More Health Care Shenanigans Courtesy of Trump

Trump has called Chuck and been rebuffed, reports ThinkProgress.

After several public failures, Trump tried to use Democrats again to push conservatives in Congress to enact his agenda. However, surely House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer are done being pawns in his game. The last time they made a deal with him, it allowed the Republicans to try to pass Graham-Cassidy. And CHIP funding lapsed. (Still has not been reauthorized, in fact.)

Current Threats to Health Care Access

There are so many moving parts to health care in Washington right now that it is hard to know where those favoring wide access to health care need to focus. Below are the top areas of concern.

1. The budget process started over on October 1, meaning Republicans can now start planning their next run at the ACA. They couldn’t get the 50 votes needed to pass reform in the Senate under budget reconciliation rules during the last fiscal year, and not for lack or trying or shady tricks. So the word is they will now tie deep Medicaid cuts to tax cuts.

The thinking on that is that Sen. Susan Collins and the other so-called “moderates” who nuked the last few repeal attempts, Senators Lisa Murkowski and John McCain, won’t be able to say no to tax cuts in order to save Medicaid funding.

It’s important to note that this is hypothetical. The reality is that Senate Majority Leader Mitch McConnell is not just a prick, but also severely weakened. He may have every nefarious trick up his sleeve to push this through, but even a team of Republicans using all the dirty schemes in the world couldn’t get health care repeal through.

And while he’s battling cancer and the loss of bipartisanship in Congress, Sen. McCain has his legacy to think of now. And the idea of flipping his vote against health care for some tax cuts is not going to appeal to him. Meanwhile, Sen. Murkowski owes her Senate seat to the native population in her state, Alaska. She’s not going to sell out her staunch supporters for tax cuts.

Sen. Susan Collins probably won’t vote for tax cuts if it means health care cuts.

In short, while anything is possible, it seems very unlikely this particular scenario will play out the way Mitch wants.

2. The Senate had a deal on CHIP in mid-September and they still have yet to pull the trigger. This is unconscionable but typical. Minnesota needed a loan on October 1 to keep the state’s CHIP kids insured after all state funds were gone. Certainly at this point it’s fair to ask whether Republicans are holding off on CHIP so they can use it to bargain for drastic Medicaid cuts. Also, note that CHIP was Secretary Clinton’s big accomplishment when she tried to reform health care as First Lady in the 1990’s. She campaigned on it. And Republicans have shown time and again they are not above petty BS, even if children pay the price.

3. The Trump administration has continued to undermine the ACA, in every way possible. First, every day they don’t guarantee the CSRs, the insurers in the ACA exchanges have to keep their prices high just in case the CSRs go away. If the Trump administration decided to guarantee the CSRs, it wouldn’t be until after the enrollment period is over. But the reality is that Trump campaigned against the ACA and out of petty jealousy that Obama is more admired, he will never do anything that might help the ACA survive. He won’t guarantee the CSRs and it is up to Congress to make that happen, if they so choose. I will write about that below.

Second, the Trump administration has cut the open enrollment period for health insurance through the exchange in half, to six weeks this year. That means people who don’t spend a lot of time following this stuff could miss the deadline to enroll for next year. If you haven’t yet joined the Thunderclap for open enrollment, you can do so here.

Third, mysteriously, the federal exchange website will be offline for repairs from 12 am-12 pm every Sunday during five of the six weeks of open enrollment. We all know this is sabotage but there’s not much we can do to stop it.

Fourth, the advertising budget for open enrollment has been cut by 90%. And eighteen cities have lost “assisters” who, as their name suggests, help people sign up for insurance in healthcare.gov.

As he has said numerous times, Trump is trying to let ACA fail.

4. Trump has also done some truly sinister stuff that will bankrupt people or destroy their health, for the sole reason of destroying Obamacare. The ongoing attacks on the essential benefits from Obamacare, which include hospitalization, prescription drugs, maternity care and mental health services, among the ten or so items all insurance plans must cover. This element of ACA has been a big battle even in Congress because a quick way to lower prices for insurance plans sold on the exchange is to reduce health care services covered by the insurance. It’s also a quick way to make buying insurance on the exchange unpopular; these plans could be junk insurance without the essential benefits.

But think about the otherwise uninsured being stuck with these plans. They will be on the hook for costs should they need maternity care or mental health services.

The rumor out this week is the Administration is planning to change regulations for small business health insurance. These “association” plans would be exempt from essential benefit rules suddenly because they would move to large group rules under the guise of increasing health care options. These small businesses could in theory then move their employees to cheaper large group insurance with limited benefits. Now, the worst case scenario would be if an employee in the one of these small business health care plans with large group regulations had a sudden serious illness that required care not available through the large group plan. That would raise costs so much for the small business (you can’t spread the risk and control costs if one of your ten employees has a major, expensive illness) that the only option would be to move back to a small business ACA exchange plan with essential benefits. Over time, only very sick people would buy into the exchange, until mostly the very sick and expensive remained. This means individual, non-group insurance would be prohibitively expensive, especially for the healthy people you would want to attract to bring overall costs down. Things would get progressively worse until the exchanges inevitably imploded.

5. And the Senate is dragging its feet on bipartisan efforts to stabilize the ACA markets. If you think that they have general consensus so they can pass legislation quickly, think again. Nothing will happen before the end of enrollment on December 15. Republicans want the exchanges to fail. While they could legislate CSR payments and instantly drop exchange insurance prices by 20%, they don’t want prices to fall. They can’t allow affordable insurance to be available during open enrollment.

Waiting for the Other Shoe To Drop
We avoided the nightmare scenario of 20 million+ Americans losing access to care three times already this year, but as the options for mayhem listed above show, we are not out of the woods. I get a lot of questions about what will happen if Trump is impeached, so I want to be clear. He’s not going to be impeached. He may even win re-election even though half the country thinks he’s an irresponsible nut job.

I will write a longer post about this soon, but suffice to say the Republicans in Congress will not impeach him, and based on what we have already seen through several special elections this year, Democrats are not going to take back the House or Senate in 2018. I hate to say this, but after living in Washington, DC, and watching this stuff for two decades, it won’t happen. I will be out there precinct walking with you, but it doesn’t look good.

The Administration will neglect and destroy the ACA exchanges until millions lose insurance, whenever that happens.

The best case scenario for a more stable health care reform is for Sen. McCain to negotiate a bipartisan reform. But even then, the odds it will not have some horrific change that would cut off millions from Medicaid is slim.

People didn’t realize it at the time, but President Obama, then-Speaker of the House Pelosi, and then-Senate Majority Leader Harry Reid put together an amazing victory when they passed the Affordable Care Act. And if it stands in four years, it will be due to their brilliance and the activism of groups on the left like ADAPT, Little Lobbyists, UltraViolet, and Credo. Also, luck. It will not be because Democrats saved the ACA after winning back the majority in both houses in 2018, or because Trump was impeached.

I hope I’m wrong. But I’ve seen this before and it doesn’t end well for the 60 million+ on Medicaid.

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