GOP health care so far: 22 million Lose Insurance, 20% Increase in Premiums, Insurers Leaving Individual Market. Nice!

There is no tweak, amendment, or new plan that will change the devastating impact of the GOP Trumpcare/Ryancare debacle. And today, the CBO confirmed to everyone that Trump and Trump alone controls the fate of the Affordable Care Act's Marketplaces.

Uncertainty has forced many insurers out of the individual market completely. In those markets where insurers pulled out completely, Republicans wrongly assumed no one else would step in and take their place, ignoring just how markets work. Doh!

The new CBO report offers up even more bad news for Republicans, including every American who's life depends on being insured.

If President Donald Trump stops cost-sharing reduction payments to insurers participating in the Affordable Care Act’s exchanges, premiums for individual plans would go up 20% on average, according to new analysis released on Tuesday by the Congressional Budget Office (CBO) and the Joint Committee on Taxation.

Trump himself has great power over whether the ACA survives, and one of the ways to help “Obamacare victims,” a term Trump and Vice President Mike Pence have used, is to guarantee these cost-sharing reduction payments to insurers, instead of threatening to stop them.

The Office’s findings underscore that Trump has control of the costs of these health insurance premiums. Many insurers that exited the marketplaces said they did so because of uncertainty over whether they would receive the cost-sharing payments.

“The most important thing that the president and the Republican senators can do is to ensure the funding for the cost-sharing reductions continues,” Dr. Mario Molina, former CEO of Molina Healthcare, told Yahoo Finance in July. “[Trump] has funded those on a month-to-month basis with no assurance they will continue. This is causing a lot of destabilization in the marketplace.”

For the insurers that have elected to stay on the exchanges to offer plans, many premiums were set in a similar ballpark to the CBO’s 20% as the insurers sought to hedge should the payments stop.

TrumpCare Odds and Ends....

Here's something I'll bet Democrats will forget to use in their 2018 campaign ads. It's a sure thing that can't miss...

...or something like this easy to write ad: "Paul Ryan's idea of health care reform didn't fool anyone."

...or Scott Walker's problem with math...

...and the dehumanization of liberal Americans - the other. Complete and utter projection from Eric Trump:

One of the great lessons of history is that it's not a good idea to dehumanize people, particularly when you are a powerful person with a large platform. President Trump did so with Muslims and journalists during his campaign. No one ever accused his son, Eric, of being The Smart One, so he went a step further last night. Eric explained that his father's Democratic opponents were not just political enemies. They are "not even people."

In the words of my conservative friend in Milwaukee...

Republicans run from Constituents, blame "threats" and "safety" concerns for blowback from their own unpopular agenda!!!

Republican speakers have played up their fear of angry liberal crowds on the nations college campuses for years. The more security they think they need, the more supposed threats they get, and the more controversy created in the media, the more famous and richer they become. Research David Horowitz's book selling, speaking tour con job, now being used by Ann Coulter and others.   

These blatant self-serving tours of victimhood are now being adopted by House Republicans…because it works.

So, who’s going to buy into the whiny Republican excuses about “threats” and “safety” as a reason not to meet with constituents anymore? What, can't take the rowdy town halls and loud angry forgotten real Americans? These are the same cowards and whiners who claimed they needed concealed carry to protect themselves against other imagined bogymen.

Maybe I’m mistaken, but constituent anger, even happiness, is the final arbiter in our system of checks and balances. You just can’t cut that out because it’s uncomfortable to answer to the public for radically unpopular decisions.

Be amazed at the Republicans fearful reaction to the perceived threats and the predictable consequences of their radical agenda. The Hill:

A growing number of House Republicans are facing physical threats from angry constituents in their districts, leading many to fear for their safety. 

Scores of GOP lawmakers have experienced going viral this year with video of constituents shouting their disagreement on support for President Trump and policies like the GOP’s healthcare bill. 

In the last few weeks alone, the FBI arrested a man threatening Rep. Martha McSally's (Ariz.) life; a woman pursued Rep. David Kustoff (Tenn.) with her car, and Rep. Thomas Garrett (Va.) heightened security at a recent town hall in response to death threats. 
 Other Republicans still holding town halls say they haven't felt physically threatened by protesters, but they worry about the depth of anger from some constituents in the polarized environment and what it means for political civility.  

Well, that kind misses the point, right? It’s policy that is the polarizing factor!!!

Our cafeteria conservatives often try to get around the Constitution by resorting to our “God given rights,” a sneaky religious expansion that runs counter to the 1^st Amendment.  So is it “a fundamental tenet of western civilization?”  

Rep. Dave Brat (R-Va.) described attendees at a town hall in his district last week who booed him down after he said people’s rights are God-given. “They booed God. They booed the pastor. They booed the prayer. They booed the name of the church. They booed when I said rights come from God,” Brat recounted to The Hill just off the House floor. “That’s a fundamental tenet of western civilization. I mean, I didn’t think that was partisan.”

One Republican who continues to tell the story about losing his special needs daughter doesn’t get that backing TrumpCare makes him a hypocrite and shameful exploiter of his own family tragedy.

