
Republicans pull healthcare legislation plan in blow to Trump - technologyvault
http://www.reuters.com/article/us-usa-obamacare-idUSKBN16V149
======
leereeves
This seems like a good time to ask about the actual impact of the vague
executive order Trump issued in January, basically telling the executive
branch to "waive, defer, grant exemptions from, or delay" whenever legally
possible:

> To the maximum extent permitted by law, the Secretary of Health and Human
> Services (Secretary) and the heads of all other executive departments and
> agencies (agencies) with authorities and responsibilities under the Act
> shall exercise all authority and discretion available to them to waive,
> defer, grant exemptions from, or delay the implementation of any provision
> or requirement of the Act that would impose a fiscal burden on any State or
> a cost, fee, tax, penalty, or regulatory burden on individuals, families,
> healthcare providers, health insurers, patients, recipients of healthcare
> services, purchasers of health insurance, or makers of medical devices,
> products, or medications.

[https://www.whitehouse.gov/the-press-
office/2017/01/2/execut...](https://www.whitehouse.gov/the-press-
office/2017/01/2/executive-order-minimizing-economic-burden-patient-
protection-and)

Does anyone know what to expect when renewing insurance in 2017?

~~~
e15ctr0n
> _This seems like a good time to ask about the actual impact of the vague
> executive order Trump issued in January_

Trump Issues Executive Order Scaling Back Parts of Obamacare | Jan 20, 2017
[https://www.nytimes.com/2017/01/20/us/politics/trump-
executi...](https://www.nytimes.com/2017/01/20/us/politics/trump-executive-
order-obamacare.html)

What Does Trump's Executive Order Against Obamacare Actually Do? | Jan 21,
2017 [https://www.nytimes.com/2017/01/21/upshot/what-does-the-
orde...](https://www.nytimes.com/2017/01/21/upshot/what-does-the-order-
against-the-health-law-actually-do.html)

Get a digital subscription to the _Washington Post_ or the _New York Times_.
There's a lot happening that affects the little guy.

~~~
leereeves
That's really not helpful.

I've read both of those and neither contains much information. But I haven't
seen the news mention anything more recently. Surely we've learned something
about the actual impact in two months, but the news has moved on.

------
kcorbitt
This legislation was a complete mess. Republicans have been warning about the
Obamacare "death spiral" for years. For the life of me I can't figure out why
no one is talking about the much worse, much faster death spiral embedded in
this legislation: no one would be forced to buy insurance, but insurers
_still_ have to take your preexisting condition, and can only charge 30% more
for one year for the extra risk. Hello adverse selection!

I'm a pretty free-market guy and can get behind healthcare reform in general,
but this bill had holes big enough to drive trucks through from the right and
left simultaneously with plenty of room to spare. I could believe it coming
from Trump, but I have no idea what Paul Ryan was thinking... the guy is
supposed to be a policy wonk.

~~~
ethbro
This. As someone who's worked on the insurance side of the equation for a
while, it always amazes me when people don't realize the majority of health
insurance policy is a zero sum game.

If insurance companies aren't solvent and profitable, products won't be
offered. And that's exactly what happens when you force unfunded / unbalanced
mandates on them. Congress can easily legislate the country into a market
where no one wants to offer insurance because there's no way to do so
sustainably.

 _That said_ , one of the _best_ things that ACA did was finally target some
of the inefficiency in as conservative of a business as insurance. The
provision capping administrative costs did a lot to jolt companies into
streamlining their operations and investing in modern, more efficient
technologies.

~~~
LyndsySimon
> the majority of health insurance policy is a zero sum game

That's what "insurance" _is_. I also don't get why people don't seem to
understand that.

IMO, a big part of a solution has to be to stop conflating "health insurance"
with "healthcare".

