Obamacare

New CBO Report Says the Senate GOP Health Care Bill Would Make Obamacare's Problems Worse

The Republican health care plan wouldn't solve the problems Republicans say they want to solve.

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MICHAEL REYNOLDS/EPA/Newscom

In January of this year, as congressional Republicans were ramping up legislation to repeal, or at least rewrite, Obamacare, Mitch McConnell, the top Republican in the Senate, went on Face the Nation to make his case against the current health care law.

"What you need to understand is that there are 25 million Americans who aren't covered now," he said. "If the idea behind Obamacare was to get everyone covered, that's one of the many failures. In addition to premiums going up, copayments going up, deductibles going up. And many Americans who actually did get insurance when they did not have it before have really bad insurance that they have to pay for, and the deductibles are so high that it's really not worth much to them. So it is chaotic. The status quo is simply unacceptable."

McConnell's case against Obamacare, highlighted at the time by Vox's Ezra Klein, was that it didn't cover enough people, that premiums were too expensive, that out of pocket payments and deductibles were too large, and that the system as a whole, with its unstable health exchanges, was too chaotic. Something would have to change.

McConnell's argument had the virtue of being essentially true. Health insurers have exited the exchanges. Deductibles in Obamacare plans run high. Premiums for typical plans under the law went up 22 percent last year. The current system has increased coverage, but it has not covered everyone, and those who do have coverage have reported frustrations with the expense and limitations of their plans.

At the time, Republicans had not released their own health care legislation, or shared the framework for their plan. But now they have, and it is hard to square McConnell's criticisms of Obamacare with the legislation his office helped produce. According to a Congressional Budget Office (CBO) estimate released this afternoon, the Senate health care bill, the Better Care Reconciliation Act (BCRA), would make every single one of the issues that McConnell mentioned worse.

Essentially, the CBO's report concludes that the Senate GOP's health care bill would not solve any of the problems that Mitch McConnell said he wanted to solve. Like the Senate health care bill itself, it highlights the cynicism and emptiness of Republican thinking on health care policy.

Let's start with coverage. McConnell complained that "one of the many failures" of Obamacare was that it left 25 million uncovered. According to CBO, however, under the Senate health care plan 15 million fewer people would have coverage next year than under current law. By 2026, the CBO estimates that the figure would rise to 22 million. McConnell couched this criticism in a caveat—"if the idea behind Obamacare was to get everyone covered"—which perhaps suggests that this is only a failure if the idea is to cover everyone. But Republicans did not and do not have another idea. Indeed, around the same time, President Trump promised that the Republican plan would provide insurance for everyone.

McConnell also hit Obamacare for rising premiums. But the Senate health plan would not halt those increases either. CBO estimates that if the plan were to become law, premiums would be about 20 percent higher next year than under Obamacare. To be clear, that's a 20 percent increase above and beyond what is already projected. In 2019, premiums would be 10 percent higher than under current law. Starting in the next decade, CBO estimates that premiums would be lower than under current law by about 30 percent. But that's after several years of significant hikes.

Which brings us to one of McConnell's other criticisms, that the insurance provided under Obamacare isn't very valuable. According to CBO, the biggest reason why premiums would be lower, relatively speaking, in the next decade is because, on average, health plans would cover significantly less than they do now.

The Senate bill pegs its subsidies to health plans with lower actuarial values than Obamacare does; these plans are known as benchmark plans. The actuarial value is the percentage of expected health costs that a plan must pay. What this means is that the Senate legislation is built around standard plans that offer less generous coverage than under Obamacare. At the same time, it leaves many of Obamacare's insurance regulations in place. So in order for health insurers to offer standard plans that also comply with Obamacare's regulations, they end up having to include high deductibles. Under Obamacare, plans that resemble the Senate bill's standard plans typically have deductibles of about $6,000, meaning that beneficiaries have to pay that amount before using their coverage.

In some cases, the deductibles would be high enough that they would limit the value of plans, according to the CBO, especially to low-income individuals. "As a result," the report states, "despite being eligible for premium tax credits, few low-income people would purchase any plan."

You might summarize this by saying, for example, that the Senate bill might result in people having "really bad insurance that they have to pay for, and the deductibles are so high that it's really not worth much to them."

Do they have to pay for it? The Senate health care bill does eliminate Obamacare's individual mandate. But it includes a workaround, intended to synthesize the mandate's effects, by penalizing people who go without coverage for 63 days in a different way—prohibiting them from obtaining insurance coverage for six month.

And what about insurance markets? Today's CBO report expects that under the Senate plan, individual insurance markets would continue to be stable in "most parts of the country"—emphasis on the "most." This is another way of saying that the Senate bill would not significantly improve on the conditions we are seeing under Obamacare. The CBO also notes, with some uncertainty, that some of the provisions in the Senate bill could cause insurers to exit the market, or refuse to enter. So it would not be less chaotic. It might be more so.

Are the CBO's estimates perfectly accurate? Almost certainly not. As point estimates, they are quite likely to be wrong. And the CBO's models sometimes miss complex economic feedback effects.

But the single point estimates are less important than the broader shifts the agency foresees. CBO's projections are likely to be directionally accurate: higher premiums and deductibles, fewer people with coverage and lingering questions about market stability. CBO's report is a picture of an insurance market that has all of the flaws that Mitch McConnell diagnosed in Obamacare, but worse.

As with the structure of the Senate health care bill—a dysfunctional rewrite masquerading as repeal—what CBO's report exposes is the GOP's unwillingness to think beyond the parameters of Obamacare.

