Nothing is certain but death and taxes, and “preexisting conditions”!

“Healthcare is the top issue for many heading into the midterm elections, and particularly for Democratic voters, according to a new report.
In the Kaiser Family Foundation’s latest tracking poll of about 1,200 people, 30% said healthcare was the most important issue in this election. By comparison, 21% said the economy and jobs was their top issue, while 15% said gun laws or immigration were their biggest concerns…
Even with the partisan split, though, healthcare is a hot-button issue. More than 70% of those polled said it was at least “very important” to them in the upcoming election. KFF has “regularly found healthcare among the top issues voters want to hear candidates talk about during their campaigns,” the researchers said.” (A)

“Republicans could try again to repeal Obamacare if they win enough seats in U.S. elections next month, Senate Republican Leader Mitch McConnell said on Wednesday, calling a failed 2017 push to repeal the healthcare law a “disappointment.”
In a forecast of 2019 policy goals tempered by uncertainty about who will win the congressional elections, McConnell also blamed costly social programs, such as Social Security and Medicare, for the fast-rising national debt.
On Nov. 6, Americans will vote for candidates for the Senate and the House of Representatives.
McConnell’s Republicans now hold majority control of both chambers. Democrats will try to wrest control in races for all 435 House seats and one-third of the 100 Senate seats.
Despite their dominance of Congress and the White House, Republicans dramatically failed last year to overturn former President Barack Obama’s signature healthcare law, known as Obamacare. McConnell called it “the one disappointment of this Congress from a Republican point of view.”
He said, “If we had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks… We’re not satisfied with the way Obamacare is working.”” (B)

“In advertisements, in debates and on the campaign trail, Republican candidates are abandoning their promise to “repeal and replace” the Affordable Care Act and are swearing that they never voted to undo protections for people with pre-existing medical conditions — and never will….
…Some of the campaign claims have been audacious — Senator Ted Cruz of Texas, in a debate this week with his Democratic rival, Representative Beto O’Rourke, said he had never taken aim at pre-existing conditions, even though the “Cruz amendment,” offered during the Senate debate to repeal the Affordable Care Act, expressly permitted insurance companies to offer plans with none of the protections of President Barack Obama’s signature domestic achievement, including those for pre-existing conditions.
In the House, dozens of lawmakers who voted repeatedly to repeal the Affordable Care Act have introduced or signed onto resolutions affirming the importance of coverage for those with pre-existing conditions, even though such protections would have been weakened or removed by their votes.” (C)

”Senate Majority Leader Mitch McConnell said in new remarks Thursday that he backs the Trump administration’s decision to join a lawsuit that would undo Obamacare’s protections for the sick.
“It’s no secret that we preferred to start over,” the Kentucky Republican said about Obamacare, which included new protections for people with pre-existing health conditions. “So no, I don’t fault the administration for trying to give us an opportunity to do this differently and to go in a different direction.”..
The suit could result in all of Obamacare being thrown out, or just its protections banning health insurers from turning away sick people or charging them more. GOP efforts to overhaul Obamacare failed in 2017 after the party fell short by one vote in the Senate…
“Nothing wrong with going to court. Americans do it all the time; we can do it too,” McConnell said…
Adding to the political sensitivity of the issue, the Trump administration did not defend the law in court, but rather agreed with the plaintiffs, though it asked to toss only the rules on pre-existing conditions…
McConnell told Bloomberg that Republican candidates were able to handle the attack ads.
“There’s nobody in the Senate that I’m familiar with who is not in favor of coverage of pre-existing conditions,” he said.” (D)

“For months, Democratic candidates have been running hard on health care, while Republicans have said little about it. In a sign of the issue’s potency, Republicans are now playing defense, releasing a wave of ads promising they will preserve protections for Americans with pre-existing health conditions.
The ads omit the fact that the protections were a central feature of the Affordable Care Act and that the Republican Party has worked unceasingly to repeal the law, through legislation and lawsuits.
Republicans in Congress have recently come forward with limited legislative proposals to ensure some pre-existing conditions protections if the health law is overturned. One, a House resolution, would have no force of law, even if adopted. The other would contain a significant loophole: Insurers would have to cover those with pre-existing illnesses, but would not have to cover care for those particular illnesses. (Neither is on track to become law.)..
Protection of pre-existing conditions is popular, and surveys suggest that voters trust Democrats more than Republicans on health care. A few months ago, Republican candidates were happy to focus their messages elsewhere — on the economy, or immigration policy. They are now defending themselves on less friendly territory.” (E)

“Simply put, protecting preexisting conditions is really popular. In its most recent poll, the Kaiser Family Foundation found that 75 percent of Americans say it’s very important to them that the rule prohibiting insurers from denying people coverage remain law.
You’ll notice independent voters overwhelmingly support that provision and the ban on charging people more based on their medical history. That has to be the most worrying finding for GOP candidates, especially in races that are likely to be determined by swing voters.
Yet even a majority of Republicans support those ideas in this poll. Some minds might genuinely be changing about preexisting conditions. Last year’s Obamacare repeal fight really brought this issue to the fore, and people might be reassessing their prior beliefs.
But that’s what makes the Republican position so perplexing. Rather than simply concede Obamacare has solved an important problem and proposing ways to improve it, they want to maintain total opposition to the ACA while also claiming they support the most popular parts of the law…
The politics of health care, so advantageous to Republicans for most of this decade, have been turned upside-down in 2018. No single issue makes that more clear than preexisting conditions and the Republican contortions to counter the Democratic attacks against them.” (F)