Further north in New Jersey, Rep. Tom MacArthur (R-N.J.) faced pushback from a crowd when he began telling the story of his special-needs daughter who died at the age of 11. “Shame!” people shouted. “We’ve heard this story.” “This child in 11 years has shaped my life more than anybody. So if I talk about my daughter too much, well then so be it. But this is the one human being that has impacted my life more than anybody,” MacArthur said. Another person sarcastically yelled … “Maybe I will write a book,” MacArthur shot back. 

Yet Democrats don’t have the same problem, again because of the publics roll in our checks and balances system.

Still, not every town hall has veered into nastiness. Rep. Mike Coffman (R-Colo.), a top Democratic target in 2018, said his town hall attendees expressed their clear displeasure with his positions but remained civil. “You know, they had the signs and stuff like that. But I thought they were pretty nice, I thought they were pretty respectful,” Coffman said. “From the stories I have heard in other districts, I’ve got it pretty good.”

Now gun loving Republicans, who backed Clive Bundy’s use of weapons to threaten government agents, cheered on armed civil protests for open carry, and passed right to kill “stand your ground” laws are scared to death of angry armed...liberals. Big surprise? For every action, there’s a equal and opposite reaction…or did Republicans forget? It doesn’t make it right, but desperate Americans who need their health care to stay alive are left with few civil choices:

The FBI arrested a Tucson, Ariz. man for leaving three threatening messages on McSally’s congressional office voicemail, in which he allegedly said her days “were numbered” and threatened to shoot her. A criminal complaint filed last week in the U.S. District Court in Tucson said the suspect told agents he was upset over McSally’s votes in support of Trump … the same swing district previously represented by then-Rep. Gabrielle Giffords, who was shot in the head in 2011 during a constituent meet-and-greet.

In Tennessee, a woman angry over Kustoff’s vote for the GOP health care bill this month pursued a car carrying him from an event at a local university. Kustoff and a staffer eventually turned into a driveway and came to a stop. Then the woman approached the car, yelled at Kustoff and struck the car’s windows, according to local reports.

Meanwhile, Rep. Tom Garrett (R-Va.)  spokesman Andrew Griffin said the freshman lawmaker has received at least three death threats … One constituent called Garrett’s Washington, D.C. office and said if his health care is taken away, he would take Garrett’s life away.

A constituent angry over the GOP’s healthcare bill approached Rep. Kevin Cramer (R-N.D.), took dollar bills from his wallet and tried to shove them into the lawmaker’s suit pocket, the Bismarck Tribune reported. 
 Rep. Jeff Fortenberry (R-Neb.) wasn’t home when his young daughter found a sign on the family’s lawn last week that read: “Traitors put party above country Do the right thing for once, shithead.”“Attack me, protest against me, but do not frighten my children at their home,” Fortenberry said in an interview with Fox News’s Neil Cavuto.

Rep. Ted Yoho (R-Fla.) described protesters vandalizing his Gainesville, Fla. Office … “They’re mad to the point where they’re cussing at my staff, pushed one of them, poured stuff on one of the staff’s car,” Yoho told The Hill. “If they start acting responsible and respectable, we’ll do the same.” 

No more Town Halls for Ryan!!! Afraid and hiding from angry crowds, or protecting constituents from "a harassing environment?" Took High School students Questions in Advance?

Elected politicians are supposed to answer to their constituents. Not anymore out of fear and constituent anger over their agenda.

Scott Walker said he wanted to divide the public and destroy the unions, and did just that despite the outcry and anger of millions of Wisconsin protesters. Instead of moderating or acknowledging their existence, Walker said Wisconsinites were trying to intimidate him...seriously, who thinks like that?

So Walker no longer answers to the state voters because he's afraid to appear in public. He now appears only at closed corporate events.

Add House speaker and Wisconsin Rep. Paul Ryan to the list of frightened unreachable's. Ryan's excuse? He's protecting his constituents of course. Make no mistake, he's personally not afraid to defend his indefensible health care plan in an unpredictable town hall environment, like Scott Walker:

"It's not that I'm not doing town halls. I'm getting around to see constituents all the time. I'm doing office hours, I'm doing telephone town halls, I'm doing business interviews. I'm doing it in a way so constituents don't go into a harassing environment." -Ryan

Ryan attacked those out-of-state protesters, not the in state protesters. Reminder, Ryan's agenda affects all Americans, so in this case, out-of-state citizens showing up makes a lot of sense:

Ryan: "I'm doing it in a way so that constituents don't go into a harassing environment. So I want to make sure my constituents don't be agitated and walking into a harassing environment. I want to be able to interact with my constituents in a way that THEY feel comfortable as well." 

Meeting with constituents is a test of whether a politician doing their job or not. And if the pubic is angry, disruptive and asking pointed questions that can't be logically answered, well, that tells that elected official he or she is out of touch.

Oh, and it appears Ryan can't take heat from even high schoolers?

At Badger High School, Ryan, responding to questions that a school official said were submitted in advance...

Republican Rep. MacArthur wrote State Waiver Amendment for TrumpCare, gets Angry Voter Feedback!!!

It's getting ugly, and for good reason. The guy responsible for allowing states to roll back patient protections is on the receiving end of angry constituents:

Rep. Tom MacArthur, a former insurance executive, ensured passage of the American Health Care Act by drafting an amendment allowing states to seek waivers from the federal requirements.

"He clearly ignited a backlash from his constituents that will be on display," said Maura Collinsgru, health care program director for Citizen Action. "Unfortunately, he's on the wrong side of an issue and I think his constituents will be there to grill him on that."