Republicans did not respond to the failures of Obamacare with a different vision of how the health care system should be organized. They did not build a case for policies with different goals about the health care system. Instead, they criticized Obamacare for not living up to its own goals, for failing on its own terms. Even in their criticisms, they bought into to its premises. They had no policy goals of their own to promote.

So it is hardly surprising that when it came time to repeal and replace Obamacare, they instead produced legislation that simply rewrote it, offering the same thing, but less of it. And it is even less surprising that the legislation they have released undercuts the criticisms that McConnell and others have made of Obamacare, because their plan has the same problems—but even more acute.

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80 responses to “New CBO Report Says the Senate GOP Health Care Bill Would Make Obamacare's Problems Worse

  1. Didn’t read the article, but CBO is in fantasy land about the impact of the Individual mandate.

  2. This is the same CBO that blessed the PPACA?

    Can they provide comparative assumptions and their justification?

    Non-partisan ?

    “Your house is on fire and I’m selling you fire insurance”

    1. It’s not the CBO’s fault that Congress wrote laws saying how they had to score laws and then the Democrats wrote a bill designed to exploit loopholes in the laws. They did a fair job and even unofficially said they didn’t believe their numbers.

  3. On another note, the GOP is so damn stupid for trying this “six month waiting period” bit. It does nothing for their right wing because it still requires all preexisting conditions to be covered. It lets the media and the left have an absolute field day with the image of people dying on the streets for six months. It gives insurers a shield for anticompetitive practices because it’s easy for everyone to max out the government limit in their policy without people shopping around – it’s the law, ma’am.

    They legitmately might have had more success issuing a “fuck you, slaver” statement and completely deregulating preexisting condition coverage, and that’s nothing but a Salon fever dream.

  4. “Do they have to pay for it? The Senate health care bill does eliminate Obamacare’s individual mandate. But it includes a workaround, intended to synthesize the mandate’s effects, by penalizing people who go without coverage for 63 days in a different way?prohibiting them from obtaining insurance coverage for six month.”

    The insurance companies shouldn’t be forced to cover anybody who skips paying their premiums at all.

    Letting the insurance companies refuse to sell people insurance for six months because they hopped off the program and back on when they got sick or pregnant was just added to the Senate plan over the weekend. It was in response to critics claiming that the insurance companies charging people a 30% fee for coming back onto their plan after skipping payments was just like siccing the IRS on people for not buying insurance a la the individual mandate.

    Have you guys read anyone around here making such an outrageous comparison?

    Meanwhile, when they fix that problem in reaction to four libertarianish Republicans (including Rand Paul), you call the solution to that “problem” out as a problem, as well?

    In reverse Pelosi fashion, it seems that some people don’t need to know what’s in the bill to oppose it. They’ll just oppose it no matter what’s in it.

  5. “Starting in the next decade, CBO estimates that premiums would be lower than under current law by about 30 percent. But that’s after several years of significant hikes.”

    Those savings presumably kick in after the ObamaCare Medicaid expansion is phased out in 2019.

    If that phase out of the Medicaid expansion were accelerated, the Senate wouldn’t pass it.

    Is Suderman saying we shouldn’t support a plan to phase out the Medicaid expansion because it doesn’t happen immediately?

    Imagine if I refused to cash in my winning lottery ticket because it doesn’t pay out until two years from now.

  6. “Republicans did not respond to the failures of Obamacare with a different vision of how the health care system should be organized. They did not build a case for policies with different goals about the health care system.”

    Republicans put together a plan to move people from Medicaid to private insurance with subsidies–exactly like moving kids from public schools to private schools with vouchers.

    This fundamental shift is a road map to using free market solutions to bring quality medical care to the poor by shifting them from a socialist Medicaid system to private insurance.

    This isn’t just a way to get rid of the ObamaCare Medicaid expansion. It points the way to eliminating Medicaid entirely. And it’s revolutionary. Has anyone ever tried to roll back Medicaid eligibility before?

    1. It’s not EXACTLY like moving kids from public schools to private schools with vouchers because schools are the direct providers of education, while insurance companies provide no medical care whatsoever. They pick and choose what they will pay for and how much they will pay for it.

      1. No they don’t.

        I linked this elsewhere in the thread. Look at it again:

        http://tinyurl.com/lcayz2f

        The insurance companies have paid almost as much as 150% of the cost of care in recent years to make up for the amount providers lose treating Medicare and Medicaid patients.

        Furthermore, what they cover is imposed on them by ObamaCare, especially.

        For instance, they are not allowed to offer policies that don’t cover pregnancy and mental health.

        1. The insurance companies have paid almost as much as 150% of the cost of care in recent years to make up for the amount providers lose treating Medicare and Medicaid patients.

          You misread your chart.

  7. Seriously Reason. You are going with CBO estimates. No one in DC can estimate…well how far they can piss this evening, let alone how much of anything will be in 10 years. Plus, I thought this was a libertarian site. the best estimate is 20 some million people don;t want insurance at the price it exists. And you are supporting the concept that the country should.

    Did you just forget about the whole “free minds and free markets” thing? Or is that only for SJW things.

    The fact that the bill is one more, “we are more budget conscious than the Dems” kinda of a bill is what you should be talking about. Tere is nothing free market here. Please stop talking like a liberal think tank or CNN

    1. I thought this was a libertarian site.

      noob !

    2. Rand and Mike are full of shit. We had a free market in healthcare for the uninsured until shortly after Medicaid. Guess what the outcome was? Universal treatment for the uninsured, regardless of income, fully paid for by the American people, voluntarily, charitable care … the market outcome that they DEFY. As a doctor, Rand is the worst of the two.

