{"id":6325,"date":"2017-03-25T21:44:39","date_gmt":"2017-03-26T03:44:39","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/?p=6325"},"modified":"2017-03-26T08:03:22","modified_gmt":"2017-03-26T14:03:22","slug":"veni-vidi-addixi-rip-ryancare","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2017\/03\/veni-vidi-addixi-rip-ryancare.html","title":{"rendered":"Veni, vidi, addixi: RIP, Ryancare"},"content":{"rendered":"\n<\/head>

\"https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg;<\/p>\n

So it\u2019s official: \u00a0the GOP has had so little support for the \u201cAmerican Health Care Act\u201d that it pulled the plug and is now saying, \u201cwell, we tried \u2014 on to tax reform!\u201d<\/p>\n

In other words, bitching and moaning about Obamacare has proven easier than fixing it \u2014 not because the fixes were too difficult, but because the Republican leadership just didn\u2019t have the political skills needed to corral a fractious party.<\/p>\n

To be sure, the Ryancare plan had a lot of flaws, chief among\u00a0them being that it preserved the pre-existing condition restriction restriction, while at the same time eliminating the mandate that was meant to force enough people into the pool to control the death spiral this provision would otherwise produce, as well as the substantial decrease in subsidy level for those at an income level low enough that purchasing health insurance on the open market would simply be too great a financial hardship, and with respect to whom the new consensus is that it simply isn\u2019t adequate to assume that emergency treatment mandates, payment plans, hospital financial assistance programs, direct charity care, and the write-off of bad debt will be sufficient.<\/p>\n

But these were not the complaints of the Freedom Caucus. \u00a0To the best of my understanding (and the Washington Post<\/a> provides some of the background and context) they really, truly, wanted a full repeal, or as close as they could get, and, specifically wanted the elimination of the \u201cessential health benefits\u201d provision of the ACA. \u00a0(According to the\u00a0Washington Examiner<\/a>, they had even more wide-ranging demands, including the elimination of the ACA\u2019s bans on lifetime limits, the preventive care requirements, the \u201csingle risk pool\u201d requirement, and so on. \u00a0But I think the EHB elimination was their non-negotiable.)<\/p>\n

Now, the \u201cessential health benefits\u201d are very broad categories of benefits: \u00a0outpatient care, ER visits, in-hospital care, maternity care, mental health\/chemical dependency, prescription drugs, rehab and related therapies, lab tests, preventives services, and pediatric services. \u00a0(This list is everywhere, but see, for instance, NBC News<\/a>.) \u00a0The exact mechanics of how this provision of the law works are not as simple as saying that all health plans must cover all services listed in these categories, and must do so at identical coverage levels; there\u2019s some degree to which the specific services are then set based on a \u201cbenchmark plan\u201d at the state level, and, to be honest, I\u2019m not entirely certain how that works.<\/p>\n

I\u2019m also not certain exactly what was underlying the Freedom Caucus\u2019s demand here: \u00a0did they want to enable insurers to offer plans without maternity, or without mental health coverage? \u00a0Or was their demand more symbolic, that without some element of removing the ACA\u2019s extensive regulatory component, Trump and the Republican leadership weren\u2019t fulfilling their \u201crepeal\u201d pledge?<\/p>\n

But, again, if I understand correctly, what it boiled down to is that the Freedom Caucus wasn\u2019t willing to \u201cplay by the rules.\u201d \u00a0As laid out by the GOP leadership, only bills that have to do with \u201cbudgetary\u201d items can be passed by a pure majority vote in the Senate; anything else and the bill is filibuster-able. But the Freedom Caucus rejected this. \u00a0It\u2019s not clear to me from what I\u2019ve read, whether they thought they could push the bill through with 51 votes, because of some arcane loopholes that would allow them to get this through, or whether they could shove this through by \u201cbrute force\u201d, or whether they simply wanted to be able to vote on \u201ctheir\u201d bill, even if only symbolically, and with the understanding that those provisions wouldn\u2019t survive.<\/p>\n

Honestly, I\u2019ve read the description multiple times. \u00a0Maybe I\u2019m too tired at the moment. \u00a0But I\u2019m just not clear on which it is \u2014 though, ultimately it doesn\u2019t matter, except perhaps in determining whether they\u2019re fools (for valuing the objective of a purely symbolic vote) or ***es for trying to push the leadership to do something that really seems to have been stretching the Senate rules to such a degree as to be unethical.<\/p>\n

The bottom line, though, is that Trump couldn\u2019t persuade these recalcitrant congressmen to accept their half-loaf, and probably didn\u2019t try very hard, and then went on-camera to say, \u201chey, we tried; now we\u2019re finished with that and going to move on to other things, and will return to Obamacare when it implodes.\u201d \u00a0But that isn\u2019t a path forward.<\/p>\n

Yes, maybe another round of premium increases might get the public riled up, but the Democrats are getting increasingly set on Single Payer, and are not especially sympathetic toward those with rising premiums, who are generally those who don\u2019t qualify for subsidies: \u00a0after all, what they are ultimately complaining about is the new obligation imposed on them to subsidize their ill fellow citizens, which they should accept without complaint. \u00a0And the horror stories of doubled premiums, of deductible of $10K per year, and equally-high premiums, we\u2019re told, are the rare exception to the rule. \u00a0So I simply can\u2019t see the Democrats running to the Republicans for help in a way that produces a useful compromise.<\/p>\n

So does this mean that Trump and Ryan turn out to be failures at what was supposed to be Trump\u2019s signature skill, negotiation? \u00a0Or were the Freedom Caucus folks simply so intractable in their demands that no degree of negotiation skill would have gotten them to budge? \u00a0Of course, either way, the final outcome is both a disappointment, and admittedly also a relief.<\/p>\n

But the whole episode over the last several weeks has even been all the more frustrating because, well, it\u2019s been a matter of watching the home team fail, rather than the guys you hate anyway. \u00a0I liked<\/em> Ryan and his plans to bring new ideas to government. \u00a0Sigh. . .<\/p>\n

Image: \u00a0https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg; By Unknown photographer [Public domain], via Wikimedia Commons<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

So it\u2019s official: \u00a0the GOP has had so little support for the \u201cAmerican Health Care Act\u201d that it pulled the plug and is now saying, \u201cwell, we tried \u2014 on to tax reform!\u201d In other words, bitching and moaning about Obamacare has proven easier than fixing it \u2014 not because the fixes were too difficult, […]<\/p>\n","protected":false},"author":2209,"featured_media":5217,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[356,256],"class_list":["post-6325","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-health-insurance","tag-obamacare"],"yoast_head":"\nVeni, vidi, addixi: RIP, Ryancare<\/title>\n<meta name=\"description\" content=\"So it's official: \u00a0the GOP has had so little support for the "American Health Care Act" that it pulled the plug and is now saying, "well, we tried -- on\" 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