Following the bill's passage, the Cook Political Report, a Washington-based publication that tracks congressional races, said MacArthur now would have a tougher re-election campaign, and an advocacy group that opposed the repeal legislation began running television and digital ads against him.

Reporter Dave Weigel kept us updated on the town hall fiasco. Starting his tweet storm from the bottom:

Health Care: the Bad, the Ugly, the Good.

I recently tweeted a link to the list below of health care services we would lose if the GOP TrumpCare plan passed into law, with the state waiver plan in place. 

One of the biggest problems the ACA had was getting people insured through their employer a working understanding of the individual market plans. Employees had no idea how dysfunctional our system was since they never had to "shop" for insurance, so it was easy to hate and oppose ObamaCare. And Republicans knew that, exploited that, and turned public opinion against it.

But as the public paid more attention to the details exposed by town hall video clips, the CBO analysis, and Paul Ryan's first failed attempt to get something passed, support for the ACA finally took off, and surprise, Republicans were stuck with an old repeal and replace plan nobody wanted. Oops.

Now Employee Provided Health Insurance Gets Crushed: Swept into Ryan's celebrated House bill was this draconian surprise:

An inconvenient truth uncovered by the Wall Street Journal exposes that the bill would allow individual states to opt out of the ACA minimum benefit standards. Employers could just reduce covered benefits they offer by hunting the most bare bones standards offered by the most regressive state, limiting, for example, existing ACA requirements that cap out of pocket expenses.

Republican voters and twitter trolls don't seem to care one way or another about any of this, including the list below, but they will once their wallets empty and their stuck planning bake sales or car washes to fund a life saving medical procedural for their family member:

There is nothing "free market" about the RyanCare plan. Sure you can shop for insurance, but once you buy it, well, you're stuck with insurance bureaucrats, red tape, narrow networks, limits to coverage, copays, and sky high deductibles. 

Republican Health Savings Accounts to the Rescue? This is voodoo health care magic for the true believers. It's a rip off and complete nonsense. Twenty years ago I bought into their voodoo HSA plan just to see what would happen, and here's what I got...and what you're going to see in the future:

1. 20% to 30% premium increases every year. This happened with each of the two companies I had policies with.

2. Through the roof deductibles. My last deductible was $10,500 in 2006, a supposed bargain because the higher deductible lower my monthly premium increase by a few dollars. Lucky me.

3. The tax deduction for a Health Savings Account only covered half of my yearly deductible. That was no bargain.  

4. The myth of actually having money in your Health Savings Account. I gambled and had almost nothing in mine, because I couldn't afford to park money away like that. That's the dirty little secret about the HSA's. No one will fund their accounts.

5. "Freedom and Liberty" isn't offered by insurers. I tried to remove my $700 a year prescription drug option for a year or two because I didn't need it, but was told I could never add it back onto the policy if I removed it, ever. 

6. Bills from doctors who strolled through my operating room, who weren't part of the insurer network, happened regularly. That was huge, like having a second deductible. 

It's back to the old health care nightmares, made worse by invasive drug tests, work requirement and benefit limits.

See if California's plan fits what you would like from health care, and your government: "The Healthy California Act proposal meets the common-sense standard that the American people are demanding:"

1. Every Californian eligible to enroll, regardless of age, income, employment, or other status

2. No out-of-pocket costs, such as high deductibles and co-pays, for covered health services.

3. Comprehensive coverage, including hospital and outpatient medical care, primary and preventive care, vision, dental, hearing, women’s reproductive-health services, mental health, lab tests, rehab, and other basic medical needs.

4. Lower prescription-drug costs.

5. Long-term care services provided under Medi-Cal continue, and will be expanded with an emphasis on community and in-home care.

6. No narrow insurance networks, one medical card, real patient choice of provider.

7. No insurance claims denials based on corporate-profit goals.

8. Funding through a consolidation of resources currently spent on health coverage, including federal payments for Medicare and Medicaid, major savings from elimination of insurance waste, other bureaucracy, and profits with coordinated planning on health resources, and added revenues through a progressive tax (program).

New GOP Health Care con keeps ACA benefits, then grants Waivers to ACA benefits!

Here's my theory; Republicans want to keep the ACA framework in place so they can keep blaming "ObamaCare" for the failure of their meddling "revisions."

What else could explain the "new and improved" revised TrumpCare plan. Try not to laugh at how transparently ridiculous it is: Keep all the provision of Obamacare, but grant waivers to all the ObamaCare provisions!!! Nuts right?

The MacArthur Amendment would:• Reinstate Essential Health Benefits as the federal standard• Maintain the following provisions of the AHCA: Prohibition on denying coverage due to preexisting medical conditions. Prohibition on discrimination based on gender. Guaranteed issue of coverage to all applicants. Guaranteed renewability of coverage. Coverage of dependents on parents' plan up to age 26. Community Rating Rules, except for limited waivers.

Here are waivers that basically repeals ObamaCare, state by state:

The amendment would create an option for states to obtain Limited Waivers from certain federal standards, in the interest of lowering premium costs and expanding the number of insured persons.