      The goober marketers think they can repeal Medicaid tomorrow and the entire private care infrastructure will will spring from the ground, magically, after disappearing 50 years ago. SNAP YOUR FINGERS!

      Anti-government is NOT pro-liberty, REAL libertarians have proposed and debated various ways to transition back to free market outcomes. It must be a phase-in, and the cash transfers must be the same pace and timing as needed to restore it all, without abandoning anyone.

      Progressives are kicking our ass BECAUSE of Paul and Lee. The free market PROVES that Americans willingly pay to treat the uninsured. If we have no better way to do that, then Bernie Sanders has the only acceptable option.

      1. ???? That should have appeared here:
        https://reason.com/blog/2017/06…..nt_6885239

  8. Let’s add some other stats from the CBO that Reason published on this very website over the weekend:

    1) “The House changes, according to the nonpartisan Congressional Budget Office, would reduce the number of people on Medicaid by 14 million by 2026.”

    2) “Under the House plan, the federal savings would amount to $880 billion over a decade. The Senate bill is supposed to wring out even more.”

    https://tinyurl.com/yaa3xpwf

    And those stats were quoted in an article that was againstcutting Medicaid!

    I look at those statistics, and I see the government getting smaller. Why are so many ostensibly libertarian commentators whining?

    1. I look at those statistics, and I see the government getting smaller. Why are so many ostensibly libertarian commentators whining?

      AGAIN? How many times???? . It DEFIES the free market outcomes, when we had one, which was universal treatment for the uninsured, regardless of income — which Americans paid for, willingly and voluntarily,

      Cutting Medicaid ,,, which your other bullshit says won’t happen — is for anti-gubmint goobers.
      Pro-liberty libertarians have been proposing — since the 1970s – a transition back to private charity.

      The goobers think they can repeal Medicaid tomorrow and the entire private infrastructure — dead for 50 years — will magically restore itself. Plus, it’s hysterical to see fake libertarians reject BOTH private charity AND free-market outcomes.

      Government has caused a lot of damage, Sparky. And why do you shit on free market outcomes?

      Oh yeah, since Americans overwhelming support care for the indigent — and are willing to pay for it — you strategic geniuses want Bernie Sanders to be the only option. Umm, consent of the governed and will of the people are also rejected by you authoritarians. So cut the shit about being a libertarian.

      YOU are a walking billboard for single-payer … and an example of what the progs call “heartless assholes.”
      You and your ilk are a disgrace to individual liberty.

  9. Wait, think I get it now!

    We libertarians are supposed to oppose slashing Medicaid eligibility, cutting spending by $880 billion, and making the government smaller–because Mitch McConnell is full of crap.

    Do I have that right?

    1. Ken, the bill does not cut spending by $880 billion. First, that’s from the CBO analysis of the House bill, not the Senate bill, and the number is actually $834 billion, not sure where the $880 billion came from. Second, that figure constitutes the proposed reduced rate of growth of Medicaid compared to the projected ObamaCare status quo, not an actual reduction in spending. Tom Price is right when he said that Medicaid spending would increase under this bill. See here (p. 16, “Basis of Estimate”)

      Third, these cuts are PHONY. They are only planned to occur after 2020. This is because they are not serious about it. They are only using this as a way to buy votes from their base who is insistent that Obamacare really ought to be repealed. This is the exact same stunt that they pulled in 2010, and in 2014, and most recently in 2016. I for one am not inclined to reward the Republicans’ mendacity.

      I think the correct response to McConnell should be something like: Prove to us that you really weren’t lying the whole time about repealing ObamaCare, prove to us that you really are serious. Put your own necks on the line and insist that these unpopular cuts happen BEFORE the next election, not after. Don’t just use this health care bill as just one more stunt to try to wring more votes out of angry Americans and to save your sorry pathetic ass.

      1. This comment is full of so many absurdities, it’s hard to know where to start.

        Are you saying you would support the bill if it cut $880 billion over ten years rather than a mere $834 billion?

        You’re saying that the eligibility cuts are phony because they don’t take effect immediately?

        Then you actually mentioned that the ACA’s expansion didn’t take effect until 2014, but was the 2010 ObamaCare Medicaid expansion phony because it wasn’t scheduled to take effect until 2014?

        There’s an old adage about how you know your marketing is working when your customers regurgitate your marketing logic back to you. I guess Suderman’s marketing has been very effective with you–you seem to just be regurgitating shit you’ve read here. Apart from that explanation, what you’re saying doesn’t make any sense.

        We should oppose a law to cut Medicaid eligibility because some future congress may expand Medicaid eligibility again? Does that kind of “logic” work in any other context? Should we oppose legalizing marijuana because some future congress might criminalize it again?

        What you’re saying doesn’t make any sense, and it shouldn’t make any sense to you.

        1. Ken, more plainly, I’m saying that the Medicaid cuts are a gimmick. They are a way for Republicans to gin up votes among their angry voters – vote for us in 2020, otherwise those dastardly Democrats will stop the ObamaCare cuts from being enacted! I’m saying that they have played this game before, and I don’t think they ought to be rewarded for these games and gimmicks. We ought to demand action NOW, cuts NOW, to prove to us that they are serious about what they claim to stand for.

          “Should we oppose legalizing marijuana because some future congress might criminalize it again?”

          No, but if, say, a politician proposed to legalize marijuana in, say, 20 years, and then kept running campaign ads which said “you had better keep voting for me otherwise pot won’t ever be legalized 20 years down the road!”, then it’s pretty safe to say that this politician really doesn’t give a damn about pot, and wants instead to use the issue in order to secure his own position of power.

          And yes, Obama did the same thing, when he deliberately delayed implementation of the more onerous parts of ObamaCare until after 2012.