------
devopsproject
The republicans had 7 years to prepare for this. What a joke.

~~~
pavlov
What a difference a year makes! In January 2016, Congress passed legislation
to repeal Obamacare, confident that Obama would veto it:

[http://edition.cnn.com/2016/01/06/politics/house-
obamacare-r...](http://edition.cnn.com/2016/01/06/politics/house-obamacare-
repeal-planned-parenthood/)

Now that Republicans have the power, they can't agree on anything anymore.
What a miserable bunch of phonies.

------
khuey
The problem for the Republican leadership is that the House of Representatives
is effectively a hung parliament. There's the far right House Freedom Caucus
(~30 members), the moderate-right Tuesday group (~40 members), and the party
doesn't have a majority without both groups. When John Boehner was speaker he
kept the government mostly functioning by combining the moderates in the
Republican party with the Democrats to pass bills to keep the lights on
(continuing resolutions, debt ceiling increases, etc). But that doesn't work
for major policy initiatives like health care.

~~~
ethbro
The leadership drove the bill the wrong way. They should have hung the Freedom
Caucus out to dry, moderated the bill, and tried to peel the necessary votes
from Democrats in red states.

Torpedoing essential benefits without a more fundamentally comprehensive
replacement was like strapping engines to a car and expecting it to turn into
a plane.

~~~
dragonwriter
> The leadership drove the bill the wrong way.

There was no right way; the only way to win was not to play the game. Anything
that destroyed the basic model of the ACA—except to move to a stronger public
guarantee which basically no Republican members are interested in—was never
going to attract significant Democrstic support; the initial version of the
AHCA had substantial opposition from both hard-line conservatives and
moderates in the Republican Party, and anything that did more to appeal to
either of those groups expanded opposition on the other side.

------
tbihl
I wonder if the leadership suffered from the same confusion that this article
shows. It's hard to call the Republicans Trump's party. Perhaps even calling
Republicans a single party is going too far.

------
itbeho
I've been a frequent critic of Obamacare. I've personally experienced some of
its shortcomings: lesser coverage, more out of pocket, higher deductibles,
can't see the family doctor my other family members see, and that I saw for
years, etc.

But I saw nothing from the Republicans that indicated they were fixing or
improving anything.

I think a number of dissenting House Republicans know that premiums are going
to go up no matter what and decided they'd rather see Obamacare go down the
drain with his name on it than step up and fix what needs fixing.

~~~
maxerickson
What coverage did you lose under the ACA?

------
nextweek2
This is how I see a lot of the Trump presidency going. The USA isn't a
dictatorship, Obama ran into similar roadblocks and I credit him for actually
getting something passed rather than what was passed.

------
sputknick
non-Americans: can you describe what dealing with your health care system is
like? I want to understand: is it a supply constrained, health-care rationing,
expensive bureaucracy; or is it an affordable, convenient, healthy paradise;
or something in between? I see reports from people who create a portrayal of
European and Asian health care systems that match their narrative of these
systems either being excellent, or horrible. Can I hear from actual people who
live in this systems if they are good or bad?

------
defen
Can anyone explain to me why it would have been a _bad_ idea for the
Republicans to have introduced a single-player plan and then claimed to have
fixed healthcare? Feels like they missed a big opportunity there. Is it purely
ideology?

~~~
thebiglebrewski
Because this wasn't really a "healthcare bill" it was a tax cut bill to
transfer 600 billion dollars from the poor to the wealthy. It was never even
about healthcare, it's about wealthy/monied interested who own the Republican
party, which has somehow become the standard bearer for poor people who
apparently just don't understand that their own party has it out for them.

~~~
wahern
Technically speaking, I think the nominal notion was to _prevent_ the transfer
of $600 billion from the wealthy to the poor.

In actuality, because of twisted Republican orthodoxy combined with the
reality of politics, at the end of the day the approach would have resulted in
$600 billion in deficit spending.

------
technologyvault
It seems like most people's response to this news is either extremely happy or
very upset.

I'd be interested to hear why anyone on here feels either of those emotions.

For me, it looks like I'll have to continue paying the Obamacare penalty for
the foreseeable future, and it will be impossible to find an insurance plan
that makes sense for my family.

~~~
aaronbrethorst
I have insurance through the Washington State Health Benefit Exchange (i.e.
Obamacare), and a pre-existing condition. My insurance is kind of 'meh,' but
it means that I will not be bankrupted if something serious happens to me.

Had this morning's version of Trumpcare been made law, the odds of me being
able to afford useful insurance would've been slim to none. So, I am
_ecstatic_ about this news.

~~~
ap3
Isn't that the whole point of insurance? Life, auto, home, fire, farmer's?