Spelled out, "Maintaining the following provisions of the AHCA" which maintain some of the provisions of the ACA, means choosing not to maintain the provisions. You can't make this stuff up:

States could seek Limited Waivers for:• Essential Health Benefits• Community rating rules ... freeing insurers to go back to using an individual rating system to set premiums ... except for the following categories, which are not waivable: Gender. Age (except for reductions of the 5:1 age ratio previously established)o Health Status (unless the state has established a high risk pool or is participating in a federal high risk pool).

The "Limited Waiver Requirements" may include just of the following excuses to rip health care to shreds. Republicans desperately want to push sick people into high cost "state risk pools," where we socialize the care of our sick with taxpayer money, and give insurance companies healthy people and healthy profits:

States must attest that the purpose of their requested waiver is to reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre-existing medical conditions. The Secretary shall approve applications within 90 days of determining that an application is complete.

Thank god Trump stepped up with a few of the finer details?

Trump: "This is a great bill, a great plan, and this will be great health care. It's evolving, it was never a give up...and the plan gets better, and better and better. And it's gotten really really good. And a lot of people are really liking it a lot."

As Vox's Sarah Kliff reports:

But because of the conservatives, they won’t provide the funding experts say is necessary to really make those high-risk pools work. So people are at risk again.

Of course ignoring public opinion is nothing new....

Visualization by Graphiq

Trump will be blamed for ACA collapse!!!

Overwhelming majorities in both party's support making changes to the existing Affordable Care Act. And yet Trump is now saying he wants changes that would directing break many of his campaign promises to lower prices and offer better care, just so he could supposedly save $900 million and throw 24 million people off insurance:

Trump: "I think we're doing very well on healthcare. It's been very much misreported that we failed with healthcare. We haven't failed — we're negotiating and we continue to negotiate and we will save perhaps $900 billion." 

Trump is referring to the CBO report on the AHCA ... estimated that the bill could cut the federal spending by $880 billion over the next 10 years ... (but) After the most recent additions to the AHCA, the CBO updated this estimate to say the deficit could shrink by only $151 billion.

And while Paul Ryan continues to try and reinvent the health care wheel, ignoring other successful systems worldwide while bringing back those failed "high risk pools," the market based solution he so badly wants is right there in front of him; the all-payer nationalized plan, where countries with insurers negotiate one price for each procedure. That in turn, eliminates the massive and costly price differences between providers, saving everyone lots of money.

Alaska Plan: If we had an "all-payer" pricing policy, and did what Alaska did with "reinsurance" (not risk pools), we could stabilize premiums for years to come:

Premiums for individual health insurance plans were set to rise 42 percent. So the state tried something new and different — and it worked. Lori Wing-Heier, Alaska’s insurance commissioner, put together a plan that had the state pay back insurers for especially high medical claims submitted to Obamacare plans. This lowered premiums for everyone. In the end, the premium increase was a mere 7 percent. The state already had a tax on insurance plans (not just health but also life and property insurance) ... used that money.
Now other states are interested in trying Alaska’s idea, especially because Wing-Heier is working with the Trump administration to have the federal government, not the state, cover those costs.

It's the old reinsurance model, paired with low predetermined prices for care.

Reinsurance essentially backstops insurers’ losses; it guarantees they won't be on the hook for the bills of a handful of exceptionally sick patients.

This didn't just save customers money. The federal government subsidizes premium costs for 86 percent of Alaska's Obamacare enrollees. With cheaper premiums, the federal government didn’t have to spend as much money. The cost of these subsidies fell by $56 million when Alaska created the reinsurance fund.

But Republicans have never worked hard on solutions that require research, knowledge and debate. It's much easier to repeal something, and then promise to "look into" or "study" the issue at another time.

Now Trump wants to blackmail Democrats into negotiating with him and Paul Ryan.

Trump’s new threat is that he will cut off so-called cost-sharing reductions, which subsidize insurance that offers lower out-of-pocket costs to 7 million lower-income Americans. For all the details, see this piece by Jonathan Cohn; if Trump does this, premiums could skyrocket and insurers could flee the individual markets, causing them to melt down and ultimately pushing millions off coverage. As Cohn notes, Trump is basically “threatening to torpedo insurance for millions of Americans unless Democrats agree to negotiate with him.”

Will Trump kill the ACA?

Trump told the Journal that “Obamacare is dead next month if it doesn’t get that money,” adding that “Democrats will start calling me and negotiating.” Trump treats the word “deal” as some kind of magically irresistible end in itself. But under these circumstances, the only known endpoint — the supposed “deal” — is worse than the “threat.” Why should Dems feel any incentive to respond to such a threat?

Here's what the recent Kaiser Family Foundation poll said about Trump's "let it explode" idea:

President Trump threatened to leave the law alone and let it self-destruct. But the April Kaiser Family Foundation survey finds that 75 percent of the public wants the president and the Republicans to do what they can to make the law work, compared to only 19 percent who think they should let the law fail so they can replace it later. Moreover, 61 percent say that the president and the Republicans are now in charge and are responsible for problems with the ACA—not President Obama and the Democrats who enacted it.

Failed TrumpCare Plan successfully avoids debating an "All-Payer" plan.

Republicans are really great time wasters, debating how little health care coverage should be allowed before voters turn on them. Reelections matter to them. When the Democrats passed the ACA, they knew what the risks were, and it didn't turn out well for them.

But there is a solution, and it's part of the discussion they don't want to have.

