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Ad will collapse in seconds CLOSE May 8, 2017 05/08/2017 12:44 pm By Jonathan Chait Share Republicans celebrate the House passage of Trumpcare. Photo: Mark Wilson/Getty Images

Last week, after a nearly all-male group of Republicans celebrated the passage of a House bill that would, they boast, enable men to stop having to pay for womens health care, and as a completely male Senate Republican working group gets to work on the upper chambers bill, a Republican aide told CNN that gender is a nonissue: We have no interest in playing the games of identity politics, thats not what this is about; its about getting a job done. Just a bunch of gender-neutral human beings making gender-neutral decisions about public policy!

Except there happens to be the coincidental factor that the policy in question is inextricably linked to gender. The health-care debate revolves around whether, and to what degree, the medically and economically fortunate should have to subsidize the medically and economically unfortunate. Women have, on average, higher lifetime medical costs than men, which means a market-based insurance system, where every individual plan is priced based on that persons expected medical costs, will charge women on average higher premiums.

Republicans have been dancing around this implication for years with their argument that people who dont need prenatal care should not have to buy insurance that covers it. (This means, of course, that the costs of prenatal care would be borne entirely by those who do need it, i.e., women of childbearing age.) National Review columnist Kevin Williamson comes right out and makes the case that charging women higher rates for insurance is the natural order of things. Why Shouldnt Women Pay More for Health Insurance? asks his headline. Williamsons answer turns out to be Science:

Its worth noting that the vast majority of American health insurance operates on the principle of gender parity. If you get standard employer-based insurance, then your firm divides the cost of insurance among employees without regard to gender. Likewise, Medicare, Medicaid, and the VA are financed without regard to fact that women absorb more medical care. We certainly could change those systems to reflect actuarial science. Employer insurance could charge female employees higher premiums and deductibles than male ones, and Medicare could change its financing so that women pay more than men. Oddly, nobody not even Williamson is proposing these changes. The non-group insurance market is the only segment of American health care in which anybody proposes to make women pay proportionately more.

Conservatives have made all kinds of practical arguments for the Republican health-care bill. They have made a smattering of moral arguments, too, such as the principle that people with more expensive medical needs have failed to make healthy choices and deserve financial punishment for their failings. What is telling about the gender debate is that it lacks even the pretext of personal responsibility. There is no case to be made that women ought to pay more for insurance because they chose to be female. There is no principle at all except that people who have more ought to keep it.

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Why Republicans Want to Make Women Pay More Than Men for Health Insurance - New York Magazine

House Republican leaders have set a Thursday vote on a bill that would repeal and replace ObamaCare, they announced Wednesday.

The vote announcement indicates that the GOP has enough votes to pass the so-called American Health Care Act (AHCA) and send the measure to the Senate for consideration. Republican leaders had spent several daysscrambling to round up the votes.

"We're gonna pass it," House Majority Leader Kevin McCarthy, R-Calif., told Fox News, adding that the bill had the support of the required 216 members to pass out of the chamber.

The bill's passage would mark the culmination of seven years' worth of promises by Republicans to undo Obama's signature legislative achievement andand provide a long-sought win for President Donald Trump, who has been in office more than 100 days without a significant congressional victory save Senate confirmation of a Supreme Court justice.

The latest iteration of the GOP bill would let states escape a current requirement that insurers charge healthy and seriously ill customers the same rates, a measure that has drawn the ire of some moderate Republicans.

However, a pair of moderates flipped their position earlier Wednesday and announced they were supporting the legislation after winning Trump's backing for their amendment to the measure.

The proposal by Reps. Fred Upton, R-Mich. and and Billy Long, R-Mo., would provide $8 billion over five years to help some people with pre-existing medical conditions afford coverage. Upton said their plan would put "downward pressure" on premium costs.

Upton's conversion was especially significant because he's a respected, centrist voice on health issues and former chairman of the House Energy and Commerce Committee.

