama-esque rewrite of federal law; he explicitly ordered his subordinates to follow federal law.

It is not enough to say Orrick mulishly ignores the clear text of the executive order. Again and again, Justice Department lawyers emphasized to the court that Trump’s order explicitly reaffirmed existing law. Orrick refused to listen because, well, what fun would that be? If the president is simply directing that the law be followed, there is no basis for a progressive judge to accuse him of violating the law.

Were he to concede that, how would Orrick then win this month’s Social Justice Warrior in a Robe Award for Telling Donald Trump What For? Orrick can’t confine himself to merely inventing a violation, either, because there is no basis for a lawsuit unless a violation results in real damages. So, the judge also has to fabricate some harm. This takes some doing since, in addition to merely directing that the law be enforced, the Trump administration has not actually taken any action against any sanctuary jurisdiction to this point.

No problem: Orrick theorizes that because San Francisco and Santa Clara receive lots of government funding, Trump’s order afflicts them with “pre-enforcement” anxiety. They quake in fear that their safety-net and services budgets will be slashed. Sanctuary cities? Maybe we should call them snowflake cities. As noted above, there is a transparent agenda behind Orrick’s sleight of hand. The judge is keen to warn the president that, if ever his administration were to deny funds to sanctuary cities, it would violate the Constitution. It is in connection with this advisory opinion that the judge makes the only point worthy of consideration — albeit not in the case before him. Here, it is useful to recall the Supreme Court’s first Obamacare ruling.

Sanctuary cities? Maybe we should call them snowflake cities.

As noted above, there is a transparent agenda behind Orrick’s sleight of hand. The judge is keen to warn the president that, if ever his administration were to deny funds to sanctuary cities, it would violate the Constitution. It is in connection with this advisory opinion that the judge makes the only point worthy of consideration — albeit not in the case before him. Here, it is useful to recall the Supreme Court’s first Obamacare ruling.

Sanctuary cities? Maybe we should call them snowflake cities. As noted above, there is a transparent agenda behind Orrick’s sleight of hand. The judge is keen to warn the president that, if ever his administration were to deny funds to sanctuary cities, it would violate the Constitution. It is in connection with this advisory opinion that the judge makes the only point worthy of consideration — albeit not in the case before him. Here, it is useful to recall the Supreme Court’s first Obamacare ruling.

As noted above, there is a transparent agenda behind Orrick’s sleight of hand. The judge is keen to warn the president that, if ever his administration were to deny funds to sanctuary cities, it would violate the Constitution. It is in connection with this advisory opinion that the judge makes the only point worthy of consideration — albeit not in the case before him. Here, it is useful to recall the Supreme Court’s first Obamacare ruling.

While conservatives inveighed against Chief Justice Roberts’s upholding of the individual mandate, the decision had a silver lining: The majority invalidated Obamacare’s Medicaid mandate, which required the states, as a condition of qualifying for federal Medicaid funding, to enforce the federal government’s generous new Medicaid qualifications. In our system, the states are sovereign — the federal government may not dictate to them in areas of traditional state regulation, nor may it conscript them to enforce federal law. The Supremes therefore explained that state agreements to accept federal funding in return for adopting federal standards (e.g., to accept highway funding in exchange for adopting the federally prescribed 55-mph speed limit) are like contracts. The state must agree to the federal government’s terms. Once such an agreement is reached, the feds may not unilaterally make material changes in the terms, nor may they use their superior bargaining position to extort a state into acceding to onerous new terms in order to get the federal money on which it has come to depend. Whether a particular case involves such an extortion, as opposed to a permissible nudge, depends on the facts. If the feds are too heavy-handed, they run the risk of violating the Tenth Amendment’s federalist division of powers.

Who knew federal judges in ur-statist San Francisco had become such federalists? Orrick contends that if Trump were to cut off funds from sanctuary cities for failure to assist federal immigration-enforcement officials, it would offend the Tenth Amendment. This is highly unlikely. First, let’s remember — though Orrick studiously forgets — that Trump’s order endorses only such stripping of funds as Congress has already approved. Thus, sanctuary jurisdictions would be ill-suited to claim that they’d been sandbagged.