“Republicans have released legislation that would amend the Health Insurance Portability and Accountability Act to require insurance companies to sell plans to people with pre-existing conditions and not charge them more because they have been, or are, sick. Insurers, however, would be able to deny coverage for specific illnesses. In other words, insurers would have to sell coverage plans to people with pre-existing conditions, say diabetes, but would not have to cover their diabetes. Insurance companies could also increase premiums based on age, gender, or occupation.
Another Republican approach, discussed during the “repeal and replace” debate, would make available subsidized plans, such as the ACA, but increase premiums over time if individuals failed to purchase them at the outset. In theory, healthy individuals would jump into the pool to avoid paying a penalty at a later date. This is an approach used under Medicare Part B, a voluntary program that covers outpatient services, that has been fairly effective and politically acceptable.
Whether it would work outside of Medicare and avoid the need for more intrusive government intervention remains to be seen. The elderly are much more likely to feel that they need insurance and to respond to incentives to get it earlier rather than later, while younger, healthier people may be more reluctant to buy and then end up priced out of the insurance market.” (G)

“But in our distorted political combat, “pre-existing conditions” is standing in for “access to affordable health insurance.” The real crux of the Republican assault on the ACA last year was shrinking support for the poor and near-poor. The ACA repeal bill that passed the House in May 2017 would have rolled back the Medicaid expansion, reducing Medicaid enrollment by 14 million, according to the Congressional Budget Office. It would have slow-strangled federal funding for all Medicaid programs, which cover 75 million Americans. It would have eliminated the Cost Sharing Reduction subsidies that make coverage affordable for more than 5 million enrollees in the ACA marketplaces, raising their deductibles by thousands of dollars.
Democrats are fighting first and foremost to protect insurance access for low-income Americans, but they’re focusing on the more relatable goal of protecting access for people with medical conditions. Is this the most effective way to hold Republicans accountable for their efforts to uninsure tens of millions? Maybe you go to war with the spear your opponent hands you.” (H)

“President Trump’s economic adviser Larry Kudlow, speaking to conservatives at a private dinner on Wednesday night, said the administration had no plans to touch large entitlement programs, but would address deficits by going after Obamacare, adding work requirements to smaller entitlement programs, and spurring economic growth…
“We have no plans to tackle the large entitlement programs,” Kudlow acknowledged, referring to Medicare and Social Security. But he went on to explain three ways be believed the Trump administration would address deficits, including by targeting Obamacare.
His comments come as Democrats, on offense on the healthcare issue during the 2018 midterm elections, are seizing on comments made by Senate Majority Leader Mitch McConnell, R-Ky., about the importance of addressing entitlements and of his willingness to have another go at repealing Obamacare if he has the votes.” (I)

(A) Healthcare remains a top issue for voters as midterms approach, KFF says, by Paige Minemyer, https://www.fiercehealthcare.com/payer/healthcare-top-issue-for-voters-kff-says-mcconnell-another-aca-repeal-attempt-possible
(B) McConnell says Senate Republicans might revisit Obamacare repeal, https://www.cnbc.com/2018/10/17/mcconnell-says-senate-republicans-might-revisit-obamacare-repeal.html
(C) Republican Candidates Soften Tone on Health Care as Their Leaders Dig In, by Catie Edmondson, https://www.nytimes.com/2018/10/18/us/politics/republicans-health-care-pre-existing-conditions.html
(D) Mitch McConnell defends Trump administration’s anti-Obamacare lawsuit, by Kimberly Leonard, https://www.washingtonexaminer.com/policy/healthcare/mitch-mcconnell-defends-trump-administrations-anti-obamacare-lawsuit
(E) Republicans Are Suddenly Running Ads on Pre-existing Conditions. But How Accurate Are They?, by Margot Sanger-Katz, https://www.nytimes.com/2018/10/16/upshot/republicans-health-care-ads-midterms.html
(F) The real Republican record on preexisting conditions: GOP is trying to roll back protections, byBy Dylan Scott, https://www.vox.com/policy-and-politics/2018/10/11/17955688/2018-midterm-elections-preexisting-conditions-obamacare
(G) Coverage for pre-existing conditions lives on, even though the Affordable Care Act seemed doomed, by DAVID BLUMENTHAL, https://www.statnews.com/2018/10/10/coverage-preexisting-conditions-lives-on-aca/
(H) Republicans hand Democrats an election-year gift on health care and it’s a winner, by Andrew Sprung, https://www.usatoday.com/story/opinion/2018/10/09/republicans-gave-democrats-health-care-winner-2018-election-column/1437280002/
(I) Larry Kudlow: ‘We’ll continue to go after Obamacare’ but won’t touch big entitlements, by Philip Klein, https://www.washingtonexaminer.com/opinion/trump-adviser-larry-kudlow-well-continue-to-go-after-obamacare-but-wont-touch-big-entitlements

PREQUELS
CONSULTANTS are the one big winner of the Obamacare wars, http://doctordidyouwashyourhands.com/2018/07/consultants-are-the-one-big-winner-of-the-obamacare-wars/
“This would appear to be Republicans’ last-ditch attempt (well, their latest last-ditch attempt) to repeal Obamacare.”, http://doctordidyouwashyourhands.com/2018/06/this-would-appear-to-be-republicans-last-ditch-attempt-well-their-latest-last-ditch-attempt-to-repeal-obamacare/
From REPEAL & REPLACE to WRECK & REJOICE (from Obamacare to Trumpcare), http://doctordidyouwashyourhands.com/2018/04/from-repeal-replace-to-wreck-rejoice-from-obamacare-to-trumpcare/
“It leaves us with two laws… Call the first one Obamacare… Call the second one Trumpcare”, http://doctordidyouwashyourhands.com/2017/12/it-leaves-us-with-two-laws-call-the-first-one-obamacare-call-the-second-one-trumpcare/

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