Obamacare Still Lumbering Along, At Least Until Trump Stabs It In The Face To Death (Some More)

I'm a businessman. Trust me.

At his press conference Thursday, Donald Trump gave a slightly premature obituary for the Affordable Care Act, saying, as he has before, that there's no point comparing TrumpCare to Obamacare, because there's no such thing as Obamacare anymore: "Obamacare is collapsing. It's dead. It's gone. It's a fallacy. There's nothing to compare it to because we don't have health care in this country."

National Public Radio did a quick fact check on whether we do, in fact, have health care in this country, and lookie whose Tweet they cited!

While the ACA does have problems with insurers dropping out of some markets (a problem that can be addressed without throwing the whole law out), the ACA remains the law of the land, as Paul Ryan said after the first attempt to pass the GOP's terrible repeal and replace bill failed. Oh, but even though the ACA repeal attempt hasn't yet passed the Senate in any form, there is in fact a very serious threat to Obamacare. As the Los Angeles Times details in a disturbing report, the ACA isn't dead, but the Trump Administration seems to be trying to do everything it can to murder it even without a legal repeal.

The LA Times piece makes it very clear that Trump and the Republicans are lying when they say the ACA's marketplaces are collapsing under their own weight: Instead, the administration is

driving much of the current instability by refusing to commit to steps to keep markets running, such as funding aid for low-income consumers or enforcing penalties for people who go without insurance.

“All this uncertainty is not helpful,” warned Blue Shield of California Chief Executive Paul Markovich, who said health plans were being forced to make plans to raise premiums to account for the turmoil, jeopardizing Americans’ coverage.

Isn't that clever of the Trumpers? Nobody could have seen it coming, except for everyone who saw it coming. Markovich was one of the few insurance company officials willing to go on record about frustrations with the Trump administration, because of the possibility of retribution from Trump. That's how a functioning first-world country works, isn't it? But other executives seemed a little less than appreciative of President Business:

“It’s hard to know who’s home,” said one chief executive. “We don’t know who is making decisions.”

Another chief executive said: “There seems to be no coordination or coherent planning.… It’s a mess.”

A third official observed: “There is a sense that there are no hands on the wheel and they are just letting the bus careen down the road.”

One of the health insurers' greatest frustrations is that the Trump administration refuses to say whether it will enforce the tax fines that serve as an incentive for people to enroll (fines still required by the law). Or whether the administration will continue to provide -- again, as the law requires -- the federal aid that provides subsidies that helps lower-income policyholders pay for their insurance. The payments, known as cost-sharing reductions, or CSRs, are at the center of a lawsuit by Republicans, who argue they must be subject to an annual congressional appropriation. The Obama administration kept paying the CSRs, but the Trump team keeps hedging on whether it will pay them or not, because Trump thinks it might be fun to withhold them to pressure Democrats to go along with scrapping the ACA.

Yes, really. Without the federal support -- which, we think we may have mentioned is required by law even though the law is being challenged -- state insurance regulators warn the marketplaces really could be in danger of collapsing, even in areas where the ACA has seen stabilizing enrollment and premiums. Isn't that a neat trick?

Why, yes, it DOES get worse: Meetings between the insurance industry and the Trump administration have only resulted in more confusion. Seema Verma, Trump's appointee to run the Centers for Medicare and Medicaid Services (CMS), offered this weirdass deal to executives at one recent meeting: The administration would fund CSRs in the short term if insurance companies would publicly support the House bill to repeal the ACA. One executive at the meeting seemed dumbfounded: "It made no sense," the executive said. It's almost as if they'd never heard of destroying the village in order to save it! (The Trump administration, meanwhile, denied that Verma had even made the offer, because why would they fund something they hate?)

Don't go looking to the government agency responsible for making the ACA work for any support. As far as the Department of Health and Human Services is concerned, it's already been repealed, even though it hasn't been. Here's HHS spokesperson Alleigh Marre:

Obamacare has failed [...] For this reason, Republicans are reforming healthcare so it delivers access to quality, affordable coverage to the American people.

Oh, sure, it's still "the law," but why should the agency that's supposed to make it work even bother anymore? Fuck you and your stupid healthcare needs, don't you know who won the election?

Go read the whole LA Times piece and prepare to be infuriated. Better, call your senators and representative and insist the president follow the law, even if he wants to repeal it.

Oh, and as for the House's rotten ACA repeal, here's a hell of a thing: While House Republicans passed the thing two weeks ago and had a big party in the Rose Garden to celebrate the first step in the process of repealing Obamacare, it seems they forgot one eensy tiny itty bitty very small part of the process: They failed to actually send the bill to the Senate, which means the House may have to vote on the damnable abomination again. OOPSIES:

House Speaker Paul Ryan hasn’t yet sent the bill to the Senate because there’s a chance that parts of it may need to be redone, depending on how the Congressional Budget Office estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority.

Republicans had rushed to vote on the health bill so the Senate could get a quick start on it, even before the CBO had finished analyzing a series of last-minute changes. The CBO is expected to release an updated estimate next week.

If the CBO score shows the House bill doesn't save at least $2 billion, the rules for passing a bill through reconciliation in the Senate would require the House to adjust its bill and pass it again. And while such a vote could possibly be camouflaged "in some kind of arcane procedural move," it would still be a second vote to kill Obamacare, and to throw tens of millions of people off their health insurance, which should be all kinds of attractive to Republicans already facing a tough slog in 2018. And with a new vote, they'd also be stuck with the CBO's updated estimate of how many more people would lose coverage -- certain to be much higher than the original terrible bill since the CBO has previously said it wouldn't count junk insurance -- cheap plans that may not cover essential health services -- as real insurance.

So Obamacare isn't dead yet. We just need to find a way to keep Donald Trump from clubbing it over the head and throwing it on the cart.

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[NPR / LAT / Bloomberg]

Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.


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