Upton and Long were among four House members who met with Trump at the White House. Also attending the White House meeting were the current Energy and Commerce chairman, Rep. Greg Walden, R-Ore., and Rep. Michael Burgess, R-Texas, who heads a health subcommittee.

"Today we're here announcing that with this addition that we brought to the president, and sold him on in over an hour meeting in here with him, that we're both yesses on the bill," Long told reporters at the White House.

"'We need you, we need you, we need you,"' Long described as the message from Trump.

Democrats remained solidly opposed to the legislation.The American Medical Association, AARP and other consumer and medical groups are also opposed. The AMA issued a statement saying Upton's changes "tinker at the edges without remedying the fundamental failing of the bill - that millions of Americans will lose their health insurance as a direct result."

Late Wednesday, House Minority Leader Nancy Pelosi, D-Calif., slammed Republicans' decision to proceed with a vote before the non-partisan Congressional Budget Office (CBO) had scored the bill for expected drops in the number of insured Americans.

"Forcing a vote without a CBO score shows that Republicans are terrified of the public learning the full consequences of their plan to push Americans with pre-existing conditions into the cold," Pelosi said. "But tomorrow, House Republicans are going to tattoo this moral monstrosity to their foreheads, and the American people will hold them accountable."

The overall bill would cut Medicaid, repeal tax boosts on higher-earning people, eliminate Obama's fines on people who don't buy insurance and give many of them smaller federal subsidies.

Before the White House meeting, House Speaker Paul Ryan, R-Wis., praised the proposal and said the GOP was getting "extremely close" to finally being able to pass the stalled legislation.

The proposal "is something that nobody has a problem with, and it's actually helping" round up support for the bill, Ryan said on radio's "The Hugh Hewitt Show."

The existing health care measure would let states get federal waivers allowing insurers to charge higher premiums to people with pre-existing illnesses who'd let their coverage lapse. To get the waiver, the state must have a high-risk pool or another mechanism to help such people afford a policy.

Opponents said that would effectively deny such people coverage by letting insurers charge them unaffordable prices. They say high-risk pools have a mixed record because government money financing them often proves inadequate.

The money in Upton's plan would help people with pre-existing illnesses pay premiums in states where insurers can charge them more.

There's already around $130 billion in the legislation states could use to help people afford insurance, but critics have said that's just a fraction of what would be needed for adequate coverage.

Fox News' Chad Pergram and the Associated Press contributed to this report.

Original post:
House Republicans set Thursday vote on health care bill

Tonight's decision comes after the party has spent weeks tweaking the bill to attract wavering members. Combine the risk involved with the level of public sausage-making and a simple question arises: Why?

After all, it's clear that threading the needle between the House Freedom Caucus on the ideological right and the Tuesday Group in the center is a perilous proposition. Republicans have already swung and missed twice. Even with the current momentum behind Michigan Rep. Fred Upton's amendment to fund state-based high-risk pools as a fix for the decision to waive the federal mandate on covering people with pre-existing conditions, it's going to be a very, very close vote -- if there is a vote at all.

I've talked to a handful of Republican members and senior campaign staffers about just that question. While they recognize voting on a bill with an uncertain legislative future is a risk, they think the bigger risk is not passing anything at all. There are two main reasons behind that thinking:

1. Repealing and replacing Obamacare -- which is not exactly what they will be doing, but whatever -- was the issue Republicans built their entire message around over the last 7+ years. The promise they made to their base was that if they were voted into power, the bill would be gone. It's on the back of that message that they won control of the House in 2010 and the Senate in 2014. It played a major role in pushing Trump over the top against Hillary Clinton too.

Given the centrality of health care to everything Republicans have talked about over the last seven years, to simply throw up their hands and give up is unthinkable. GOP strategists believe deeply that to walk away from health care would cause a revolt -- or at least a major enthusiasm dip -- within their base. And, with the Democratic base fired up beyond belief to send a message to Trump, the 2018 midterms could be a total disaster.

