24 March 2017

PUT UP OR SHUT UP TIME IN THE HOUSE:& CBO releases new score for ObamaCare repeal bill 23MAR17

(NOT MY) president drumpf/trump has issued an ultimatum to the repiglicans in the US House, pass drumpf/trump-ryancare or move on and Obamacare stays. As the +Washington Post reports "PUT UP OR SHUT UP TIME IN THE HOUSE". It will be very interesting how this plays out, especially with the latest CBO / Congressional Budget Office report on the amended repiglican health care plan from +The Hill .....

-- The Republican health-care overhaul faces its greatest test today, as President Trump and House Speaker Paul D. Ryan (R-Wis.) work feverishly to persuade enough Republican lawmakers to back the measure and push it to a floor vote. Mike DeBonis, Juliet Eilperin and David Weigel have the latest on the fluid process: “Late Wednesday, the White House and House leaders were still scrambling to grow support, and signaled at the 11th hour a willingness to rework the measure to mollify conservatives. On Thursday morning House leaders postponed a 9 a.m. meeting of the entire GOP Conference, signaling that negotiations were still underway. After insisting for weeks that the changes sought by hard-right members would render the bill unable to pass the Senate, White House officials and GOP House leaders appeared to shift their thinking — and opponents agreed to keep working on a deal with the goal of holding a floor vote in the House by Thursday night.”
Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, said he had taken personal calls Wednesday from Trump seeking a resolution, although he said no formal offer had been extended by the White House. “We are working very diligently tonight to try and get there,” Meadows said Wednesday.
-- The Koch political network has created a seven-figure fund to back up conservative lawmakers who vote against the bill. It will go toward paid TV, direct mail and grassroots engagement. “The bill as it stands today is Obamacare 2.0,” said James Davis, executive vice president of Freedom Partners. Leaders of the network describe this as following through on their promises to stand with champions of the causes they care about most, even if it means getting crosswise with the Speaker. “We want to make certain that lawmakers understand the policy consequences of voting for a law that keeps Obamacare intact,” said Tim Phillips, the president of Americans for Prosperity.
-- The Rules Committee adjourned at 11:35 p.m. last night after a party line vote to waive key rules of the House so that the Speaker can keep making tweaks until the last minute. The procedural move they used is known inside Congress as “martial law.” Because changes are being made, there is no updated score from the Congressional Budget Office. That means lawmakers will be forced to vote on something before they know how many people will lose coverage or what impact it will have on the deficit. (David Weigel documents some of the things Republicans are doing this week that they attacked Democrats for seven years ago.)
-- Trump has put all his chips on the table. “There is no Plan B,” Sean Spicer said with characteristic bluster during his daily briefing, describing the president as “the closer.” “There is Plan A and Plan A. We’re going to get this done.”
The president is meeting with members of the Freedom Caucus at 11:30 a.m. in the cabinet room. Vice President Pence huddled with the same members in his EEOB office less than 24 hours ago. Yesterday, Trump himself huddled with 18 House Republicans at the White House. As far as we know, those sessions only flipped one conservative from “no” to “yes”: Steve King, who is not a member of the Freedom Caucus. The Iowa congressman said he was swayed by “a firm, firm commitment” from Mitch McConnell to make the Senate vote on an amendment “to strike out the mandates that are written into Obamacare.”
-- Public support for Trump’s approach to health care continues to sink, which will make it harder for him to use the bully pulpit. A new Quinnipiac University poll, which gives the president a 37 percent approval ratings, shows that just 29 percent of Americans approve of how he’s handling this issue. 

Compare that to a CNN poll early this month and a Fox News poll that was in the field 10 days ago. That’s not a promising trajectory:

