Trump could still “F” it up . . .

House Republicans pull health care bill

http://www.cnn.com/2017/03/24/politics/house-health-care-vote/

Seven years of Republican efforts to eradicate President Barack Obama‘s proudest domestic achievement ended Friday before a single vote was cast.

House Speaker Paul Ryan sensationally pulled his Obamacare repeal bill from the floor Friday afternoon, a day after President Donald Trump had threatened to walk away from health care reform if he didn’t get a vote.

The decision to delay the vote marks an acute embarrassment for the President, who had gambled big by presenting holdout House conservatives with a take-it-or-leave it ultimatum Thursday night and put his own credibility on the line.
But Trump repeatedly pointed the finger directly at Democrats, who all opposed the measure, rather than at his own party, which holds a significant majority in the House.
Blogger’s comment–> The bill did not need any Democratic support to pass if enough Republicans wanted the bill to pass.
The failure of the GOP plan also puts Ryan in a much weakened political position, after being defied by his own conference, which seems just as unsuited to governing in the Trump era as it was when it was effectively a protest coalition under Obama.
They were unable to narrow the schism between Freedom Caucus conservatives (Blogger’s comment–> formerly known as the Tea Party), who believe the bill keeps too much of Obamacare intact, and moderates who worry they will pay an electoral price if millions of Americans lose health insurance.
The House meltdown on Obamacare repeal has perilous implications for the American health care system, with Republicans apparently unable to repeal the law but also unwilling to fix the deficiencies that the White House says will collapse the law.
“We came up short,” Ryan told reporters. “We are going to be living with Obamacare for the foreseeable future.”
“In my life, I have never seen an administration as incompetent as the one occupying the White House today,” said Senate Minority Leader Chuck Schumer, the New York Democrat who spars often with Trump. “Today we’ve learned they can’t count votes and they can’t close a deal. So much for the art of the deal.”
But tax reform will be no simpler.
Trump acknowledged there are many different groups in the GOP, meaning things aren’t as simple as having one party control both the White House, House and Senate.
“Lots of different groups. Lots of factions and there’s been a long history of liking and disliking within the Republican Party long before I got here,” he said.
There are clear signs of frustration in the White House at the Freedom Caucus, which has won a series of concession but is still holding out against the bill.
“We’ve emboldened them,” one White House aide said.
Rep. Leonard Lance, R-New Jersey, said that without a doubt, the decision to concede the repeal of essential health benefits to the Freedom Caucus definitely moved some of his colleagues to “no.”
“I suspect some became a no because of that,” Lance said. “That certainly didn’t help.”
The GOP health care bill would eliminate many of the taxes and eradicate the individual mandate imposed by Obamacare, officially known as the Affordable Care Act. Instead of the Obamacare subsidies that are tied to income and premiums, the GOP plan provides Americans with refundable tax credits based mainly on age to purchase health insurance.
The bill also significantly curtails federal support for Medicaid and allows states to require able-bodied adults to work. After 2020, states that expanded Medicaid would no longer receive enhanced federal funding to cover low-income adults like they did under Obamacare, and states that haven’t expanded would be immediately barred from doing so.
However, the GOP bill doesn’t touch some of the most popular pieces of Obamacare, including letting children stay on their parents’ insurance plans until the age of 26 and including protections for people with pre-existing conditions. But it would end the requirement that insurers offer comprehensive policies that cover maternity, drugs, mental health and substance abuse.
Pundit:  To negotiate from a position of strength you need a good command of the details (of whatever it is you are promoting) — Trump didn’t have that.  All-in-all there wasn’t a good case that could be made for the bill and no conservatives were on-board.  

Trump “absolutely, through executive action, could have tremendous interference to the point of literally stopping a train on its tracks,” said Sara Rosenbaum, a professor of law and health policy at George Washington University in Washington, D.C.

Perhaps Trump’s easiest action — and the one that would produce the largest impact — would be to drop the administration’s appeal of a lawsuit filed by Republican House members in 2014. That suit, House v. Burwell, charged that the Obama administration was unconstitutionally spending money that Congress hadn’t formally appropriated, to reimburse health insurers who were providing coverage to working-poor policyholders — those earning between 100 and 250 percent of the federal poverty line.

More than half of people who purchase insurance in the health exchanges get the additional help, which reduces out-of-pocket health spending on deductibles and coinsurance. While that help for consumers is required under the law, the funding was not specifically included. (Tax credits for people with incomes up to four times the poverty level to help defray the cost of premiums are a separate program and were permanently funded in the ACA.)

In April, Federal District Court Judge Rosemary Collyer ruled in favor of the House Republicans. “Such an appropriation cannot be inferred,” she wrote of the payments, and insurer “reimbursements without an appropriation thus violates the Constitution.” However, Collyer declined to enforce her decision, pending an appeal to a higher court. That appeal was filed in July and is still months away from resolution.

If Trump wanted to seriously damage the ACA, he could simply order the appeal dropped, letting the lower court ruling stand, and stop reimbursing insurers who are giving deep discounts to half their customers. That move would wreak havoc, said Michael Cannon of the libertarian Cato Institute, a longtime opponent of the health law. The insurers would still have to provide the discounts, as required by law, he said, “but they’re no longer getting subsidies from the federal government to cover the cost. So they are going to be selling insurance to these people way below the cost of that coverage.”

Even those who support the law say that mismatch would effectively shut down the health exchanges, because insurers would simply drop out. A Trump administration “really could collapse the federal exchange marketplace and the state exchanges if they end cost-sharing” payments to insurers,” said Rosenbaum, who has been a strong backer of the health law. There is already some concern about the continuing viability of the exchanges after several large insurers, including Aetna and United HealthCare, announced they would be dropping out for 2017.

Another way Trump could undermine the health law would be by simply not enforcing its provisions, particularly the individual mandate that requires most people to have insurance. That requirement is supposed to ensure that healthy as well as sick people sign up, thus spreading the costs of people with high bills across a larger population. But “executive branch non-enforcement could make a real difference to the vitality of the exchanges going forward,” Bagley said. If healthy people don’t sign up, sick people would need to pay more money for their insurance.

Aside from inflicting damage to the exchanges, the administration could also affect the law’s operations by refusing to approve states’ changes to their Medicaid programs. States rely on federal regulators to sign off on changes large and small, including which citizens are eligible, to keep their Medicaid programs operating. “There are so many things that an administration that doesn’t want a program to work can do,” Rosenbaum said.

Perhaps most important, Cato’s Cannon says, is not whether Trump could single-handedly undo the health law, but whether he could undermine it enough to force Congress to take action. If Trump were to do just enough to cause the insurance exchanges to fail, he said, “that would put pressure on Congress … to reopen the law.”

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