All-Payer: I used to describe all-payer as a national health care plan of mandated coverage and prices. It was a common element of universal or single payer systems worldwide:

Daily Kos: As Vox's Sarah Kliff rightly highlighted, "France, Germany, Japan, the Netherlands, and Switzerland all use some version of all-payer rate setting." Even with hundreds or thousands of private insurance plans, since 1980 all five countries have experienced much slower growth in health care spending than the United States (see chart below). 

All-payer rate setting is a powerful reason why: In all-payer rate setting, all of the insurers negotiate jointly with all of the health care providers, and set on one specific price for each procedure...Single-payer health care systems save money in two ways: reducing administrative costs and increasing the bargaining power of health insurers. This is true of all-payer rate setting systems, too.

Even without insurance, the lower row of prices wouldn't bankrupt most American families:

In contrast, the Republican vision for health care is a return to the Hobbesian struggle of each against all in the American health care ecosystem. And that means more pain for consumers, insured and uninsured alike. Or as Vox founder Ezra Klein put it in March: “American health care can be free market or cheap. It can’t be both.”

Before the ACA:

A 2011 report by the Department of Health and Human Services found that before the ACA took full effect “62 percent of individual market plans did not cover maternity care, 34 percent did not cover substance abuse services, 18 percent did not cover mental health coverage and 9 percent did not cover prescription drugs.”

The Four Basic Health Care Systems: This is what we should be debating:

Sick Around the World describes the four basic models including the "out of pocket" approach, the completely government-run system implemented in the UK, the Bismarckian social insurance strategies in Germany and Japan, and the single-payer system in Canada that’s emulated by South Korea and Taiwan:

Reid reports next from Japan, which boasts the second largest economy and the best health statistics in the world. The Japanese go to the doctor three times as often as Americans, have more than twice as many MRI scans, use more drugs, and spend more days in the hospital. Yet Japan spends about half as much on health care per capita as the United States.

One secret to Japan's success? By law, everyone must buy health insurance—either through an employer or a community plan—and, unlike in the U.S., insurers can neither turn down a patient for a pre-existing illness, nor are they allowed to make a profit.

Reid's journey then takes him to Germany, the country that invented the concept of a national health care system. For its 80 million people, Germany offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. Professor Karl Lauterbach, a member of the German parliament, describes it as "a system where the rich pay for the poor and where the ill are covered by the healthy." As they do in Japan, medical providers must charge standard prices. This keeps costs down, but it also means physicians in Germany earn between half and two-thirds as much as their U.S. counterparts.

Republicans are pushing a "buy what you can afford" health care insurance model. The list of physicians below shows you how difficult it would be to make those choices. And don't be naive either, insurers will charge much more for the popular choices, since they aren't about to lose money on cheap stripped down policies. And how cheap can prices go to maintain the yearly incomes below? Annual Physician Compensation Report:

Threat of Trump/Ryan Repeal will Kill the Affordable Care Act's Market Places!!! It's that easy.

JUST TO BE CLEAR: IT WILL BE THE REPUBLICANS FAULT FOR CAUSING THE ACA (OBAMACARE) COLLAPSE!!!

While Democrats may have won the health care debate for the time being, Republicans are patiently and very openly waiting for the ACA to implode, or as Trump so inaccurately claims, “blowup.”

In fact, it's not just the ACA that’s in danger, but the whole individual market (non-employer insurance); profits won’t be big enough. Modern Health:

Aetna said Thursday that it will stop selling individual policies both on and off the state's Affordable Care Act exchange next year. The decision follows on the heels of Wellmark Blue Cross and Blue Shield's announcement that it will exit Iowa's individual market in 2018. Now thousands of Iowans will be forced to switch health insurers—if they can find one.

But because both Aetna and Wellmark are pulling the plug on both on- and off-exchange individual plans, the consequences extend beyond dwindling choice on the ACA federal marketplace. “It's not clear how many options people may have even if they are able to pay full price and buy off exchange,” Cox said.

The Republican “Repeal” Poison Pill Set this in Motion: What major insurance company can conduct business under the threat of repeal? Insurers said as much:

1. An Aetna spokesman said the decision is a result of “financial risk and an uncertain outlook for the marketplace.” 

2. With a number of regulatory unknowns and no clear sign that the federal government will continue to support the individual marketplace, experts say other states could soon see an insurer exodus as well … health insurers have threatened to quit offering policies on the ACA's marketplace if they don't get the regulatory details they need to design and price their insurance plans. 

3. Insurers have warned Congressional leaders that they need to see signs that the Trump administration will work to stabilize the individual market if they are to commit to selling plans in 2018. Iowa's situation is an example of what may happen across the nation if insurers don't get answers soon.

Sounds like a problem created by Trump and Paul Ryan, ya think?

Oh, and about those tearful insurance company “losses;” let’s just call it a “decline in grotesque profits:”

Wellmark said it lost about $90 million from ACA-compliant health plans sold in Iowa over the past three years. But it is a drop in a bucket relative to the $2.7 billion in revenue Wellmark recorded in 2016 alone, financial documents show.

Given the minor loss, it is likely that Wellmark's exit has more to do with the uncertainty surrounding the future of the health insurance landscape and the prospect of further financial losses if the Trump administration fails to shore up the marketplaces, experts said.