2. The country is looking to Republicans to show they can actually govern. Not just protest the policies of the Obama Administration, but actually govern. At the moment -- and it is, granted, quite early -- the scorecard doesn't look very good. Tax reform is a long process that has only just begun. Building Trump's much-promised border wall will be a long and arduous process -- if it happens at all.

Republican members of Congress need something tangible to take to their constituents come August recess. They need to be able to point to a major piece of legislation that they promised they would deliver and show that they made good on their end of the bargain. (Obviously this argument gets complicated if the Senate either doesn't act on a House-passed measure or amends it heavily.) Health care, which is of critical importance to the Republican base (see above), would have that effect, they believe.

That's why Republicans are pushing all their chips into the middle on this. The only other option is to go bust.

See original here:
Here's why Republicans are willing to roll the dice on ...

House Republicans narrowly approved a controversial plan to dismantle the Affordable Care Act on Thursday, taking a significant first step toward fulfilling a seven-year promise to repeal and replace the 2010 law that served as a landmark overhaul of the US healthcare system.

Republicans passed the American Health Care Act with one vote to spare, following a dramatic series of negotiations that exposed deep fissures between the partys moderate and conservative wings over how to replace Barack Obamas signature legislative accomplishment.

The bill passed 217 to 213, with 20 Republicans voting against and no Democrats voting in favor. Republicans burst into applause when the bill passed the 216-vote threshold, a feat that had seemed insurmountable just days before.

Democrats too saw a reason for celebrating. After it passed, they sang the 60s hit Na Na Hey Hey (Kiss Him Goodbye) appearing to suggest Republicans would lose their seats if the repeal proved unpopular.

The bill now moves to the Senate, where it is expected to face serious difficulties.

Later in the afternoon, an exultant Trump celebrated with dozens of Republican congressmen at the White House. He punched the air in triumph as he greeted them in the Rose Garden and was met with sustained applause. Before a seated audience that included Ivanka Trump and Jared Kushner, vice-president Mike Pence declared: Thanks to the leadership of President Donald Trump, welcome to the beginning of the end of Obamacare.

What a great group of people, Trump said, referring to the Republican congressmen, and theyre not even doing it for the party, theyre doing it for this country because we suffered with Obamacare.

He described Obamacare as a catastrophe and essentially dead, adding: If we dont pay lots of ransom money over to insurance companies, it would die immediately.

Despite reservations expressed by senators, the president predicted the new bill would survive the upper chamber. Were gonna get this passed through the Senate, he said, adding, I actually think it will get even better. And make no mistake, this is a repeal and a replace of Obamacare. Make no mistake about it.

He added: As much as weve come up with a really incredible healthcare plan, this has brought the Republican party together. Next, he promised, would be the biggest tax cut in US history.

House speaker Paul Ryan was smiling as he faced the media. It really was a collaborative, consensus-driven effort, he said.

Member after member took care to lavish praise on Trump. Majority leader Kevin McCarthy told the gathering: Ive only been through a few presidents but Ive never seen someone so hands on. I walk into my office yesterday morning and they say the presidents calling again ... The president gives me a list of who he thinks I would be best to talk to on the list. And he was right.

It was a very different spectacle from the first attempt to pass the healthcare bill in March, which ended with a crestfallen Ryan admitting to reporters on Capitol Hill that moving from opposition to governing comes with growing pains.

But faced with mounting pressure from Trump and a White House eagerly searching for a victory of its own, Republicans managed to coalesce around a flagging plan that just six weeks ago was considered all but dead.

As the president approached his 100th day in office without a single legislative victory to his name, the White House escalated its push on Republicans to revive the effort to repeal Obamacare, a significant campaign promise. Behind the scenes, New Jersey congressman Tom MacArthur, a moderate, teamed up with North Carolina congressman Mark Meadows, chairman of the arch-conservative Freedom Caucus, to hammer out a compromise.

