“This would appear to be Republicans’ last-ditch attempt (well, their latest last-ditch attempt) to repeal Obamacare.”


Trump’s Justice Department says the ACA is unconstitutional (June 6th)
“The Justice Department will not defend the Affordable Care Act in court, and says it believes the law’s individual mandate — the provision the Supreme Court upheld in 2012 — has become unconstitutional…
The details: The ACA’s individual mandate requires most people to buy insurance or pay a tax penalty. The Supreme Court upheld that in 2012 as a valid use of Congress’ taxing power.
When Congress claimed it repealed the individual mandate last year, what it actually did was drop the tax penalty to $0.
So the coverage requirement itself is still technically on the books. And a group of Republican attorneys general, representing states led by Texas, say it’s now unconstitutional — because the specific penalty the Supreme Court upheld is no longer in effect…
What to watch: The argument against it is by no means a slam dunk. For starters, critics — now including the Justice Department — will have to prove that people are still being injured by the remaining shell of the individual mandate, even without a penalty for non-compliance.” (S)

Prequel: Part 1. Obamacare/ Trumpcare.
From REPEAL & REPLACE to WRECK & REJOICE (from Obamacare to Trumpcare) (April 25, 2017)


“Some conservative activists unable to surrender their long-held dream of repealing Obamacare are poised to release a long-shot plan next month to resurrect their failed effort, despite massive political odds against such a measure ever becoming law anytime soon.
But these conservatives are right about one thing: Republicans don’t have a coherent health-care message this election cycle. And they need one…
The latest plan is being forged by leaders at the conservative think tanks Heritage Foundation and the Galen Institute, along with former senator Rick Santorum and Yuval Levin of the Ethics and Public Policy Center. They’ve been meeting regularly over the past eight months to craft a recommendation for Congress to repeal much of the ACA’s coverage requirements and taxes, turn over some of its spending to states through block grants and expand the use of tax-free health savings accounts.” (A)

“Politically, the now-defunct assessment had been that passing a health-policy overhaul would scare too much of the public in an election year, making it a nonstarter. The growing understanding, though, is that Republicans are already at risk of losing to a “blue wave” this fall anyway, and that bold action to energize conservative grassroots might be the only way to stop the wave.
The Left is going to be energized this fall regardless of what Congress does, and those parts of professional suburbia that just won’t vote for Republicans under Trump also aren’t going to become even more anti-GOP than they already are. Indeed, as this is exactly the demographic that suffers the most under Obamacare, it might be slightly less likely, not more, to oppose the GOP if Republicans do actually pass reform.
But giving conservative voters a “win” on Obamacare would surely drive up Republican turnout.
Substantively, the bill design has evolved since January. It still uses the basic template of last year’s Graham-Cassidy bill, but only in the sense that it would remain a system of block grants to the states. As in January, it still envisions a significant expansion of health savings accounts — indeed, from January’s thought of doubling the existing number of HSAs, the new plan now may quadruple them — and also a guarantee that individuals served by state-government-run plans can opt-out and use the money in private markets instead.” (B)

“At the end of last year’s prolonged health care battle, many Americans breathed a sigh of relief. Some may have let down their guard too soon.
That’s because it’s clear the war on health care is far from over. Or, more precisely, the war has shifted from a ground war to a cold war. It’s shifted from major clashes in Washington, DC, heavily covered by the media, to more obscure battlefields: the states and the offices at the Health and Human Services Department where regulatory policymaking is done.
Yet this quieter fight could prove to be just as dangerous to the public…
Protections for people with preexisting conditions — as many as 130 million Americans, and growing every day — are also under attack. The Trump administration is using its executive authority to approve the sale of junk insurance plans that had been outlawed or severely limited under President Barack Obama…
Mostly, Americans want this assault on their ability to care for their families to end so we can begin the process of building back what has been allowed to erode. Americans want to pay less, not more, for health insurance. They don’t want insurance companies to be given unlimited authority again.
They want to see Medicaid strengthened, not weakened. They want the basic dignity of being able to afford medication and an end to the constant fear that grips so many that if they get sick, they will lose everything.
Americans didn’t want last year’s war on Obamacare, and they don’t want this new cold war either.” (C)