Trump and Ryan inaction will Kill the ACA: 

It is unclear if insurers will get the details they need to commit to the exchanges for 2018. In most states, they have until June 21 to decide whether to participate. But the Trump administration has yet to address insurers' most pressing concerns about availability of cost-sharing reductions and the enforcement of the mandate that consumers purchase coverage. Those two policies are essential to ensure the individual market stays afloat and affordable during the transition period to an ACA replacement plan.

And no, it’s not a problem caused by the Affordable Care Act:

“We're deeply troubled by the angst and concern the Affordable Care Act is causing in Iowa," Iowa Insurance Commissioner Doug Ommen said in a statement. "This is a problem created by the Affordable Care Act and needs to be fixed by Congress."

The Unlikable Arrogance of Paul Ryan; "I worry we'll push the president into working with the Democrats."

The Affordable Care Act tried desperately to include Republican to participate from the very beginning, and failed. It was ironic too because the ACA was nothing more than a revamped Republican/Heritage Foundation plan all along.

Wisconsin embarrassment and extremist policy wonk Paul Ryan arrogantly thought his devastating plan to toss 24 million people from health care coverage was still better than the ACA. Let's take a look at that, starting with the dramatic drop in the uninsured under ObamaCare:

Will AHCA improve people's Lives, or end them?

Oh, but don't worry, just wait until the GOP gets the 60 votes needed to pass phase 3 of their plan. That will turn all of these horrifying numbers around? Seriously?

Now in power, Paul Ryan's one party system will no longer tolerate suggestions from the Democratic Party or three quarters of the country that didn't vote Republican. In fact, it's a repugnant thought. Ryan said in an interview that aired on “CBS This Morning:

“I don’t want that to happen. About 90 percent of our members are for this bill. We’re not going to give up after seven years of dealing with this, after running on a plan all of last year, translating that plan into legislation, which is what this is. We had been an opposition party for 10 years, and I’ve been long saying, if we’re going to be successful, deliver for the American people, improve people’s lives, we’ve got to become a proposition governing party.”

If we don’t do this, then he’ll just go work with Democrats to try and change Obamacare, and that’s hardly a conservative thing. This is a can-do president, who’s a business guy, and he wants to get things done. I know he wants to get things done with the Republican Congress, but if this Republican Congress allows the perfect to be the enemy of the good, I worry we’ll push the president into working with the Democrats. He’s been suggesting that as much.”

 When Trump supporters found out ObamaCare was actually the ACA, and that 24 million people would not only lose their insurance but end up buying worse coverage with higher deductibles, the shit hit the fan:

Democrats won't let Trump "Explode" ACA!!!

Trump's tantrum over his failure to pass his TrumpCare health plan may be over, but Democrats aren't waiting around to find out.

Democrats are attacking Trump for saying he would let the ACA blowup/fold. And they're not going to let up.

With Republicans in retreat from their aborted effort to repeal the Affordable Care Act, Democrats are now in hot pursuit, demanding that the administration cease any effort to “explode” the health care law … proposing tweaks to the ACA and calling on GOP colleagues to put forward their ideas … extending subsidies for people who have higher incomes but don’t qualify for tax credits; restoring risk corridors; enabling the health and human services secretary to negotiate lower prescription drug prices; fixing the individual market; and extending reinsurance.

The most aggressive proposal so far has come from Sen. Bernie Sanders and Rep. Keith Ellison. They’re calling for party members to embrace a Medicare For All program.

The researchers at The Center on Budget and Policy Priorities aren't going to let Trump undermine the ACA without keeping the public informed:

Sabotage Watch: Tracking Efforts to Undermine the ACA: Following the failed Republican attempt to repeal the Affordable Care Act (ACA), President Trump said that, politically, the best thing to do would be to let the ACA “explode.”

Below is a gif that shows what happened to ACA signups that were well ahead of last years signups when Trump pulled the ACA signup ads (click to enlarge):

Trump focused on his reelection, not horrific and Deadly GOP health care law.

We knew going in that Trump was a sociopath with the attention span of an ant, according to the author of his book, "The Art of the Deal:"

If he could do it over again, however, Mr. Schwartz said the book would be titled “The Sociopath.”

“I feel a deep sense of remorse that I contributed to presenting Trump in a way that brought him wider attention and made him more appealing than he is. I genuinely believe that if Trump wins and gets the nuclear codes, there is an excellent possibility it will lead to the end of civilization.”

Well, on a smaller scale, at least in this country, Trump would have pared down civilization.

It's about Trump, NOT Health Care: I'm going to call it the Trump rule, where everything coming out of the White House is for the benefit of the great and wonderful wizard Trump. The following sociopathic statement from Trump even shocked the tea party ghouls pushing profits over human life:

Politico: It was Thursday afternoon and members of the House Freedom Caucus were peppering the president with wonkish concerns about the American Health Care Act—the language that would leave Obamacare’s “essential health benefits” in place, the community rating provision that limited what insurers could charge certain patients, and whether the next two steps of Speaker Paul Ryan’s master plan were even feasible—when Trump decided to cut them off. "We’re talking about one-fifth of our economy," a member told me afterward ... according to multiple sources in the room:

"Forget about the little shit, let's focus on the big picture here."
Trump wanted to emphasize the political ramifications of the bill's defeat; specifically, he said, it would derail his first-term agenda and imperil his prospects for reelection in 2020. The lawmakers nodded and said they understood. 