          1. “Ken, more plainly, I’m saying that the Medicaid cuts are a gimmick.”

            You use that word “gimmick”. I’m not sure you know what it means.

            We’re talking about a law. Not a gimmick.

            The AHCA kills the ObamaCare Medicaid expansion. It has already passed the House. That is not a gimmick. That is a requirement to become a law.

            The Senate plan, likewise, kills the ObamaCare Medicaid expansion. If they pass it, killing the ObamaCare Medicaid expansion will not be a gimmick. It will have cleared Congress. It will go to Donald Trump’s desk.

            When it goes to Donald Trump’s desk, he will sign it and say that he fulfilled his campaign promise.

            And it will not be a gimmick. The ObamaCare Medicaid expansion will be gone.

            The only way to get it back again will be 1) if the Republicans lose control of both houses of Congress so thoroughly that the Democrats can override Trump’s veto or 2) If the Democrats get a Democrat in the White House.

            1. Republicans(with a few exceptions) are playing musical chairs, just trying to keep their own seats.They (symbolically) voted several times on repeal and could bring the same repeal bill to a vote again, if only repealing the ACA were actually their end goal. This bill does nothing to reduce costs of healthcare. It switches the bailout money to the insurance companies. Will there be an opt out so I can use my money for free market solutions?Health services in America cost so much BECAUSE of insurance. It should be used to protect against the financial impact of unexpected events, not to pay for expected annual checkups, and not to determine what procedures you can get based on arbitrary one size fits all rules. I once waited for 4 months to get an MRI while my doctor could only prescribe PT and pain killers because the insurance company makes the rules(ever wonder how our current system creates an opioid addict?), not the doctor. Someone behind a desk at an insurance company gets to decide what I need based on arbitrary guidelines created to increase their profits.The two major parties stand for nothing and do not care about the American people. If you can’t see this, you’re probably in the wrong place and should be watching fox news…where truth goes to die (not any different from CNN or MSNBC).

              1. Republicans(with a few exceptions) are playing musical chairs, just trying to keep their own seats.

                You want them to do something stupid enough to create a massive Democrat majority next year?

                They (symbolically) voted several times on repeal and could bring the same repeal bill to a vote again, if only repealing the ACA were actually their end goal.

                Their “goal” should be to become THE most fucking stupid party i world history?

          2. What happens in 2 years when the impending reversal of the medicaid expansion is used by democrats to gin up their base and potentially oust republicans from their seats? Don’t be fooled into thinking Trump won’t do anything to save himself/his majorities. We know he’s favored single payer in the past anyway. If you actually trust politicians to follow through and do what they say, regardless of how it affects their own future, you are naive. We’ve seen this before. Politicians will say anything to stay in office and I’m willing to bet that If enough R’s get kickback in their districts(just like they did over repeal), medicaid will somehow be saved from the chopping block. Man is ultimately concerned with his own self interest. I’m willing to bet we don’t have too many senators who are willing to lose their seats over changing the status quo…if that were the case, we’d be looking at a repeal bill instead of a regurgitation of the ACA. You can’t make the crap sandwich that is the ACA into chocolate cake just by removing the bread…the crap is still in there.

            1. What happens in 2 years when the impending reversal of the medicaid expansion is used by democrats to gin up their base and potentially oust republicans from their seats?

              POTENTIALLY? It would be the biggest wave in US history.

              Don’t be fooled into thinking Trump won’t do anything to save himself/his majorities

              Don’t be fooled into thinking it won’t be too late.
              He was elected to provide universal coverage and NOT cut Medicaid, the worst political hack of my voting lifetime (which began with Goldwater for prez)

        2. Let me put it to you this way Ken.

          If ObamaCare really is this horrible disaster that Republicans say it is (and I think it is as well), then what is the argument for NOT speedily phasing it out as quickly as possible?

          1. , then what is the argument for NOT speedily phasing it out as quickly as possible?

            Didn’t you just make one below??
            (a silly one, but still)

            e.g.

            chemjeff|6.26.17 @ 8:59PM| block | mute | #

            A lot of people have now come to depend on ObamaCare, for better or for worse, and so at the very minimum the status quo should be phased out.

          2. Because they want to survive the next election. They’re politicians–not saintly martyrs for the libertarian cause.

            We’re talking about knocking 14 million people off the Medicaid rolls, and those people can vote.

            It’s the same reason ObamaCare wasn’t scheduled to take effect until after his reelection campaign in 2014.

            1. Umm, there was no Presidential election in 2014. And all the key parts began as soon as bureaucratically possible.

    2. We libertarians are supposed to oppose slashing Medicaid eligibility, cutting spending by $880 billion, and making the government smaller–because Mitch McConnell is full of crap.

      WHOOOOSH over your head,

      Do I have that right?

      You’re more full of crap than McConnell. And you’re no libertarian.

      What libertarians want is to restore the free market. (gasp)
      That can ONLY mean shiting government spending directly to restoring the private care. That money was stolen from private charities and charity hospitals. SHAME ON YOU, Ken, for being an accomplice to that theft by big government

      Plus make up your mind. When you’re sucking up to Trump, there are no cuts to Medicaid. Then you say there are.

  10. Obamacare was always intended as a kamikaze attack to break a path for a a single payer system. The just accelerates the process a little.

    1. Single payer does nothing to address healthcare costs and prices that are out of control. With single payer, hospitals, pharma companies and pharmacies can charge whatever they want, and there will be no price transparency. The whole healthcare system is broken.

      I have a friend who works in private practice, and they purposely have each surgeon only accepting one or two insurance plans, and then they have another surgeon “assist”, however briefly, so that they can charge out of network fees. There is corruption and waste at every level.