-- The magic number today is 22. Because a Democrat will be absent from the House today, GOP leaders can afford 22 defections. A Freedom Caucus spokeswoman said yesterday afternoon that “more than 25” members of the group oppose the bill, though that was before any deal was made. (Amber Phillips is keep a running whip count for us here.)
-- The more Ryan and Trump give to the Freedom Caucus, the more problems they may have with the middle. Four GOP moderates came out against the bill yesterday: Reps. Charlie Dent (Pa.), Frank A. LoBiondo (N.J.), Daniel Donovan (N.Y.) and David Young (Iowa). Ryan met with a dozen members of the moderate Tuesday Group in his office last night to stop more bleeding. He outlined what he might give to the Freedom Caucus and asked how they’d react.
-- Several deals have already been cut to win over lawmakers, including special goodies for Illinois and Upstate New York. GOP Rep. Daniel Donovan, who represents New York City, cited this in opposing the bill. In an op-ed for the Staten Island Advance, he said that change “gives our district short shrift.”
-- With those moderate defections, Ryan must figure out a way to get the far right of his conference. But many Freedom Caucus members have already drawn red lines that make it almost impossible to come around. Rep. Mo Brooks (Ala.) said, even after changes were made to satisfy conservatives, that the bill remains “the largest Republican welfare bill in the history of the Republican Party.” Rep. Thomas Massie (Ky.), a close ally of Rand Paul, called the bill a “stinking pile of garbage” that was written by “the insurance lobby.”
-- The risk of forcing a vote: Ryan may be forcing his biggest loyalists to walk the plank for a Pyrrhic victory. If he twists arms to get this through his chamber but then it dies in the Senate, some Republicans may lose their seats in 2018 for nothing. He could be doing what Nancy Pelosi did in 2009 when she forced Democrats to vote for cap-and-trade despite all political tea leaves that said it was a bad idea.
A good illustration of this dynamic is Barbara Comstock, who represents an affluent northern Virginia district that Hillary Clinton carried and is staying mum about how she’ll vote today. She’ll almost certainly give up her vote if Ryan needs it to get across the finish line, but she also knows the ways it that could hurt her reelection hopes next year. A savvy political operative who was heavily involved in the Clinton wars of the 1990s, it is a good bet Comstock has nightmares of the commercials that could be run against her.
-- Over the past three days, there have been several damning reports about the bill that make it hard to convince those who remain undecided. Phil Bump flags three examples:
  • Most of key tax benefits goes to millionaires. The Center on Budget and Policy Priorities, using data from the Tax Policy Center, reports that repealing two taxes that are part of the Affordable Care Act would offer no benefit at all to people making less than $200,000 a year — and would offer the bulk of its benefits, 79 percent of the total cut, to millionaires.
  • Fewer people would have insurance under the AHCA than if Obamacare were simply repealed. The New York Times’s Margot Sanger-Katz looked at the CBO’s analysis and realized something surprising: The estimated 24 million fewer people who would have insurance under the AHCA by 2026 is actually one million people higher than if Obamacare were simply repealed.
  • Deductibles will likely increase by 60 percent. The Kaiser Family Foundation’s Drew Altman calculated that average deductibles from the AHCA would be $1,550 higher than under Obamacare because people will receive smaller subsidies and therefore increasingly choose lower-cost health-care plans that have higher deductible rates.
-- Meanwhile, leading conservative intellectuals are not giving Ryan the cover he needs to change the terms of the debate:
  • “Whatever replaces Obamacare will look a lot like Obamacare,” George F. Will says in his column for this morning’s paper. “‘Mend it, don’t end it’ was President Bill Clinton’s rhetorical straddle regarding affirmative action. Republican efforts to ‘repeal and replace’ the Affordable Care Act (Obamacare) look increasingly like ‘mend it, don’t end it.’”
  • “Nothing good will come of the Obamacare repeal-and-replace debate,” writes National Review Editor Rich Lowry“If anything resembling the current bill passes and is signed into law, Republicans will spend years trying to fix it and live it down. If the bill fails, the rest of Trump's legislative agenda may sink with it.”
-- A sign of the truth-challenged times we live in. From ProPublica’s Charles Ornstein: “As the debate to repeal the law heats up in Congress, constituents are flooding their representatives with notes of support or concern, and the lawmakers are responding, sometimes with form letters that are misleading. A review of more than 200 such letters … found dozens of errors and mischaracterizations about the ACA and its proposed replacement. The legislators have cited wrong statistics, conflated health care terms and made statements that don’t stand up to verification. It’s not clear if this is intentional or if the lawmakers and their staffs don’t understand the current law or the proposals to alter it.”
-- Even if this passes the House today, the bill in its current form will be dead on arrival in the Senate. At least a dozen senators have expressed skepticism, and Trump can afford only two defections. (Sean Sullivan and Kelsey Snell have more on the state of play in the upper chamber.)

CBO releases new score for ObamaCare repeal bill

The Congressional Budget Office (CBO) on Thursday released a new score for a revised plan to repeal and replace ObamaCare that Republican leaders are struggling to pass in the House. 
The CBO found that this version of the healthcare plan contains significantly less deficit reduction than the original but would lead to essentially the same levels of coverage losses and premium increases. 
The legislation would reduce the deficit by $150 billion over 10 years, down from $337 billion in the original legislation, the report said. The plan would still result in 24 million more people being uninsured in 2026, a finding that has been a rallying cry for Democrats.
Premiums would still initially rise by 15 percent to 20 percent before eventually becoming 10 percent lower, the CBO said.
GOP leaders had pledged that they would wait for the CBO's new score before holding a floor vote on the legislation. That vote could happen as early as Friday.
The CBO's score, however, does not reflect last-minute changes that could be made to win over conservatives, including repeal of ObamaCare's minimum coverage requirements. That change would be significant, but it is possible House Republicans could bring up the vote without that revised score. 
The revised analysis takes into account a range of changes Republicans made to the bill. The main reason the deficit reduction is now lower is that Republicans moved up repeal of ObamaCare's taxes by one year, something conservatives had requested.
The revised bill also turns Medicaid funding into block grants for states and gives states the option of creating work requirements for Medicaid recipients. Another change slightly increases a cap on Medicaid spending.
GOP leaders are scrambling to shore up the 215 votes likely needed to pass the ObamaCare repeal bill. A vote on the bill for Thursday was postponed after efforts to strike a deal with conservatives came up empty.
Democrats are fighting to protect ObamaCare and rooting for Republicans to fail. They seized on the new CBO analysis.
"The CBO has reconfirmed tonight that the Republican plan will cause millions of Americans to lose their coverage and out-of-pocket costs to skyrocket, while subjecting middle-aged Americans to an age tax. They do all this to give $1 trillion in tax cuts to corporations and the wealthy, but they may not stop there," said Rep. John Yarmuth (Ky.), the ranking Democrat on the House Budget Committee.
"It is astounding and appalling that Republicans in Congress are negotiating with the health and well-being of American families. They have no moral compass."
Updated at 5:42 p.m.