Ryan's Unforgettable TrumpCare Failure!!!

As it turned out Freedom Caucus Tea Party Republicans, who wanted no real replacement to help Americans buy insurance, resulted in moderate Republicans voting no on Paul Ryan's TrumpCare monstrosity. Take note, every Wisconsin GOP Representative would have voted for the final version of this cruel inhumane joke.

The fact that Paul Ryan never came up with, or tried to put together, an agreeable GOP plan in seven years cannot be lost in all of this. TrumpCare finally exposed this self-righteous fraud.

Trump: "We will have so much winning if I get elected that you may get bored with the winning.”

Ryan Comment #1: "Moving from an opposition party to a governing party...?" No, really, you think?

Ryan Comment #2: "Are we willing to say yes to the good, the very good even if it's not the perfect?" 24 million losing their health care is "very good" and "not the perfect?" Like it's close, right?

Ryan Comment #3: "I'm really proud of the bill we produced. It would make a dramatic improvement in our health care system, and provide relief for people hurting under ObamaCare." My god what is wrong with this guy...see picture -----------------------------

Ryan Comment #4: "So I don't think the architects of ObamaCare...I'm sure they may be pleased right now,  but when they see how bad this thing gets...I don't think they're going to like that either." Sneaky. Ryan is promising not to lift a finger to fix the ACA in the future. And repeal still hangs over insurers, who may see no future in staying on the exchanges. That makes this the GOP's fault. Modern HealthCare:

Experts expect HHS Secretary Tom Price to try to pare down those mandates through rule-making. 

Insurers have complained that the huge uncertainty caused by the GOP effort to repeal and replace the ACA has made it difficult or impossible for them to make plan and rate decisions for 2018. Some say they're weighing whether to withdraw from the individual market. And that was before House Republicans and the White House last week unveiled their proposal to erase the ACA's minimum essential benefit requirements. “This is adding even more uncertainty to an already-uncertain situation, making it unlikely insurers would continue to participate,” said Cynthia Cox, associate director of health reform and private insurance for the Kaiser Family Foundation.

Trump wont fix ACA, also set it up to die from uncertainty for insurers, and then blamed the Democrats? Here's Trump's promises, his failure and MSNBC's Joy Reid showing Democrats just how to drive the point home over and over again, never letting Republicans off the hook:

Changes proposed to attract additional Republican votes for the party’s bill will narrow the amount of deficit reduction by more than half, according to the nonpartisan CBO.

Many Republican governors were relieved they wouldn't have to make really really unpopular cuts:

The nonpartisan Kaiser Family Foundation found in a study this week that trying to maintain the existing levels of Medicaid coverage would have taken cuts equal to one-fourth of some state governments' education budgets to keep the coverage without raising taxes, the report found.

Trump Denied ever saying Repeal and Replace? Well....



NJ Democrat Frank Pallone nailed Republicans for voting yes...should have gotten more press:



Important Health Care Points:

There also were concerns that eliminating the federal benefit rules or delegating benefit determinations to the states could drive up premiums for people with chronic conditions. In addition, removing the essential benefits requirement would essentially neuter the ACA's ban on insurers setting annual and lifetime caps on benefits, since they could set limits on services that are not required benefits. Removing the basic benefits mandate also would make it harder for consumers to shop and compare plans.

Oops, Ad's thanked Republicans for ACA repeal! Premature victory laps are embarrassing enough, but don't be surprised if the GOP starts congratulating itself for not repealing the ACA...that's next:

Basketball fans in several Republican-adjacent TV markets are enjoying a series of ads, prematurely bought by the American Action Network PAC, inviting viewers to call their representatives to thank them for repealing Obamacare today—something that did not happen.

Ads praising Virginia’s Barbara Comstock; it ran during the Wizards-Nets game ... ads for Fresno’s David Valadao and Des Moines’s David Young; both ran on CBS stations before March Madness coverage. Money well-spent, we think.

ObamaCare troubles a Republican Creation!

The Affordable Care Act is in trouble because Republicans refused to tweak the system as problems cropped up. 

Another problem is the introduction of competition in the insurance marketplace. Consumers finally had a chance to compare insurer plans side-by-side, forcing insurance companies to provide lower premiums to get their business. But that hurt their bottom line, and they left the exchanges. Real comparison shopping for insurance in the individual private market is impossible, which is why many sought out insurance agents for advice.

The three other biggest reasons? Republican Sabotage:    

1. See, Insurance Companies are Leaving the Exchanges…ObamaCare Failed? 

Rep. Marco Rubio severely limited the supposed "bailout fund" in the Affordable Care Act for what are called called risk corridors, a temporary aid for insurers to adjust premiums.

Rubio helped persuade Congress to prevent Health and Human Services from being able to cover expenses in its own budget. But experts have said Rubio is wrong to call the program a bailout, and that the program is supposed to pay for itself through fees from insurers.