“These Congressional plans would lower your costs if: You own a small business. You’d no longer have to pay the penalty if you don’t provide insurance. You own a medical devices company or a tanning salon. You’d no longer have to pay Obamacare taxes. A repeal would affect you even more if you are in one of the states that reduce the 10 essential benefits. It would lower your costs if you are healthy or young.
They would increase your costs if: You have a chronic disease. You are older. The Congressional plans allow insurance companies to charge seniors five times what they charge younger people. Obamacare limited that to three times. Your costs would skyrocket if you are a senior who loses Medicaid coverage under the plan. Many seniors need Medicaid to cover the out-of-pocket Medicare costs. You become pregnant. Many states would drop this from the essential benefits. You need an abortion. The plans prohibit insurance companies sold on the exchanges from covering abortion services. Your company only provided coverage because the ACA mandated it. You are one of the 22 million people who received subsidies or the Medicaid expansion. You use mental and behavioral health services, including drug rehab. The House plan includes $2 billion to pay states for drug treatment. That’s not enough to offset the cuts to Medicaid and insurance companies who drop coverage for these services. You decide to reapply for health insurance after a lapse of 63 days. You’d have to pay a 30 percent premium increase. You are a Planned Parenthood patient. The Senate plan defunds the organization for just one year.” (D)

“This would appear to be Republicans’ last-ditch attempt (well, their latest last-ditch attempt) to repeal Obamacare. It seems broadly similar to the bill from late last year, Graham-Cassidy, but drops the attempt to reform traditional Medicaid.
Hill-watchers are skeptical this effort will go anywhere before the elections later this year. It would require the GOP to pass a budget resolution, craft a bill that meets the requirements of the Senate’s “reconciliation” process (meaning, among other things, that all provisions must affect the budget), bring together the support of 50 of the Senate’s 51 Republicans, and push the legislation through the House as well…
Regarding perks for holdout senators, Spiro suggests the new legislation will “bribe” Senators Lisa Murkowski and Susan Collins. (Murkowski’s Alaska expanded Medicaid; voters in Collins’s Maine approved expansion in a referendum, but the governor is refusing to implement it.)
Remember, if the GOP loses more than one senator, the bill goes down in flames. And beyond Paul, Murkowski, and Collins, that includes John McCain, who sank the previous effort, and whose health problems have been keeping him home from D.C. So a lot rides on whether all these folks find the new formula (A) acceptable in terms of how it treats their own states and (B) something they’re willing to defend in public.” (E)

“On Tuesday, Sen. Bill Cassidy (R-LA) released a policy white paper with ideas he claimed would “make health care affordable again.” By and large, however, the plan would do no such thing.
Some of the plan’s ideas—promoting consumer transparency in health care, for instance, promoting primary care, and cracking down on monopolistic practices that impede competition—have merit, although people can quibble with the extent to which Washington can, or should, solve those problems.
However, those specific solutions have at their core a deeply flawed framework. That framework not only contradicts itself, but it leaves Obamacare’s fundamental architecture in place—indeed, would expand upon it in at least one respect. While Cassidy’s paper decries that Obamacare premiums more than doubled from 2013 to 2017, his plan would do very little to control the skyrocketing price of coverage on the individual market.
Cassidy bases his plan on a state-based block-grant funding model, similar to the legislation he and Sen. Lindsey Graham (R-SC) developed last fall. Cassidy cites various state experimental programs to argue that a block-grant approach would allow more room for innovation.
However, the last sentence of the proposal undermines the rest of the discussion: “Flexibility to states would not jeopardize protections for individuals with pre-existing conditions.” That phrase implies that Cassidy believes, as the Graham-Cassidy bill indicated, that Obamacare’s federal insurance requirements regarding pre-existing conditions should remain in place.” (F)

“The foundation also says the “new path” would build on the reform plan offered last year by GOP Sens. Lindsey Graham of South Carolina; Bill Cassidy of Louisiana; Ron Johnson of Wisconsin, and Dean Heller of Nevada.
The plan is also reportedly backed by former Pennsylvania Republican Sen. Rick Santorum and was crafted with the help of the American Enterprise Institute and the Galen Institute.
Sources said last week that the plan would include financial help to low-income residents, an effort that could help garner some Democratic support, especially from senators facing re-election in swing states or conservative-leaning ones.
Yet supporters will also face the challenge of getting Republican leaders of the GOP-controlled Senate to vote on such legislation, considering the chamber has repeatedly failed to pass such legislation after it has cleared the House.” (G)

“The White House has been quietly but constructively supportive of the project, I am told, and should provide strategic and communications support this time that is well planned, rather than the more seat-of-the-pants effort we all saw last year. Pence, in particular, has been personally engaged.
It would be typical of this White House to insist on a strategy that its own party’s congressional leadership hates with an abiding passion but cannot publicly denounce because it involves Obamacare. But what’s the political theory behind reversing the stand-pat posture of the GOP heading toward the midterms? If you guessed “base mobilization,” you get a gold star on your calendar…
Politically, the now-defunct assessment had been that passing a health-policy overhaul would scare too much of the public in an election year, making it a nonstarter. The growing understanding, though, is that Republicans are already at risk of losing to a “blue wave” this fall anyway, and that bold action to energize conservative grassroots might be the only way to stop the wave…
In the end conservatives will probably be unable to convince enough Republicans that this is a good idea in time to set into motion all the things that would have to happen (most notably that budget resolution) to make Santorum’s dream a reality. But if the president’s Twitter account gets behind it, anything could happen.” (H)