Its real easy to be unified when your vote doesnt matter and youre in the minority, Meadows said before the vote on Thursday. Its much more difficult to be unified when youre in the majority, and thats what were seeing.

Ahead of the vote, members took turns delivering impassioned speeches from the chamber floor, drawing rare applause and cheers.

A lot of us have been waiting seven years to cast this vote, said Ryan, imploring his party to make good on their promise to repeal the ACA.

As Ryan finished, Republicans rose to their feet, chanting Vote! Vote! Vote! Democrats countered: Wheres the score? a reference to Ryans decision to vote on the bill before the independent Congressional Budget Office (CBO) could provide an analysis on how it would impact voters.

Most Americans dont know who their member of Congress is, Democratic House minority leader Nancy Pelosi said. But they will now when they find out that you voted to take away their healthcare.

You, Pelosi added, singling out moderate Republicans, have every provision of this bill tattooed on your forehead. You will glow in the dark on this one.

The revised healthcare bill was immediately mired in controversy, as Democrats vowed to wage the upcoming 2018 midterms over the legacy of Obamacare and its expansion of coverage to millions of Americans.

The Republican plan has drawn particular scrutiny for gutting coverage for people with preexisting medical conditions. Prior to the passage of Obamas healthcare law, insurers were able to deny coverage to people who were already sick and whose treatment was more expensive.

The Republican bill would allow states to opt out of coverage for preexisting conditions, a move conservatives argue would lower overall premiums by removing sick people from the market. An estimated 27% of Americans under 65 have preexisting conditions, include cancer, heart disease and diabetes, that were not covered prior to the ACA.

To attract support from moderate Republicans who balked at the plan, an additional $8bn was included over five years to fund so-called high-risk pools that would help subsidize people with preexisting conditions..

Health policy experts have argued the fix is insufficient. At least one analysis, from the left-leaning Center for American Progress, found the Republican plan would fall woefully short in providing coverage to individuals with preexisting conditions.

The Republican healthcare plan also includes an attempt to defund womens health organization Planned Parenthood, as well as drastic cuts to Medicaid, totaling $370bn over a decade. A broader portrait of the bills potential consequences was unclear, because Republicans rushed a vote before the CBO could provide an analysis. The office had projected that as many as 24 million Americans would lose their health insurance under the original version of the Republican plan.

While Republican lawmakers acknowledged they would prefer to first see a CBO score, most resigned themselves to instead favor the passage of a bill they could tout as progress toward repealing and replacing the ACA.

It was an almost stunning about-face for a party that for years railed against Democrats for what they said was a rushed, backroom process to pass the ACA in 2010. (The debate over the legislation was actually far more protracted than characterized.) The latest version of the Republican bill, the text of which was still evolving overnight, was not posted until late Wednesday night less than 24 hours before the vote.

Meadows, who long blasted the Democrats as rushing Obamacare through, pushed back on accusations that Republicans were being hypocritical.

I have read the bill no less than six times, he said. If they havent read the bill its because they havent the spent the time to do that.

Whether Republicans seven-year mission to dismantle the ACA comes to fruition now lands squarely in the hands of the Senate.

Faced with a far more narrow majority in the upper chamber, Republicans plan to use a process known as budget reconciliation that would allow them to avoid a Democratic-led filibuster and pass a bill with a simple 51-majority vote. But the rules of that process pose their own hurdles, as they limit the scope of what can be passed through reconciliation to spending, taxes or the deficit. The House-passed bill would thus need to undergo substantial changes.

Republicans in the Senate signaled they were in no hurry to advance a healthcare bill.

My guess is were going to spend at least a month looking at the issue, Republican senator Bob Corker of Tennessee told MSNBC.