    2. Many parts of Obamacare were based on a Heritage Foundation plan. It was intended as a compromise to be palatable to Republicans. It wasn’t palatable to Republicans because they didn’t propose it. The Medicaid expansion was the part of Obamacare not based on the Heritage Foundation plan. The Medicaid expansion was the part of Obamacare that did the most to expand health insurance coverage.

      1. Many parts of Obamacare were based on a Heritage Foundation plan

        Bullshit, brainwashed liberal.

  11. New CBO Report Says the Senate GOP Health Care Would Make Obamacare’s Problems Worse

    correct me if i’m wrong, but didn’t suderperson also argue a while back that “merely repealing obamacare without a replacement” was also a terrible idea?

    Why not just repeal the whole mess, and return america to the (lol) “Wild West*” of 2009

    or better yet = just burn it all down. shred all the current federal involvement, and let the states and the medical industry figure out how to sell the public products and services.

    1. That’s what I’ve been banging my head against the desk wondering throughout all of this talk of a need for a “replacement” law. Pass a law that is one paragraph long or one to two pages tops, that repeals Obamacare in it’s totality and reinstates the previous shitty healthcare regime in it’s relatively less awful totality.

      Then they don’t have to rush to do build a whole new legal framework as though the nation’s figurative balls were being crushed in a legislative vice.

      1. That’s what I’ve been banging my head against the desk

        Is that what damaged your brain?

        Pass a law that is one paragraph long or one to two pages tops, that repeals Obamacare in it’s totality and reinstates the previous shitty healthcare regime in it’s relatively less awful totality.

        You seriously don’t know that we have an elected government? You may think you’re Napoleon, but you have yet to seize power for your authoritarian diktats.

        And why do you reject free market outcomes, which was universal treatment for the uninsured, regardless of income. That’s what a vast majority of Americans want .,.. but YOU have no way to do it better than Obamacare.
        Why are you trolling for Bernie Sandfers?

    2. A lot of people have now come to depend on ObamaCare, for better or for worse, and so at the very minimum the status quo should be phased out.

      But I think we all know the real reason why ObamaCare isn’t being repealed. Because Republicans were lying through their teeth the whole time they campaigned on repealing it.

      1. Probably were lying. Several of my GOP business colleagues – generous donors to the Party – are in all in favor of allowing those with pre-existing conditions to enroll, even if it costs the insurance industry (and insurance buyers) a ton of money. It’s the “cadillac tax” they want to repeal. How the expect the insurance industry to sustain itself without collapsing into “single payer” they can’t say. But they sure don’t want their GOP political friends to
        simply repeal Obamacare.

      2. A lot of people have now come to depend on ObamaCare, for better or for worse, and so at the very minimum the status quo should be phased out.

        that’s nonsense and no different than when the ACA was implemented.

        if you recall, many millions had their coverage discontinued with the ACA passed. over the first few years, it was probably 10M or so. Why is massive market dislocation excusable when implementing horrifyingly bad policy, but not when getting rid of it?

        But I think we all know the real reason

        Because you want to change the subject to some idiotic partisan jab? shocker.

        “republicans” didn’t campaign on repeal; trump did, and some various congresspeople did. that doesn’t mean that all of congress is onboard with taking responsibility for the next stage in the grand-interventionist-meddling clusterfuck.

        as you just pointed out = massive dislocation is likely no matter what. either you keep shitty system and millions suffer the growing dysfunction of the craptastic system that was imposed, or you hurt millions more by undoing it. There’s no easy way to do it. And your own idiotic “phase it out” notions are precisely the same rationales that many congresspeople have. Self awareness is in short supply.

    3. Sixty votes in Senate are necessary to simply “repeal the whole mess”.

    4. How many votes will you get, authoritarian? You understand we have an elected government, right?

  12. So yet again, neither party is doing anything to address the rapidly rising costs of healthcare, or how to reign in those costs. Health insurance mandates do nothing to address Valiant jacking up the costs of medications for the sole purpose of increasing shareholder value in the short term, even though those massively increased prices (costs never went up) get passed along to the health insurance companies and Medicare, who then in turn pass along the costs to the insured and the taxpayers. Almost no one gives a shit that we are watching them jack up the prices and force us to pay the difference. Well… as long as the shareholders are happy.

    End this deluded mantra of shareholder value above profits or success that are absolutely crippling our economy.

    1. “So yet again, neither party is doing anything to address the rapidly rising costs of healthcare, or how to reign in those costs.”

      Medicaid and Medicare are the ultimate reason why the cost of healthcare is so high, and the ObamaCare Medicaid expansion is ultimately the reason those costs have accelerated recently.

      Get your head around this chart, and you’ll start to understand that Medicaid and Medicare are the real cause of the problem.

      http://tinyurl.com/lcayz2f

      The Republican plan directly addresses that problem by slashing Medicaid eligibility.

      Medicare and Medicaid only reimburse providers for a fraction of the cost of treating their patients, and providers are left to gouge insurance companies for almost 150% of the cost of care to make up for the difference.

      ObamaCare could accurately be described as a means to expand Medicaid and to soften the shock to gouged insurers by forcing young healthy people to buy health insurance through the individual mandate–specifically because they hardly use it.

      The Republican Plan, in both the House and the Senate, directly address the increasing cost of healthcare by getting rid of the ObamaCare Medicaid expansion–and showing us the way forward on cutting Medicaid further by transferring people from Medicaid to private insurance.

      It isn’t a complete solution, but it does address the rising costs of healthcare.