Second, the money likely to be at issue would surely be nothing close to Medicaid funding. Finally, Trump would not be unilaterally rewriting an existing federal–state contract; he’d be calling for the states to follow federal laws that (a) were on the books when the states started taking federal money and (b) pertain to immigration, a legal realm in which the courts have held the federal government is supreme and the states subordinate. Still, all that said, whether any Trump-administration effort to cut off funding would run afoul of the Tenth Amendment would depend on such considerations as how much funding was actually cut; whether Congress had authorized the cut in designing the funding program; whether the funding was tightly related or unrelated to immigration enforcement; and how big a burden it would be for states to comply with federal demands. Those matters will be impossible to evaluate unless and until the administration actually directs a slashing of funds to a sanctuary jurisdiction. If that happens, there will almost certainly be no legal infirmity as long as Trump’s E.O. means what it says — namely, that any funding cuts must be consistent with existing federal law. But it hasn’t happened. And as long as it hasn’t happened, there is no basis for a court to involve itself, much less issue an anticipatory ruling. Such niceties matter only if you’re practicing law, though. Judge Orrick is practicing politics.

Thus, taking a page from the activist left-wing judges who invalidated Trump’s “travel ban” orders, Orrick harps on stump speeches by Trump and other administration officials. One wonders how well Barack “If you like your plan, you can keep your plan” Obama would have fared under the judiciary’s new Trump Doctrine: The extravagant political rhetoric by which the incumbent president customarily sells his policies relieves a court of the obligation to grapple with the inevitably more modest legal text of the directives that follow.

Here, it is useful to recall the Supreme Court’s first Obamacare ruling. While conservatives inveighed against Chief Justice Roberts’s upholding of the individual mandate, the decision had a silver lining: The majority invalidated Obamacare’s Medicaid mandate, which required the states, as a condition of qualifying for federal Medicaid funding, to enforce the federal government’s generous new Medicaid qualifications.

 

In our system, the states are sovereign — the federal government may not dictate to them in areas of traditional state regulation, nor may it conscript them to enforce federal law. The Supremes therefore explained that state agreements to accept federal funding in return for adopting federal standards (e.g., to accept highway funding in exchange for adopting the federally prescribed 55-mph speed limit) are like contracts. The state must agree to the federal government’s terms. Once such an agreement is reached, the feds may not unilaterally make material changes in the terms, nor may they use their superior bargaining position to extort a state into acceding to onerous new terms in order to get the federal money on which it has come to depend. Whether a particular case involves such an extortion, as opposed to a permissible nudge, depends on the facts. If the feds are too heavy-handed, they run the risk of violating the Tenth Amendment’s federalist division of powers.

Who knew federal judges in ur-statist San Francisco had become such federalists?

Orrick contends that if Trump were to cut off funds from sanctuary cities for failure to assist federal immigration-enforcement officials, it would offend the Tenth Amendment. This is highly unlikely. First, let’s remember — though Orrick studiously forgets — that Trump’s order endorses only such stripping of funds as Congress has already approved. Thus, sanctuary jurisdictions would be ill-suited to claim that they’d been sandbagged. Second, the money likely to be at issue would surely be nothing close to Medicaid funding. Finally, Trump would not be unilaterally rewriting an existing federal–state contract; he’d be calling for the states to follow federal laws that (a) were on the books when the states started taking federal money and (b) pertain to immigration, a legal realm in which the courts have held the federal government is supreme and the states subordinate.

Still, all that said, whether any Trump-administration effort to cut off funding would run afoul of the Tenth Amendment would depend on such considerations as how much funding was actually cut; whether Congress had authorized the cut in designing the funding program; whether the funding was tightly related or unrelated to immigration enforcement; and how big a burden it would be for states to comply with federal demands. Those matters will be impossible to evaluate unless and until the administration actually directs a slashing of funds to a sanctuary jurisdiction.

If that happens, there will almost certainly be no legal infirmity as long as Trump’s E.O. means what it says — namely, that any funding cuts must be consistent with existing federal law. But it hasn’t happened. And as long as it hasn’t happened, there is no basis for a court to involve itself, much less issue an anticipatory ruling.