2. See, since CBO wrongly estimated ACA enrollment, can't believe 24 million will lose insurance? Only 32 states expanded Medicaid, instead of all 50 states after the Supreme Court struck down the coverage mandate. That blew a hole in the CBO estimate:

3. See, Medicare is Going Broke, so now we have to Privatize to Save It: 

A key Ryan change would repeal a Medicare tax on high earners a year earlier than originally proposed. Obamacare imposed an additional payroll tax of 0.9% on individuals earning more than $200,000 and couples earning more than $250,000 (among other changes to Medicare) … leading to about $10 billion of lost revenue. “Here you have a bill where Congress is voting to actively undermine the trust fund, and it’s singularly for the purpose of providing tax breaks for the wealthy,” says Stacy Sanders, federal policy director for the Medicare Rights Center.

Insurance Industry Insider Shreds GOP's RyanCare plan.

There is one shining spot for insurers in the GOP health care plan (remember, insurance has nothing to do with providing health care).

The Republican plan does allow insurance companies to offer coverage that pays for a lower share of a person's health care costs — just half of all costs rather than the 60 percent to 90 percent mandated under the ACA.

Funny thing though, according to a former insurance industry insider, Republicans don't know what the hell they're doing. I know I've said this same thing before, but now I've got backing. From NPR:

Scott Horsley, NPR News: There is some political irony here. The people and places most likely to be hard hit by the change - older, rural, lower income - are the same ones that helped to elect the president. That's why some Republican senators who represent those areas are now talking seriously about possible changes to the GOP bill.

But there are also many Republicans who want to prevent the government from helping anyone buy insurance. And they would try their grand experiment on the entire U.S. population…which should make you wonder if they’re not the most reckless irresponsible people ever elected into public office.

What never gets enough attention are the dramatically reduced services in the GOP’s insurance policies. This is big, because it’s what made many Americans not even bother to get insurance before the ACA. It’s another big reason health care bankruptcies skyrocketed, destroying families along the way.

NPR: Republicans have said repeatedly that they want insurance companies to be able to offer cheap, stripped-down policies that don't cover as many services as those under the Affordable Care Act, also known as Obamacare. That way, consumers will have the choice to spend less on premiums if they don't want comprehensive coverage.

The problem is Republicans have a three-part strategy to reshape health care. The first is the American Health Care act, which essentially repeals Obamacare's individual mandate, taxes and subsidies, and replaces them with smaller tax credits to help people buy insurance.

Then they intend to make changes in regulations and pass additional legislation to reduce the benefits insurers have to offer and allow more competition between insurers. They say their ultimate goal is to reduce the cost of insurance so more people will buy coverage.

Stripped down coverage. Want to pay a monthly premium, that increases every year, for that? Just to be clear, if the plan below sounds good to you, well, maybe the GOP has a bridge you’d like to buy too:

The Republican plan does allow insurance companies to offer coverage that pays for a lower share of a person's health care costs — just half of all costs rather than the 60 percent to 90 percent mandated under the ACA. 

The Blind Obedience of Trump Voters, an Update!!!

Many Trump voters aren't really paying attention to the Paul Ryan health care sausage being made in D.C., because to them, they believe a multi-millionaire who can't stop lying, and campaigning, is going to take care of the forgotten little guy. Yes, now they want help from the government.

Like Captain America's Chris Evan explained:

Esquire: "I feel rage. I feel fury. It's unbelievable. People were just so desperate to hear someone say that someone is to blame. They were just so happy to hear that someone was angry. Hear someone say that Washington sucks. They just want something new without actually understanding. I mean, guys like Steve Bannon—Steve Bannon!—this man has no place in politics. Some people say, 'Don't you see what's happening? It's time to yell.' 

Yeah, I see it, and it's time for calm. Because not everyone who voted for Trump is going to be some horrible bigot. There are a lot of people in that middle; those are the people you can't lose your credibility with. If you're trying to change minds, by spewing too much rhetoric you can easily become white noise."

With that, here are two recent clips featuring Trumpian followers. In the first video, one fan was asked what Trump could improve on:

Fan: "Yea, health care, he needs to rewrite that Paul Ryan plan because honestly it's terrible. (audible laughter)...straight up terrible."

The clip below starts with Trump voters, and continues with HHS Sec Tom Price's empty promise of a 3 part plan. Like that'll happen. In fact, the clip ends with Rand Paul saying what I've been saying all along about the high risk pools paid for by taxpayers. I thought Republicans didn't want to pay for someone else's health care?:

Paul: "We're certainly not for when you get sick, the taxpayer takes over the tab for the insurance company. It's a terrible situation. What you do is socialize the insurance company losses, but you privatize the billions of dollars that they make. I'm not for giving a gift to the insurance companies, and that's what this house plan does." 

My own plan is simple; the universal "Every Doctor-Every Hospital Act"  

Ryan: ObamaCare won't exist in 10 years, so CBO can't compare it to his Plan?

The CBO simply projected what seniors would be paying on ObamaCare 10 years out, and what they would be paying for Trump/RyanCare 10 years out.

Trying to calculate projected costs is nothing new. But that didn't stop Paul Ryan from saying that because ObamaCare was collapsing and wouldn't be around, it was wrong to make that comparison. Uh, no.

I wish Ryan hadn't filibustered Fox News' Chris Wallace, who was trying to confronted Ryan on his trip down the rabbit hole of reasoning.



Even former governor Jan Brewer was repulsed:

“It just really affects our most vulnerable, our elderly, our disabled, our childless adults, our chronically mentally ill, our drug addicted. It will simply devastate their lives and the lives that surround them. Because they’re dealing with an issue which is very expensive to take care of as a family with no money.”