      1. The biggest fucking lie of the entire issue.

        The Republican Plan, in both the House and the Senate, directly address the increasing cost of healthcare by getting rid of the ObamaCare Medicaid expansion–and showing us the way forward on cutting Medicaid further by transferring people from Medicaid to private insurance

        Liar. It does not.
        Plus a REAL free market provided universal treatment for the uninsured, regardless of income — which Americans freely paid for, with private charities.
        So ,… insurance is NOT a free-market solution.

        So you confuse coverage with care .,.. like the lowest of proggies. Shameful.

        1. The AHCA and senate plans don’t phase out Medicaid, and/or those people won’t be entitled to insurance subsidies afterwards?

          You’re whacked.

          I saw you in that thread the other day. You can’t even tell who is and isn’t in favor of cutting Medicaid.

          Clueless and whacked is no way to go through life.

          Is it just that you want attention or something? You must be so lonely.

          1. The AHCA and senate plans don’t phase out Medicaid, and/or those people won’t be entitled to insurance subsidies afterwards?

            So NOW you say it;s all a shell game.

            1. I didn’t say it was a shell game.

              I said the AHCA moves people from Medicaid to private insurance with subsidies, and you called me a liar.

              1. I didn’t say it was a shell game.

                You just repeated it!

                You are a liar. Here’s the truth.

                The AHCA and senate plans don’t phase out Medicaid, and/or those people won’t be entitled to insurance subsidies afterwards?

                So NOW you say it;s all a shell game.

                I said the AHCA moves people from Medicaid to private insurance with subsidies, and you called me a liar.

                A FUCKING liar. The truth is immediately above your pathetic new lie.

                YOU ALSO SAY THE EXACT OPPOSITE .. THAT THEY DO CUT MEDICAID … AND YOU EVEN CITE HOW MUCH IN DOLLARS.

          2. Ken is confused again. Here’s why.,

            The AHCA and senate plans don’t phase out Medicaid, and/or those people won’t be entitled to insurance subsidies afterwards?

            I saw you in that thread the other day. You can’t even tell who is and isn’t in favor of cutting Medicaid.

            You keep confusing “cutting” with “phasing out”. And lying about the cuts. Are you Kellyanne?

            1. I linked above to Reason stating that the CBO said the current plan will cut 14 million people from the Medicaid rolls and save $880 billion over ten years.

              And you called me a liar.

              I’ve seen two-year olds throw temper tantrums that make more sense than you.

        2. There is no free market for health care and hasn’t been for as long as we’ve been alive. No one, outside of maybe Rand Paul and Mike Lee, even makes a case for it anymore.

          1. Rand and Mike are full of shit. We had a free market in healthcare for the uninsured until shortly after Medicaid. Guess what the outcome was? Universal treatment for the uninsured, regardless of income, fully paid for by the American people, voluntarily, charitable care … the market outcome that they DEFY. As a doctor, Rand is the worst of the two.

            The goober marketers think they can repeal Medicaid tomorrow and the entire private care infrastructure will will spring from the ground, magically, after disappearing 50 years ago. SNAP YOUR FINGERS!

            Anti-government is NOT pro-liberty, REAL libertarians have proposed and debated various ways to transition back to free market outcomes. It must be a phase-in, and the cash transfers must be the same pace and timing as needed to restore it all, without abandoning anyone.

            Progressives are kicking our ass BECAUSE of Paul and Lee. The free market PROVES that Americans willingly pay to treat the uninsured. If we have no better way to do that, then Bernie Sanders has the only acceptable option.

        3. “Plus a REAL free market provided universal treatment for the uninsured, regardless of income — which Americans freely paid for, with private charities.”

          Bullshit. Uninsured people who couldn’t pay in advance for care were being denied care before Obamacare. They still are.

          1. (lol)

            “Plus a REAL free market provided universal treatment for the uninsured, regardless of income — which Americans freely paid for, with private charities.”

            Bullshit. Uninsured people who couldn’t pay in advance for care were being denied care before Obamacare. They still are.

            LBJ’s Medicaid DESTROYED the private charities 45 years BEFORE Obamacare …. and INCREASED the uninsured!

            1 in 4 Uninsured Are Eligible for Aid But Aren’t Enrolled
            One in four Americans — about 12 million people — who don’t have health coverage are eligible for Medicaid and the State Children’s Health Insurance Program (SCHIP) but aren’t enrolled, a new report shows.

            SHAME on you people for ranking politics above human life.
            Before LBJ, we had universal treatment, 100% private. NO government care. Spent 5.8% of GDP,
            Today, government has prox 40% of the market. For-profit insurers less than 20% and we spend 18% of GDP … BUT PRIVATE INSURANCE IS THE PROBLEM????

            The United States spends more per capita on PUBLIC healthcare, for 40% of our population, than TOTAL per capita spending in Sweden, the U.K., Australia, New Zealand, and Japan
            Commonwealth Fund page 3
            We could mandate everyone with private coverage be uninsured, and STILL spend more than those coutnries. BUT GOVERNMENT IS THE SOLUTION???
            Shameful.

    2. So yet again, neither party is doing anything to address the rapidly rising costs of healthcare, or how to reign in those costs

      Nor does the entire libertarian establishment! Can anything possibly be more stupid than Cato;s Medicare Vouchers — to impress the Gomers.

  13. For those who didn’t read past the headline, the lead is buried halfway down the page (perhaps unintentionally).

    “CBO estimates that if the plan were to become law, premiums would be about 20 percent higher next year than under Obamacare. To be clear, that’s a 20 percent increase above and beyond what is already projected. In 2019, premiums would be 10 percent higher than under current law. Starting in the next decade, CBO estimates that premiums would be lower than under current law by about 30 percent.”

