Note to Sen Collins: Look Around the Poker Table- If You Can’t See the Patsy, You’re It! *

Before she voted for the Senate version of the Republican tax bill, Sen. Susan Collins saw that Congress would soon be passing separate spending deals, and she had demands.
The Maine Republican laid out a series of conditions for her to support the final “conference committee” version of the tax proposal. Most notably, she wants Congress to pass two separate health care bills first….
It’s unclear how the separate health bills would become law before a final tax vote. Though Collins secured support from both President Donald Trump and Senate Majority Leader Mitch McConnell (R-Ky.), neither man controls the House of Representatives.
House Speaker Paul Ryan (R-Wis.) has suggested he doesn’t support the Collins demands, saying he wasn’t a party to her deal with McConnell. And Rep. Mark Walker (R-N.C.), leader of a group of lawmakers called the Republican Study Committee, said the conservative bloc had been promised by GOP leaders that the health bills would not be part of a must-pass spending package this month.
Collins wants Congress to pass the so-called Alexander-Murray deal — an agreement worked out between Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) that would provide for “Cost Sharing Reductions” for Obamacare insurers — and another bill providing $2.25 billion annually for states to offset the high insurance costs of some individuals.
Without those measures signed into law, McConnell could just invite Collins to become the one remaining “no” vote Senate Republicans can afford, since their tax bill passed with 51 votes last Saturday….
It would be difficult for Republican leaders to appease Collins without betraying House conservatives.
On Thursday, they went along with a stopgap spending bill under the conditions that there would be no Alexander-Murray provisions in any of the other upcoming measures to fund the government. Ryan and House Republicans could very well pass another short-term appropriations bill in two weeks, have the Senate change the bill — because, after all, McConnell needs Democratic votes to pass that bill in his chamber — and then force Ryan and House Republicans to pass the Senate version or shut down government.
But no matter the ultimate conclusion, Collins is already being asked to accept more things on faith than she was supposed to. Earlier in the week, the House Freedom Caucus nearly derailed a vote to begin merging the separate versions of the tax legislation until leaders agreed to “decouple” the tax bill from the other spending bills, with Freedom Caucus Chairman Mark Meadows (R-N.C.) telling reporters that the final tax bill would now likely come next week, days before Senators vote again on a spending bill.
If that’s the case, Collins will once again be asked to vote for legislation she believes is harmful to Americans with the promise that Congress will mitigate their actions in the future.
If Collins objects, any one other Republican senator — with Bob Corker (R-Tenn.) continuing to oppose the bill — could sink the tax legislation. And other senators may hold up the process until Collins receivers firmer commitments. Sen. John McCain (R-Ariz.), for example, could have a problem with McConnell going back on his word.” (A)

“But it should be clear at this point, to Collins and to House conservatives, that someone is going to get hoodwinked. At least one GOP leader is going to have to go back on his word. And it should be clear at this point that these commitments Republicans are making are a lot looser than members of Congress think…
Republican Sen. Susan Collins of Maine says she would consider removing her support from GOP tax plans, saying in an interview she could change her vote if her proposed amendments don’t make it in the final version.
“I would (consider changing my vote),” she told CNN affiliate CBS WABI5 on Thursday. “I’m going to look at what comes out of the conference committee meeting to reconcile the differences between the Senate and House bill. So I won’t make a final decision until I see what that package is.”…
Collins, a moderate Republican, voted for the GOP’s tax plan last week despite having helped kill the GOP’s Obamacare repeal efforts earlier this year. Several aides told CNN that Collins made clear to Senate Majority Leader Mitch McConnell that she wanted to get to “yes” on the tax legislation, unlike with health care.
“There’s a real fear that the tax bill is going to trigger a 4% cut in Medicare,” she told CBS WABI5 in the interview. “I am absolutely certain that 4% cut in Medicare that I mentioned will not occur. I have it in writing from both the speaker of the House, Paul Ryan, and also Senator Mitch McConnell.” (B)