Such niceties matter only if you’re practicing law, though. Judge Orrick is practicing politics.

 http://www.nationalreview.com/article/447058/trump-administration-sanctuary-city-executive-order-activist-liberal-judge-william-h-orrick

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Mexico–United States barrier

From Wikipedia, the free encyclopedia

Border fence near El Paso, Texas

Border fence between San Diego‘s border patrol offices in California (left) and Tijuana, Mexico (right)

The Mexico–United States barrier is a series of walls and fences along the Mexico–United States border aimed at preventingillegal crossings from Mexico into the United States and vice versa.[1] The barrier is not one continuous structure, but a grouping of relatively short physical walls, secured in between with a “virtual fence” which includes a system of sensors and cameras monitored by the United States Border Patrol.[2] As of January 2009, U.S. Customs and Border Protection reported that it had more than 580 miles (930 km) of barriers in place.[3]The total length of the continental border is 1,989 miles (3,201 km).

Background

Two men scale the border fence into Mexico near Douglas, Arizona, in 2009

Two men scale the border fence into Mexico near Douglas, Arizona, in 2009

The barriers were built from 1994 as part of three larger “Operations” to taper transportation of illegal drugs manufactured in Latin America and immigration: Operation Gatekeeper in California, Operation Hold-the-Line[4] in Texas, and Operation Safeguard[5] in Arizona.

96.6 per cent of apprehensions by the Border Patrol in 2010 occurred at the southwest border.[6] The number of Border Patrol apprehensions declined 61% from 1,189,000 in 2005 to 723,840 in 2008 to 463,000 in 2010. The decrease in apprehensions may be due to a number of factors including changes in U.S. economic conditions and border enforcement efforts. Border apprehensions in 2010 were at their lowest level since 1972.[6] In March 2017 there were 17,000 apprehensions, which was the fifth month in a row of decline. In December 2016 apprehensions were at 58,478.[7]

The 1,954-mile (3,145 km) border between the United States and Mexico traverses a variety of terrains, including urban areas and deserts. The barrier is located on both urban and uninhabited sections of the border, areas where the most concentrated numbers of illegal crossings and drug trafficking have been observed in the past. These urban areas include San Diego, California and El Paso, Texas. As of August 29, 2008, the U.S. Department of Homeland Security had built 190 miles (310 km) of pedestrian border fence and 154.3 miles (248.3 km) of vehicle border fence, for a total of 344.3 miles (554.1 km) of fence. The completed fence is mainly in New Mexico, Arizona, and California, with construction underway in Texas.[8]

U.S. Customs and Border Protection reported that it had more than 580 miles (930 km) of fence in place by the second week of January 2009.[3] Work is still under way on fence segments in Texas and on the Border Infrastructure System in California.

The border fence is not one continuous structure and is actually a grouping of short physical walls that stop and start, secured in between with “virtual fence” which includes a system of sensors and cameras monitored by Border Patrol Agents.[2]

As a result of the effect of the barrier, there has been a marked increase in the number of people trying to illegally cross the Sonoran Desert and crossing over the Baboquivari Mountain in Arizona.[9] Such illegal immigrants must cross 50 miles (80 km) of inhospitable terrain to reach the first road, which is located in the Tohono O’odhamIndian Reservation.[9][10]

Status

Aerial view of El Paso, Texas and Ciudad Juárez, Chihuahua; the border can clearly be seen as it divides the two cities at night

Aerial view of El Paso, Texas (on the left) and Ciudad Juárez, Chihuahua (on the right), the border can clearly be seen as it divides the two cities at night

The wall in Tijuana, Mexico.

U.S. RepresentativeDuncan Hunter, a Republican from California and the then-chairman of the House Armed Services Committee, proposed a plan to the House on November 3, 2005 calling for the construction of a reinforced fence along the entire United States–Mexican border. This would also have included a 100-yard (91 m) border zone on the U.S. side. On December 15, 2005, Congressman Hunter’s amendment to the Border Protection, Anti-terrorism, and Illegal Immigration Control Act of 2005 (H.R. 4437) passed in the House. This plan called for mandatory fencing along 698 miles (1,123 km) of the 1,954-mile (3,145-km) border.[11] On May 17, 2006 the U.S. Senate proposed with Comprehensive Immigration Reform Act of 2006 (S. 2611) what could be 370 miles (600 km) of triple layered-fencing and a vehicle fence. Although that bill died in committee, eventually the Secure Fence Act of 2006 was passed by Congress and signed by President George W. Bush on October 26, 2006.[12]