    So, what we’re saying is that rolling back Medicaid eligibility won’t happen until 2019, and its effects won’t be fully realized until 2020. When the ObamaCare Medicaid expansion is completely rolled back in 2020, the CBO expects insurance premiums to fall by 30% below where they are today.

    In the meantime, the increases we expect to see in 2018 and 2019 aren’t really attributable to the AHCA or the senate version–because the Medicaid eligibility rollback won’t really take effect until 2020. The increases in 2018 and 2019 aren’t due to the AHCA. They’re due to the ObamaCare status quo.

    In short, the CBO may have said the Senate GOP healthcare plan will make things worse, but they also said that the Senate GOP healthcare plan will drive the cost of insurance premiums down by 30%.

    1. the CBO expects insurance premiums to fall by 30% below where they are today

      FROM SEVERELY REDUCED COVERAGE.. That;s shifting the costs from one payer to another, not cuttng costs.
      Like the proggies, that confuses care with coverage.

      How’d ya miss this?

      In some cases, the deductibles would be high enough that they would limit the value of plans, according to the CBO, especially to low-income individuals. “As a result,” the report states, “despite being eligible for premium tax credits, few low-income people would purchase any plan.”

      Ken — and his fellow goobers – say. “Hey, if you get cancer, WE GOT YA COVERED! Simply pay the first $6,000 out of pocket and your coverage will pay all the rest! Because you’re piece-of-shit poor, and WHO CARES that a free market paid your entire treatment, when we still had one, right up to Medicaid.”

    2. You have comprehensively misunderstood the projected 30% reduction in premiums

      a) It is not with respect to today. It is compared to where premiums would be in the future under current law.
      b) More importantly, the reduction is in the average premium collected per person covered. The demographic covered under the Senate proposal is expected to be considerably younger than today because the law will make old people’s premiums more expensive and young people’s premiums cheaper. If every old person drops their plan in July, the average premium collected per person in August will drop. That doesn’t mean premiums went down.
      c) The average actuarial value of enrollee coverage under the Senate proposal is projected to be lower than today (higher deductibles). This is mostly due to the elimination of the CSRs which make deductibles quite low for enrollees with incomes under 200% of the FPL, as well as the change in the benchmark for tax credits from silver to bronze.

      When adjusted for the demographic shift and higher deductibles, premiums under the AHCA actually went up w.r.t the ACA instead of down 10%. I haven’t seen an analysis of the Senate bill, but for sure an apples-to-apples comparison would show much less than a true 30% in premiums. It might even show an increase.

      1. the CBO expects insurance premiums to fall by 30% below where they are today

        FROM SEVERELY REDUCED COVERAGE.. That;s shifting the costs from one payer to another, not cuttng costs. Like the proggies, that confuses care with coverage

        You have comprehensively misunderstood the projected 30% reduction in premiums

        You’re full of shit, Ken. … again (or still) From the REAL CBO — nort your mnasturbation fantasies.
        https://www.cbo.gov/publication/52849

        In 2020, average premiums for benchmark plans for single individuals would be about 30 percent lower than under current law. A combination of factors would lead to that decrease?most important, the smaller share of benefits paid for by the benchmark plans and federal funds provided to directly reduce premiums.

        (laughing)

        1. Wrong Ken. Read the whole comment.

          1. My deepest and most sincere apology.
            But all my cites were accurate. The reduction is mostty by reduced benefits,

            1. Indeed, I should have included the effect of the market-stabilization funds – a big factor in 2020. As for the relative significance of my b) and c) and above, I was thinking of the AHCA analysis. It does appear, as you say, that for the BCRA, the benefit reduction is the more important factor.

              1. Since you too are a nerd (g), here’s an even bigger one.
                Those CSR subsidies (Cost-Sharing Reduction). Do you know what they cover? NOBODY will tell you (in the political elites) Wait for it …

                They subsidize the high deductibles for the Silver Plans, because HIGH-DEDUCTIBLES are fucking stupid … even when libertarians promote them in the private market!

                Obamacare
                “Let’s have a high-deductible plan, with affordable premiums for.low-incomes … who cannot afford the deductible … so we have to subsidize them. ON TOP OF THE PREMIUM SUBSIDIES.”

                Cato (libertarians)
                “We’ve got your back! If you’re poor and diagnosed with cancer, you’ll have full coverage … after you pay the first $6,000.

                Fiscal conservatives are health care hustlers … EXACTLY like economic progressives … to extort campaign cash from the gullible tribes … differing only in the masters they serve … big business or big government.

  14. Republicans did not respond to the failures of Obamacare with a different vision of how the health care system should be organized.

    Neither did libertarians — most of which are driven by their hatred of gubmint, the exact opposite of a love of liberty on healthcare. So they’re just the flip side of the same authoritarian coin.

    When we still had a free market for the uninsured, Americans willingly paid to assure care for the uninsured, regardless of income. So fuck you, Rand Paul for placing your own gooberism above REAL free market outcomes. You and your dad have essentially destroyed the libertarian movement.

    According to Cato, 60% of the electorate self-identify with core libertarian values, fiscally conservative and socially liberal … but 91% of those libertarians REFUSE to call themselves libertarian. In marketing terms, the libertarian brand is “toxic” — a severe threat to its product or service. Dead..

    1. When you are gonna stop throwing this stupid “fiscally conservative and socially liberal” bromide around? That phrase is so generic as to be almost meaningless. Of course people will agree with it. It’s like asking someone if they like puppies. Does that mean they will adopt one? No. Similarly, saying you are fiscally conservative and socially liberal does not mean you will actually support any spending cuts or loosening of drug or prostitution laws.