Meanwhile, it looks as though funding for another cost-sharing reduction (CSR) payments won’t make it into the next spending bill, according to The Hill. Republican Study Committee chairman Rep. Mark Walker said House leaders made that promise during a meeting Tuesday.
That is likely unwelcome news for Sen. Susan Collins, R-Maine. She agreed to vote for the Senate’s tax bill—which repeals the ACA’s individual mandate—after striking a deal with Senate Majority Leader Mitch McConnell to pass a bill funding CSR payments and her reinsurance proposal. The idea is that those bills might mitigate the negative effects of repealing the individual mandate—though some analyses have disputed that notion.
Collins said Friday that she might change her vote on the GOP’s tax overhaul if party leaders don’t include her amendments to that measure, which are related property tax and medical expense deductions, the Associated Press reported. Collins also noted that House and Senate leaders promised her they would remove the threat of a 4% cut to Medicare. (C)

“Sen. Lisa Murkowski (R-Alaska) is pushing back on Democratic attacks that she is undercutting ObamaCare, saying opponents are simply using “scare tactics.”
In a question-and-answer video posted on her YouTube page, Murkowski defended her vote for tax reform this month. Murkowski backed a bill that includes language repealing ObamaCare’s individual mandate.
“I think it’s important that people really look to what is included in this bill when it relates to the Affordable Care Act and to get beyond the scare tactics and the rhetoric that is designed to just instill fear and paranoia in people,” Murkowski said.
She notes that the only provision in the tax bill related to ObamaCare is the repeal of the requirement to have coverage or pay a fine.
“What this bill does is says if you can’t afford health-care coverage, or if you don’t see that value in it, we’re not going to fine you,” she said. “It doesn’t impact the ACA in any other way. If you receive a subsidy for your health-care insurance before this tax bill passes you will still be able to receive a subsidy after.”
Murkowski was one of three Republican senators who voted down a Republican ObamaCare repeal attempt over the summer, which included repeal of the mandate. She has drawn sharp criticism from Democrats this time for voting for the repeal of the mandate.
Opponents of her move argue that eliminating the mandate will have wider impacts, and that it could lead to a spike in premiums or insurers dropping out of the market once an incentive for healthy people to enroll is removed.
The Congressional Budget Office finds that premiums will increase 10 percent and 13 million fewer people will have coverage over a decade if the mandate is repealed.
Murkowski argued that subsidies available under the health-care law will encourage many people to remain enrolled in ObamaCare.
She also touted a bipartisan bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) as one that would help stabilize the market by providing funds for key insurer payments.
“It is my understanding that as part of the negotiation, not only has the Senate leadership committed that we will advance Alexander-Murray, but the president has indicated that support as well, so prior to the end of this year, I think we can anticipate that we will see that piece inserted as well,” Murkowski said.
Many House Republicans, though, are opposed to the bill, raising questions on if it can pass that chamber.
Experts say that Alexander-Murray alone is also not enough to counteract the premium increases from repealing the mandate, and that additional funding would be needed to bring down premiums.” (D)

“Marc Short, the White House director of legislative affairs, said the change for state and local tax deductions is “certainly being discussed.” But he said “the biggest challenge is the pay-fors” — that is, how to cover the revenue that would be lost by offering a larger deduction….
By Monday, Cohn added, “we’ll have a pretty final tax bill here, and we’ll know where we’re going to be.”
Short predicted that two GOP senators who have cited specific concerns about the legislation — Marco Rubio of Florida and Susan Collins of Maine are “going to be fine” in the end….
Collins has said she wants to see separate legislation passed to shore up health-insurance marketplaces if the ultimate tax bill repeals the individual mandate that’s part of Obamacare. The measures will almost surely face rough sledding in the House, however.
On Thursday, the White House didn’t commit to supporting the health-care bills Collins wants. Short said Friday that “if those reach the president’s desk he will sign them, but there’s some elements of that as far as the lobbying and whipping of votes that is out of our control.”” (E)