“According to data from Gallup and Sharecare, the number of uninsured Americans rose by 1.3 percentage points in 2017. This is what the start of a death spiral looks like.
Three states have announced preliminary 2019 premium-rate requests for Obamacare individual-market policies, and the numbers don’t look good…
It is not hard to see why prices might spike. Thanks to Republican efforts to sabotage Obamacare, the pool of individual-market enrollees is getting smaller and sicker – and, as a result, much more expensive…
The net effect of all these changes: Younger, healthier and cheaper enrollees are getting siphoned out of the Obamacare marketplace. Older, sicker and more expensive people are sticking around, because they actually need coverage.
This pool of remaining enrollees raises average costs for insurers, who then raise premiums, which drives out additional relatively healthy people, which pushes premiums up further. And so on.” (I)

“An independent federal study found President Donald Trump’s planned expansion of short-term health plans will see higher enrollment and cost more than previously predicted, according to The New York Times.
Here are four things to know from the report.
1. The short-term policies have skimpier protections than employer-based and ACA marketplace insurance, as they aren’t required to provide benefits like maternity care, prescription drug coverage and preventive care. In February, President Trump’s administration projected a few hundred thousand Americans would sign up for the short-term plans.
2. However, a recent study from CMS’ Chief Actuary Paul Spitalnic pegs enrollment at 1.4 million people in the first year of the policy, and 1.9 million by 2022, according to the NYT… (J)

“Democrats run on GOP health care ‘sabotage’. Candidates have a unified message blaming Republicans for ‘sabotaging’ the health law.
They’ve got a unified message blaming Republicans for “sabotaging” the health care law, leading to a cascade of sky-high insurance premiums that will come just before the November midterm elections. They’re rolling out ads featuring people helped by the law. And Tuesday, they’re starting a campaign to amplify each state’s premium increases — and tie those to GOP decisions.
That’s a big change from four election cycles of reluctance to talk about Obamacare on the stump. During those campaigns, red-state Democrats were often on the defensive, dodging accusations they imposed government-run health care on unwilling Americans, made it impossible for people to keep their doctors and health plans, and caused double-digit premium increases every year.
Now, even those Democrats see Obamacare as a political advantage. The Affordable Care Act has grown significantly more popular. And as Republicans learned last year when they failed to repeal it, the public had scant interest in taking away coverage from millions of Americans, including low-income and vulnerable people on Medicaid. Democrats are also seizing the issue of rising prescription drug prices — another health care cost problem for which the public holds the GOP responsible, according to polls.” (K)

“… Expanding health coverage is a winning issue for Democrats; trying to take it away is a losing issue for Republicans. Why would the G.O.P. want to keep charging into that buzz saw?
But the growing popularity of key parts of Obamacare is precisely the reason Republicans are highly likely to make a last-ditch effort to kill the A.C.A. For them, it’s now or never.
Here’s what history tells us: Expansions of the social safety net are relatively easy to demonize before they happen — before people get to see what they actually do. Opponents declare that they’ll destroy freedom, that they’ll be wildly expensive, that they’ll be a national disaster. American politics being what it is, opponents of a stronger safety net also tap into racial resentment, convincing white voters that new programs will benefit only Those People.
Once social programs have been in effect for a while, however, and it turns out that they neither turn America into a hellscape nor break the budget — and also that they end up helping people of all races — they become part of the fabric of American life, and very hard to reverse…” (L)

“The viability of the health-insurance exchanges depends on getting enough people, particularly healthy people, to sign up. Ending the individual mandate removed one means of pressuring likely healthier people into buying insurance in the marketplaces. Furthermore, the Trump administration has made several decisions that will alter the quality of benefits people receive under the ACA. In the fall of 2017, the administration announced it would stop making “cost sharing reduction” payments, which had compensated insurers for the losses they incurred by reducing out-of-pocket expenses for lower-income households receiving insurance through an exchange plan. At the time, President Trump denounced these payments as a “bailout” for the insurance companies, but many observers worried that the move would further undermine already unstable insurance markets. As well, in recent months, the administration has been planning regulatory changes that would allow states to offer coverage that does not include the essential health care benefits included in the ACA and pays a smaller percentage of health care costs.
HHS has also given the green light to states to challenge one of the underlying principles of the Medicaid expansion. One of the truly novel features of the ACA was that it extended Medicaid to cover everyone whose income is below 138 percent of the federal poverty level, no matter what their personal circumstances and with no need to meet criteria of deservingness. Yet, acting on guidance issued by the Trump administration in early 2018, nearly 20 states are developing requirements for people to engage in paid work or unpaid “community engagement” as a condition of Medicaid participation.” (M)