      1. When you are gonna stop throwing this stupid “fiscally conservative and socially liberal” bromide around?

        1) Like Cato and everyone else, chump?
        2) You talk like another social conservative trying to destroy us, the way Goldwater said you’d destroy the GOP.

        Of course people will agree with it.

        Rick Santorum? Mike Huckabee? Neil Gorsuch? THE CHRISTIAN RIGHT LEADERSHIP?…. (sneer)

        It’s like asking someone if they like puppies

        You said that in public?

        What does YOUR “chipper” mean? The vast majority of the commentariat using that word are crazy goobers who celebrate feeding people into woodchippers. Are THEY socially tolerant? Was Auschwitz?

  15. The CBO is saying mostly the same things over and over again.

    They estimate that 15 million (magically changed from 14 million from the previous report) will drop coverage by 2018, mostly because the individual mandate would be watered down. Again, this is not “coverage loss”.

    The CBO says by 2026, the average premium should be low – lower than it would be under Obamacare. But there’s a scary caveat. Because some states will waive EHB mandates and some plans will cover less things, your “out of pocket” costs might increase. You don’t have to pay high premiums to pay for others’ mental health services and maternity care, but should you need those services – YOU must pay! Gasp.

    The CBO is underestimating the people’s willingness to make adjustments. If I can’t qualify for medicaid coverage in a state that applied for waiver, I may still request tax credits to buy plans that don’t have ACA’s 8 essential benefits. Like other cruel libertarians, I don’t want to pay for women’s maternity services. My sister was on a HSA
    plan and she was a fan. The CBO insists that they won’t cover me as insured” unless I have comprehensive coverage, but why should I care?

    1. They estimate that 15 million (magically changed from 14 million from the previous report) will drop coverage by 2018,

      Magically, it’s a different bill! The House and Senate are different,

      YOU must pay! Gasp.

      Prices go down ONLY because they sell you less/ How’d you miss the entire point? .

      he individual mandate would be watered down. Again, this is not “coverage loss”

      It’s actually worse. — accelerate the death spiral of premiums even worse than Obamacare, Only because the GOP preserves guaranteed issue, which allows people to avoid insurance until they get sick. Who pays for that? There’s no such thing as a free lunch.

      And they defy free-market outcomes for the uninsured … which was universal treatment to all who walked in. And Americans paid for it voluntarily.

      1. If hospitals increase costs for the insured and insurance premiums then go up (as a result of having more uninsured charity cases) that’s a free-market outcome.

        I wonder how fast all the charity-minded billionaires would react to save us all money if we shut down Medicaid entirely?

        1. If hospitals increase costs for the insured and insurance premiums then go up (as a result of having more uninsured charity cases) that’s a free-market outcome.

          Nope. In the free market the uninsured were treated at charity hospitals and clinics — with universal treatment … fully paid by a complex web of religious and secular charities, including the fraternal organizations who had been paying to treat those who couldn’t pay since the 1500s.

      2. So different that they added another million to their projected number of people who will voluntarily drop insurance? Keep in mind that 2018 is now a little over 6 months away. So if you believe the CBO, should Trumpcare became law tomorrow, as many as 15 million Americans will forego coverage in less than a year.

        Yes, premiums should go down if insurers are no longer forced to pay for expensive treatments that became guaranteed under Obamacare. Given options, consumers will opt for what makes sense for their current needs or situations. Not everyone buys the most expensive auto insurance. Obamacare essentially forced Americans to purchase a high end product but mitigated the cost with subsidies. More money added to the debt.

        A gazillion people chose NOT to buy healthcare before ACA. They went uninsured all their lives, apparently unafraid of buses that could run right into them. Or they had cheaper plans that would be considered as coverage by the CBO. There’s no utopia or one size fits all solutions with no drawbacks. Allow the markets to address individual needs.

        1. So if you believe the CBO, should Trumpcare became law tomorrow, as many as 15 million Americans will forego coverage in less than a year.

          OF COURSE. Almost immediately. Do yopu REALLY believe nobody will cancel insurance they were forced to buy???

          CBO and JCT estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law?primarily because the penalty for not having insurance would be eliminated

          Why else repeal the mandate????

    1. How many votes will that dumbfuck get? (lol)

  16. My question is will the people who aren’t covered now and won’t be covered under the new system be able to finally buy insurance like we used to be able to do and get real coverage again not the fake coverage some have now.

    1. What low-incomes once got was FREE care (if needed) — charitable care that Americans were always willing to pay for. That was destroyed by Medicaid, which has a HIGHER uninsured rate! (underpays providers even more than Medicare, because poor folks don’t much vote.)

      This also exposes the moral bankruptcy of modern libertarianism ? anti-gubmint goobers (actually the entire fiscal right) who shouted down pro-liberty lovers. Hating government can be the opposite of loving liberty … as proven here. They chant free-market slogans, while shitting on free-market outcomes.

      Since the 70s, pro-liberty has promoted a transition back to the private charities/charity-hospitals. Every dollar the government spends on low-income healthcare was (in effect) stolen from the private care infrastructure … so give it back! (duh) .. to both rebuild and maintain what was destroyed. It has to be phased-in, to match the pace of restoration.

      Anti-gubmint goobers FUCK free market outcomes .. FUCK the clearly expressed will of the people. So … THEY redistribute keep the stolen money .. as unwitting accomplices to single-payer. Do the math. Voters want the uninsured treated and are willing to pay for it. Do the math. If goobers refuse to do that in the private market …. BernieCare is the ONLY acceptable option. Defying the will of the people is authoritarian (who else would seek to govern by electing NOBODY?)

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