The government of Mexico and ministers of several Latin American countries condemned the plans. Rick Perry, governor of Texas, also expressed his opposition saying that instead of closing the border it should be opened more and through technology support legal and safe migration.[13] The barrier expansion was also opposed by a unanimous vote of the Laredo, Texas City Council.[14] Laredo’s Mayor, Raul G. Salinas, was concerned about defending his town’s people by saying that the Bill which included miles of border wall would devastate Laredo. He stated “These are people that are sustaining our economy by forty percent, and I am gonna [sic] close the door on them and put [up] a wall? You don’t do that. It’s like a slap in the face.” He hoped that Congress would revise the Bill to better reflect the realities of life on the border.[15] There are no plans to build border fence in Laredo at this time.[citation needed]However, there is a large Border Patrol presence in Laredo.

Secure Fence Act

H.R. 6061, the “Secure Fence Act of 2006“, was introduced on September 13, 2006. It passed through the U.S. House of Representatives on September 14, 2006 with a vote of 283–138.

On September 29, 2006, by a vote of 80–19 the U.S. Senate confirmed H.R. 6061 authorizing, and partially funding the “possible” construction of 700 miles (1,125 km) of physical fence/barriers along the border. The very broad support implied that many assurances were been made by the Administration—to the Democrats, Mexico, and the pro “Comprehensive immigration reform” minority within the GOP—that Homeland Security would proceed very cautiously. Secretary of Homeland SecurityMichael Chertoff, announced that an eight-month test of the virtual fence he favored would precede any construction of a physical barrier.

On October 26, 2006, President George W. Bush signed H.R. 6061 which was voted upon and passed by the 109th Congress of the United States.[16] The signing of the bill came right after a CNN poll showed that most Americans “prefer the idea of more Border Patrol agents to a 700-mile (1,125-kilometer) fence.”[17] The Department of Homeland Security has a down payment of $1.2 billion marked for border security, but not specifically for the border fence.

As of January 2010, the fence project had been completed from San Diego, California to Yuma, Arizona.[dubious ] From there it continued into Texas and consisted of a fence that was 21 feet (6.4 m) tall and 6 feet (1.8 m) deep in the ground, cemented in a 3-foot (0.91 m)-wide trench with 5000 psi (345 bar; 352 kg/cm²) concrete. There were no fatalities during construction, but there were 4 serious injuries with multiple aggressive acts against building crews. There was one reported shooting with no injury to a crew member in Mexicali region. All fence sections are south of the All-American Canal, and have access roads giving border guards the ability to reach any point easily, including the dunes area where a border agent was killed 3 years before and is now sealed off.

The Republican Party’s 2012 platform stated that “The double-layered fencing on the border that was enacted by Congress in 2006, but never completed, must finally be built.”[18] The Secure Fence Act’s costs were estimated at $6 billion,[19] more than the Customs and Border Protection’s entire annual discretionary budget of $5.6 billion.[20] The Washington Office on Latin America noted on its Border Fact Check site in about the year 2013 that the cost of complying with the Secure Fence Act’s mandate was the reason it had not been completely fulfilled.[21]

Rethinking the expansion

In January 2007 incoming House Majority Leader Steny H. Hoyer (D-MD) announced that Congress would revisit the fence plan, with committee chairs holding up funding until a comprehensive border security plan was presented by the United States Department of Homeland Security. Then the Republican senators from Texas, John Cornyn and Kay Bailey Hutchison, advocated revising the plan, as well.[14]

The REAL ID Act, attached as a rider to a supplemental appropriations bill funding the wars in Iraq and Afghanistan, decreed, “Not withstanding any other provision of law, the Secretary of Homeland Security shall have the authority to waive all legal requirements such Secretary, in such Secretary’s sole discretion, determines necessary to ensure expeditious construction of the barriers and roads.” Secretary Chertoff used his new power to “waive in their entirety” the Endangered Species Act, the Migratory Bird Treaty Act, the National Environmental Policy Act, the Coastal Zone Management Act, the Clean Water Act, the Clean Air Act, and the National Historic Preservation Act to extend triple fencing through the Tijuana River National Estuarine Research Reserve near San Diego.[22] The Real ID Act further stipulates that the Secretary’s decisions are not subject to judicial review, and in December 2005 a federal judge dismissed legal challenges by the <