“Sen. Susan Collins, the Maine Republican whose vote was pivotal in pushing the GOP tax bill forward last week, thought she had a deal to bolster health care protections in exchange for her support.
But it’s now unclear whether her strategy to shore up part of the Affordable Care Act will prevail or that it would produce the results she anticipates.
The tax bill repeals the ACA’s fines for the individual mandate, which requires most people to have health insurance or pay a fine. Collins says she would vote for it if Senate Republicans promised to allow a vote on two other health bills….
The tax bill is now the subject of final negotiations between the House and the Senate. First, even if the bills pass the Senate, there is little to suggest that the House Republicans would go along. On Tuesday, House Speaker Paul Ryan, R-Wis., reportedly told other House leaders he was not a party to Collins’ health care deal with McConnell. Ryan had previously expressed opposition to restoring the cost-sharing payments.
In response to Ryan, Collins on Thursday signaled that she might not vote for the tax bill’s final passage.
But would Collins’ changes offset the elimination of the mandate? Some analysts question whether the bill restoring the federal cost-sharing subsidy payments could actually do more harm than good.
“It’s a mess,” says insurance industry consultant Robert Laszewski. Many states allowed insurers to raise premiums to make up for the loss of the federal cost-sharing reduction payments. So passing the law now, at least for 2018, would require insurers to make refunds to individuals and the federal government for those overpayments….
The elimination of the mandate penalties is permanent, but Collins’ bill would fund the cost-sharing and reinsurance programs for only two years. Because of that, says Timothy Jost, a former law professor and expert on the health law, “I don’t think it’s going to be much of a carrot” to encourage insurers to stay in the individual market…..” (F)

Health insurance companies know that an insurance market without the requirement that everyone get coverage will be worse for them and their customers. They just aren’t sure how much worse.
HuffPost contacted dozens of health insurance companies to ask them to assess the impact that removing the so-called individual mandate ― which Republicans in Congress are on the verge of doing as part of their tax bill ― would have on their businesses and their customers.

Fifteen companies responded ― and all warned that eliminating the mandate would force them to further raise prices, and could drive some insurers to leave the market altogether. Both of those outcomes would lead to fewer Americans having health insurance and destabilize an insurance market already plagued with problems.
Let’s assume for a second that you eliminate the mandate and so those healthy people decide to sit out, whether they need a subsidy or not, the pool shrinks,” said Jim Havens, senior vice president of individual and senior markets for Mountlake Terrace, Washington-based Premera Blue Cross.
“That means that the people left are people who either intend to use it or think they will be using it, which is going to make it more expensive,” Havens said. Premera is the sole insurer offering individual policies in Alaska and also operates in Washington state.
The biggest losers would be middle-class people who don’t get health benefits from their employers and make too much money to receive subsidies for private insurance from a health insurance exchange. They will see fewer choices and higher prices in the future.
People who live in sparsely populated regions are at the greatest risk of extremely high premiums, and of having no insurers doing business where they live because rural areas already are the toughest locations to make a profit.” (G)

*Quote attributed to Warren Buffet

(A) Susan Collins Never Had An Actual Deal On Taxes, by Arthur Delaney and Matt Fuller, https://www.huffingtonpost.com/entry/collins-tax-vote_us_5a2ac0d1e4b0a290f050378a
(B) GOP Sen. Susan Collins says she would consider changing her tax plan vote over amendments, by Daniella Diaz, http://www.cnn.com/2017/12/08/politics/susan-collins-republican-gop-tax-plan-amendments/index.html
(C) GOP lawmakers mull health insurance tax delay, by Leslie Small, https://www.fiercehealthcare.com/regulatory/gop-lawmakers-mull-health-insurance-tax-delay
(D) Murkowski pushes back on ObamaCare ‘scare tactics’, by Peter Sullivan, http://thehill.com/policy/healthcare/363975-murkowski-pushes-back-on-obamacare-scare-tactics
(E) Trump Backs Keeping State Income Tax Break With Cap, Cohn Says, by Toluse Olorunnipa and Jonathan Ferro, https://www.bloomberg.com/news/articles/2017-12-08/trump-backs-keeping-state-income-tax-break-with-cap-cohn-says
(F) Doubts Rise About Sen. Collins’ Strategy To Shore Up Insurance Market, by Julie Rovner, http://www.wbur.org/npr/569421827/doubts-rise-about-sen-collins-strategy-to-shore-up-insurance-market
(G) Health Insurers See Higher Prices And A Big Mess Ahead Without The Obamacare Mandate, by Jeffrey Young, https://www.huffingtonpost.com/entry/health-insurers-higher-prices-obamacare-mandate-repeal_us_5a272277e4b0c2117626a077