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Wednesday, July 26, 2017

Obamacare Repeal whiplash week

Given that federal health care policy will drive the incentives (pro and con) and actions of every stakeholder sector of the U.S. health space -- both across the breadth of the goods and services providers' sides and with respect to those of patients, all eyes are now on the Senate. By the time you start to post about developments, they seem to change materially.

Yesterday the Senate voted 51 to 50 (VP Pence casting the tie-breaker) on a "Motion to Proceed" to open debate on "Calendar 120, H.R. 1628," the 132 page "budget reconciliation" AHCA bill. This bill does nothing beyond repealing funding for most provisions of the ACA that impact the 2017 federal FY17 budget.

Critics of "repeal" had better be vigilant regarding a "bait and switch" bill, given the GOP insistence on quickly ramming through a vote.

Steve Findlay just posted on update comment on his latest THCB post How Insane Could This Get?
Another vote will occur today, on the bill to “repeal and delay.” It will fail, as did last night’s Better Care Reconciliation Act, version 2.5.

After that, it looks as is the “skinny” bill will be introduced, possibly as early as tomorrow.

This is not a bill that any senator has yet seen! And it’s unclear whether the Republican moderate camp or conservative camp will support it.

In keeping with the bizarre nature of this process, the contents of the skinny repeal bill do not seem to matter. They’ll be symbolic—allowing some Republicans to say they voted to repeal the individual and employer mandates, for example.

Rather, the skinny repeal bill is a vehicle and tactic. If it musters 51 votes, its passage would lead to a conference committee with the House. Negotiations could then continue in both chambers, possibly past the August 11 recess and into September, in search of a larger-scope bill that could garner enough R support to pass.

McCain’s passionate plea yesterday to his colleagues to stop all this nonsense and reach across the aisle on big issues like health care is unlikely to change anything, particularly since McCain ended up voting for BCRA hours after he said he would not...
I'd previously left my own comment under that THCB post:
Calendar No. 120, H.R. 1628, “The American Health Care Act” is the bill now voted on “Motion to Proceed” for Senate debate (via 51-50 vote, Pence tie-breaker). 132 pages at this point (in my PDF download). The word “repeal” occurs 42 times. Salient because it’s a “budget reconciliation” bill not subject to 60-vote supermajority. Only speaks to rescinding spending authority provisions granted the PPACA pertaining to THIS federal fiscal year (that’s what “budget reconciliation” means).

The phrase “the Secretary” appears 36 times (goes to HHS “regulatory discretion”). “Amend,” 100 times, “amended” specifically 67 times. THAT stuff has you scurrying over to the other laws cited for amendment.

Notable for its utter lack of specifics, beyond cutting funding for ACA provisions. Nil amount of “Replace” language.

Will have to watch closely for ‘bait and switch” updates.
And, another:
Pen-in-hand-sitting-waiting-in-the-Oval-Office Trump in particular just wants a bill to sign. He will never read the first word of it; he simply doesn’t care, all he wants is to be able to go on to his next red state Trumpkin MAGA eternal campaign rally and crassly brag about his “Great Win on Health Care.” There will be PLENTY of time later to blame everyone else for the inevitable subsequent Custerfluck.
The Brink of the Unthinkable
The Senate has started down a path America has never taken: dismantling the social safety net.

On Tuesday, the Senate—with the late, dramatic arrival of Sen. John McCain, who cast a deciding vote—opened the floor to Obamacare repeal. A procedural vote, it was the remarkable capstone of an unprecedented effort to pass major legislation without hearings, independent testimony, or public input. What makes it potentially history-making, and not just noteworthy, is that it also marks a milestone for our country: the beginning of what is, thus far, one of the most aggressive attempts at revoking a broad guarantee of the American welfare state. A door that, once opened, may prove difficult to close…
Obama Stays Silent on Health Care Debate. Here’s Why.
Democrats worry if President Obama tries to publicly save his health care law, he might kill it.

As the process for repealing and replacing Obamacare incrementally advances through Congress, its namesake remains largely absent from the give-and-take of the debate.
President Barack Obama has weighed into the health care fray only occasionally—and always from a distance—even as his eponymous signature piece of domestic legislation comes under heightened threat.

It is not for lack of want. Aides and advisers say that the former president is, like all Democrats, troubled by ability of Republican leadership to keep repeal efforts alive. One official said he did not expect GOP lawmakers to get even this far. But he is wary of engaging in a highly visible way, even in this critical hour, for fear that it would backfire politically.

“We are acutely aware that opponents of the Affordable Care Act would like no better foil than him,” said one Obama advisor. “We don’t want to make this any harder than it is. Allowing opponents to make this about Obama’s legacy undermines the debate about the actual impact of the law.”

For now, Hill Democrats say they’re comfortable with Obama at a distance. Though the party has been unable to stop repeal-and-replace efforts at critical junctures—the most recent coming in the form of a narrowly-lost vote to start debate in the Senate—the prospect of turning the debate into a Obama-v-Trump narrative is viewed as counterproductive...
I have to agree.

"Nice little state ya got here. Be a real shame if something bad happened to it."
Previously on KHIT, The Presidential Oaf of Office.


The Senate "Skinny Repeal" bill went down to defeat at about 3 a.m. EDT. I was up.

 I'm sure there will be more. The cluelessness. He has 52 GOP members in the Senate.
"Let Obamacare implode."

Beyond that fact that every health care goods and services delivery sector stakeholder group opposed these nihilistic GOP "repeal" bills, the average of the most recent public opinion polls (spanning the most conservative to the most liberal) indicate that 5 of 6 American voters oppose them as well (~16% repeal approval).


From Trump's Saturday tweetstorm.


More to come...

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