House Republicans said they expected the Senate to make changes to the legislation, with the goal of ultimately improving it. But that would tee up another vote in the House on its final passage and potentially reopen the chasm between the GOPs moderates and its right flank.

Democratic Joe Manchin, a senator from West Virginia facing a tough re-election battle next year, made clear Republicans were on their own as they eyed next steps.

I cant say [the Republican bill] is dead on arrival, he told Politico in an interview.

But they dont have 60 votes, so its dead on arrival.

The rest is here:
House Republicans pass healthcare bill in first step toward ...

While House Republicans have already celebrated their passage of a bill that would replace the Affordable Care Act, several of their GOP colleagues at the other end of the Capitol have already said the House version of the legislation is untenable.

At this point, there seem to be more questions than answers about its consequences, Sen. Susan Collins, R-Maine, said in a statement of the House bill.

Collins and a group of other Senate Republicans had already expressed concerns about the original version of the House bill, initially floated in March. But the new version of the House bill, which contains added provisions that would ease requirements that insurers cover pre-existing conditions, does little to assuage the senators initial concerns.

Senate leaders said Thursday that while they will review the House bill, they will also write their own version of a health care overhaul. But the differences among individual senators, and the fact that there can be no more than two Republican defections for the bill to pass underscores the challenge the Senate has ahead of it in coming up with a bill that satisfies enough holdouts.

Conservative GOP Sens. Rand Paul of Kentucky, Mike Lee of Utah and Ted Cruz of Texas all tweeted after the original House bills introduction that they would oppose anything short of a full repeal of Obamacare. They also said the House bill's tax credit structure to help people pay for coverage amounted to a new entitlement, too similar to the subsidies available under Obamacare.

The latest House bill would provide tax credits between $2,000 and $14,000 a year for individuals who dont get insurance coverage from an employer or the governments. The tax credits would be based on age instead of income, increasing as a person gets older.

After the House vote Thursday, Paul said he opposed the House bill because it guarantees the fundamental promise of Obamacare kept.

Cruz told ABC News earlier in the week that he still has a number of concerns about the bill, and I think many senators do.

In addition to such conservative members, four GOP senators from states that expanded Medicaid under Obamacare expressed concerns about the lack of protections for expansion beneficiaries: Sens. Cory Gardner of Colorado, Lisa Murkowski of Alaska, Rob Portman of Ohio and Shelley Moore Capito of West Virginia.

The House bill would raise the bar for Medicaid eligibility among lower-income Americans and cap payments to states for the program through block grants, reducing federal spending on the program by $880 billion over the next decade. It would also allow states to impose work requirements for able-bodied adults.

I continue to have concerns that this bill does not do enough to protect Ohios Medicaid expansion population, especially those who are receiving treatment for heroin and prescription drug abuse, Portman said in a statement after the House vote.

Capito also could not support the bill in its current form, a spokesman said.

Finally, Collins had originally expressed concerns about the bills revocation of federal funding for Planned Parenthood, barring Medicaid recipients from getting any reimbursements for visits to the family clinic, which many Republicans oppose because the organization provides abortions among its services.

She also raised concerns about the new additions to the House bill, asking in a statement, Exactly how does the bill treat individuals with pre-existing conditions? There should be no barrier to coverage for pre-existing conditions as long as people enroll and pay their premiums.

Collins may be one of the only Senate Republicans who wants to keep Planned Parenthood funding, but she is one of only 52 Senate Republicans. If she can't come around to the eventual Senate version of the bill, only one other Republican can vote against the bill and have it still pass (Vice President Pence would come in to cast a tie-breaking vote for Republicans).

Sen. Bill Cassidy, R-La., predicted a long road ahead for his chamber as they work to corral the disparate groups of skeptics and come up with a bill that at least most of them can support.

We need 50 votes and there are 52 of us, he said. So it will be a collaborative process where everyone's concerns are heard.

Originally posted here:
The trouble with House health care bill for Senate Republicans