Last night on Twitter, Robert Costa posted up his take on the collapse of the MTP vote on Trumpcare. This is a very smart take on the state of the board on this bill and on the political prices and choices in play.
A few thoughts on the health-care stall tonight in the Senate…
— Robert Costa (@costareports) July 18, 2017
An ideologically-driven GOP leadership is confronting the reality of a law that now has roots in states, fading as rally cry for base.
— Robert Costa (@costareports) July 18, 2017
Most elected Rs don't fear primary challenge if they buck repeal. They see base's ire as grievance/"fake news" focused, not ACA obsessed.
— Robert Costa (@costareports) July 18, 2017
Most elected Rs don't fear primary challenge if they buck repeal. They see base's ire as grievance/"fake news" focused, not ACA obsessed.
— Robert Costa (@costareports) July 18, 2017
Trump's sale was limited, as were threats for foes. A little chatter about Flake, a few tweets, brief ad war with Heller. That's it.
— Robert Costa (@costareports) July 18, 2017
Privately, several House mbrs and Sns told me for weeks they didn't really want to pass it. Like groom w/ cold feet, after long engagement.
— Robert Costa (@costareports) July 18, 2017
What many Rs wanted was to check box without political cost. Passionless effort. Saw Dems salivating at what passage meant for '18. Cringed.
— Robert Costa (@costareports) July 18, 2017
What you have to understand is that privately many Rs rather "blame Dems" ahead of 2018, rather than shoulder burden of passing this bill.
— Robert Costa (@costareports) July 18, 2017
So while the details matter tonight, and every Sen has their own concerns, one major undercurrent is GOP anxiety over cuts/phase out of ACA.
— Robert Costa (@costareports) July 18, 2017
What this became at the end was a Medicaid debate that very few Rs wanted to have. Fighting "Obamacare" fine, fighting Medicaid complicated.
— Robert Costa (@costareports) July 18, 2017
This, like most things, at its core about $. Under ACA, chunks of $ promised to states. GOP would "phase out" (cut). Uproar, of course.
— Robert Costa (@costareports) July 18, 2017
So fundamentally, this is Repeal and Replace business is where it always was — with a GOP who needed it to keep stoking its resentment politics, but who can’t face the prospect of cutting or rolling back Medicaid. Even when it means that the people who pay for their campaigns do not get their tax cut. And it is really the corner they’ve been boxed into. The ACA is basically GOP health care solution — which is why Mitt Romney stole it from the Heritage Foundation to implement it in Massachusetts. This is the extent of the GOP ideas on Health Care — or at least the extent of the ideas that they can get insurance companies to buy. Their base wants as much health care as they can eat. And the old demonization was focused on a fair bit of fake news and resentments that Costa notes here. The resentments that there might be poor people or black or brown people getting a better deal from the government on health care than they do or the fake news that the government should not be involved with health care and all of the tin foil hatted BS that came from that.
In the meantime, some of their base came to understand how rolling back the ACA would hurt them. Or at least leave them with alot more medical risk than before. Dems were in the wings ready to run on this damage, but they really have not been forward on what fixes Obamacare. And now that the ACA endgame is in sight, Dems are not really in this conversation. Mainly because they haven’t communicated any real fixes to the ACA that start addressing the concerns of the people who are genuinely upset by these possible changes.
Today, even Plan C failed — doing a clean repeal. As Costa notes, Medicaid really is the new Third Rail. There have been multiple calls for going back to the drawing board for a real process, a bipartisan one, to fix Obamacare — John McCain, Jerry Moran, Susan Collins have been talking this up. While this makes all kinds of sense, I don’t know what you could do that would pass the House or get signed by the GRIFTUS.
Here’s the other thing that makes me nervous about regular order for this fix — bipartisanship. If both sides agree that the point of the exercise is to shore up the markets and stabilize rates and participation for the insured, then OK. But I think that Democrats are going to be so glad to be working at bipartisanship that they will agree to a whole lot of GOP-loved stuff that won’t help many people at all. Like HSAs. What I am imagining is that the Senate gets to regular order, the GOP gets a ton of its wishlist (without cutting Medicaid), the GOP emerges declaring victory and the Dems emerge declaring bipartisan success. We can’t just be glad to sit at the table, we have to do some work that means something to Democrats, to the people who need this health care.
I do think that activists around this issue can’t sit down yet. There are not enough Dems willing to be lead the band for Medicare for All or some other form of single payer.
Actually I am taking advantage of an HSA for the new high deductible plan my employer is offering (they are only offering one plan). The deductible is high enough that I would set aside savings for it anyway even though I rarely use healthcare services. But the combination of pre-tax contribution and year to year roll over really make it a no brainer.
HSAs are a reasonable tool if you have the money to put away in the first place. Lots of people don’t especially after they pay their ACA premium. Your employer gets a lower premium and your insurance company doesn’t have to worry about cost control until you have to access their funds. It shifts the the need to control costs from you insurer to you.
Yes, exactly. The difference between monthly premiums from my previous employer’s low deductible plan pays for this deductible in 3 months (tax free which is better, as I always paid deductibles with after tax monies). After that, its a lot more money in my pocket.