“Following the passage of the ACA, the health-care law faced numerous legal challenges, culminating in a controversial 5–4 decision by the Supreme Court in 2012 to uphold the ACA, with Chief Justice John Roberts delivering the deciding vote…
Roberts’ view that the individual mandate amounts to a tax, despite the language of the bill and repeated denials by the Obama administration that the ACA raises taxes, has been the subject of much criticism, but it could now serve as the basis for eliminating the entire law, thanks in large part to the tax reform bill Congress passed in December.
On January 1, 2019, the Tax Cuts and Jobs Act eliminates the penalty on those who do not purchase qualifying health insurance plans. The fine is currently $695 per adult, up to a family maximum of $2,085, or 2.5 percent of income, whichever is greater. Without the penalty, the Affordable Care Act’s individual mandate can no longer reasonably be considered a tax, and thus the entire basis upon which Roberts built his defense of the law has evaporated.”.. (N)

““Obamacare repeal may be closer than you think.” That was the headline from the Washington Examiner’s Quin Hillyer late last week. It was enough to send a shiver down my spine.
In the column (self-identified as opinion), Hillyer lays out that former Sen. Rick Santorum, Vice President Mike Pence and the minds behind the Graham-Cassidy Obamacare repeal plan haven’t given up their work. It could still be revived, he argued, especially now that the bipartisan health care talks have fallen apart. What do Republicans have to lose in pursuing their signature campaign promise, given that Democrats are already very energized for the 2018 midterms while GOP voters seem demoralized?..
So how seriously should we take this? Are these just the extended death rattles of the GOP’s Obamacare failure? Or could the last act of the 115th Congress be another run at repeal?
To be clear, I don’t have any reason to doubt Hillyer’s reporting that Obamacare repeal planning is still underway and top Republicans, up to and including the vice president, are taking an interest. But I made the rounds today with the K Street insiders who guided us through the health care fight last year, and I found a lot of skepticism.
”I believe the part where they are working on something,” one GOP health care lobbyist told me. “I don’t believe there is any way it gets further than any of the previous attempts in this Congress. What’s the path to victory?”
Another Republican lobbyist laid out the problems in more detail”… (O)

“It would be a tactical and moral mistake for Democrats to not use [Obamacare] to expand coverage as much as possible.”
Health insurance on Affordable Care Act (ACA) exchanges could be effectively free for families making less than $100,000 a year if state-level legislators were willing to “game the complex design” of Obamacare to create state-run health insurance companies, according to a progressive think tank.
Jon Walker, a health-care policy analyst and writer for the People’s Policy Project, last month outlined a six-step plan showing how state lawmakers could make the federal government pay for health insurance for most residents. It would involve creating a government-run health insurance company to sell insurance on ACA exchanges; requiring insurance be sold at one price for people of all ages (as is already required in New York and Vermont); driving private insurance companies off the state exchanges; and automatically enrolling people who qualify for tax credits into free coverage.”.. (P)

“Healthcare policy experts, business leaders, and patient advocates praised Gov. Phil Murphy’s endorsement of a state requirement that residents obtain medical insurance or face a fine, a move they said will help protect recent gains in insurance coverage, control premium prices, and ensure New Jersey still receives billions in federal funding.
Murphy signed Democratic-backed legislation Wednesday, making New Jersey the second state — after Massachusetts — to create its own individual mandate. The law requires those without health coverage to pay a tax penalty starting next year, when the federal mandate that is part of the national Affordable Care Act is scheduled to end. He also approved a measure to create a healthcare reinsurance fund, fueled by industry fees and federal dollars, to help offset the costs of the most expensive treatments…
“The truth is that most people are unaffected by the mandate because they already have coverage from a job, Medicare, or another source,” said Joel Cantor, a Rutgers professor and director of the health policy center. “But there is plenty of evidence that the mandate will help keep premiums down, and when people hear that they are much more likely to say they support the idea. “ (Q)

“Conservative groups gear up for another summer Obamacare war, but they may be flying solo…
The recommendation, which is being spearheaded by former Sen. Rick Santorum, R-Pa. and includes participation from the Heritage Foundation, would convert the law’s Medicaid expansion and insurance subsidies into block grants provided to states. These changes would not apply to traditional Medicaid. The group is targeting June to coincide with the initial release of rates for Obamacare in most states. Several states have released major rate hikes for Obamacare next year, blaming Trump administration policies and the repeal of the individual mandate’s penalties for the boost in premiums. The goal is to have the Senate take up the block grant recommendation this summer. “Our plan will come out in June and then they have July and part of August really to get their work done,” the source said. “There is really no way you are going to have an impact on 2019 [Obamacare coverage year] premiums unless they act this summer.” (R)

(A) The Health 202: Conservative activists aren’t giving up their Obamacare repeal dream, by Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/05/29/the-health-202-conservative-activists-aren-t-giving-up-their-obamacare-repeal-dream/5b0c18101b326b492dd07eb9/?noredirect=on&utm_term=.fe81c1aa642f
(B) Obamacare repeal may be closer than you think, by Quin Hillyer, https://www.washingtonexaminer.com/opinion/obamacare-repeal-may-be-closer-than-you-think
(C) The Republican cold war on the Affordable Care Act, by Andy Slavitt, https://www.vox.com/the-big-idea/2018/5/14/17350818/affordable-care-act-repeal-attacks-gop-medicaid-preexisting-condition-health
(D) Obamacare Repeal and Replacement Plans, by Kimberly Amadeo, https://www.thebalance.com/congressional-plans-to-repeal-and-replace-obamacare-4160599
(E) Obamacare Repeal: One More Time, with Feeling, by Robert VerBruggen, https://www.nationalreview.com/corner/obamacare-repeal-2018-republicans-attempt-again/
(F) Sen. Bill Cassidy’s New Health Plan Is Obamacare On Steroids, by Christopher Jacobs, https://thefederalist.com/2018/06/01/sen-bill-cassidys-new-health-plan-obamacare-steroids/
(G) Conservative groups, congressional Republicans appear poised for another try at ObamaCare repeal, by Joseph Weber, http://www.foxnews.com/politics/2018/05/26/conservative-groups-congressional-republicans-appear-poised-for-another-try-at-obamacare-repeal.html
(H) Conservatives Plan One More Obamacare Repeal Effort Before the Midterm Wave, by Ed Kilgore, http://nymag.com/daily/intelligencer/2018/04/could-gop-try-a-final-obamacare-repeal-bid-before-midterms.html
(I) Opinion: The slow, continuing decline of Obamacare, by Catherine Campell, https://www.northjersey.com/story/opinion/columnists/2018/05/15/opinion-slow-continuing-decline-obamacare/612623002/
(J) Trump’s health insurance plan could inflate federal spending $38.7B over next decade, by Morgan Haefner, https://www.beckershospitalreview.com/payer-issues/trump-s-health-insurance-plan-could-inflate-federal-spending-38-7b-over-next-decade.html
(K) Democrats are confidently running on Obamacare for the first time in a decade, by DAVID GREENBERG, https://www.politico.com/story/2018/05/15/democrats-embrace-obamacare-2018-539411
(L) The Plot Against Health Care, by Paul Krugman, https://www.nytimes.com/2018/05/31/opinion/republicans-health-care.html
(M) Eight years of attacks and Obamacare still stands by Daniel Béland, Philip Rocco, and Alex Waddan, http://policyoptions.irpp.org/magazines/may-2018/eight-years-attacks-obamacare-still-stands/
(N) How President Trump Could End Obamacare With A Single Tweet, by Justin Haskins and Sarah Lee, http://thefederalist.com/2018/05/07/president-trump-end-obamacare-single-tweet/
(O) 6 reasons Obamacare repeal (probably) isn’t coming back in 2018, by Dylan Scott, https://www.vox.com/policy-and-politics/2018/4/30/17304184/obamacare-repeal-probably-dead
(P) State Lawmakers Could Make Obamacare Free for Most—If They Want, by Dennis Carter, https://rewire.news/article/2018/06/01/state-lawmakers-make-obamacare-free-want/
(Q) MURPHY SIGNS LAW TO CREATE NJ’S OWN HEALTH INSURANCE MANDATE, by LILO H. STAINTON, http://www.njspotlight.com/stories/18/05/31/murphy-signs-law-to-create-nj-s-own-health-insurance-mandate/
(R) Daily on Healthcare: Get ready for the summer Obamacare war, June 2nd
(S) Trump’s Justice Department says the ACA is unconstitutional, by Sam Baker, https://www.axios.com/trumps-justice-department-says-aca-is-unconstitutional-06f8714d-7606-4104-9982-f057786828a7.html

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