To not go bankrupt and share the risk.

------
programminggeek
Another brilliant Trump move.

~~~
dahdum
Did Trump really think it would pass though? I figured he pushed the vote
knowing it'd likely fail so he could move on to tax breaks. He then "tried",
and Ryan / Freedom Caucus takes the fall in the midterms.

~~~
burkaman
It doesn't really make sense to invest so much time into promoting the bill if
this was the plan, though. He claimed to be personally calling hundreds of
representatives, threatened those planning to vote against it, had Spicer
guarantee its passage, etc. I don't know if Trump thought it would pass, but
he certainly gave lots of signals that he wanted it to and was taking
responsibility for it.

~~~
LyndsySimon
He appeared to be pushing hard on it, but even as someone who voted for him I
don't trust the perception of what he's doing.

He _may_ have been actively trying to get this bill passed, but it seems at
least as likely to me that he merely intended to be seen as doing so.

~~~
dahdum
He absolutely had to be seen as pushing for it, even if he realized that many
millions losing coverage would hurt him deeply in 2020.

Right now healthcare is shelved and the far right reps lose steam, having
failed to work with their own party and a President far more popular with
their constituents than they are.

Honestly I don't think he care whether it passed or not. He's not playing the
game we see.

~~~
dragonwriter
> Right now healthcare is shelved and the far right reps lose steam, having
> failed to work with their own party and a President far more popular with
> their constituents than they are.

Current polling data to support the claim that any far right Republicans are
far less popular with their own constituents than Trump is would be welcome.
Given his cratering approval numbers, including with Republicans, I kind of
doubt that is true in general.

------
mwpmaybe
On one end of the spectrum, you have the 25 year old single dude who works for
a big company. He pays $60 every two weeks for his PPO and doesn't understand
what the big deal is. Can people really not afford $60 every two weeks? He
votes Republican because he's a maker, not a taker, and he wants a tax cut. He
fundamentally misunderstands the nature of his coverage: his employer pays 80%
(or 100%!) of his premium.

On the other end of the spectrum, you have a family of five that makes too
much money to qualify for a subsidy. They live in a red state that didn't
expand Medicaid, uses the federally-managed exchange, and suffers from a lack
of competition because there's only one insurer on that exchange. An HDHP for
the family would cost $1,300/mo, which they can't afford, so they pay the
penalty and go without insurance. They vote Republican because as they see it
the government is forcing them to buy something they can't afford, and they
want it to be better... or at least go back to the way it was.

A lot of people and families had plans and doctors they liked before the ACA
was passed, and one of two things happened:

1\. because year-over-year premium increases are regulated by the government
per the ACA, insurers were forced to make their plans more efficient by
reducing the size of their networks in one way or another. This meant that a
lot of people lost access to their doctors and had to find another, often
having to travel further and/or wait longer to see their new doctor.

2\. they had _terrible_ insurance before the ACA was passed, but didn't
realize it. Perhaps they had unreasonably high deductibles, or access to few
essential services, or ridiculously low lifetime limits, or punitive
coinsurance rates, or... Perhaps they'd refuse to cover something because it
was a "preexisting condition." Perhaps they'd drop you mid-treatment, making
it impossible to get further treatment without going into severe debt. This
insurance wouldn't have been much use to anyone in the event of cancer, or a
heart attack, or a broken leg, but they were paying the premiums anyway, and
it sure helped them _feel_ insured. ACA made all of these practices illegal,
or at least put some controls on them to ensure a baseline quality of
insurance. These plans went away or became as expensive as other plans.

These people vote Republican because from their point of view ACA took away
their plans and their doctors, and Obama had stupidly promised them that
wouldn't happen. They had it good, or so they thought, and it was taken away
from them.

Everyone else is experiencing rising deductibles and premiums with no end in
sight. What most people fail to realize is that deductibles and premiums would
be rising with or without ACA—as they were before the passage of ACA—at a
greater rate! ACA bent the curve, so they're still increasing, but less so.
Yes, your insurance cost $300/mo last year, and it costs $400/mo this year,
but how much would it cost if ACA hadn't been passed seven years ago? Would
you even be able to get insurance? Do you or a family member have a
preexisting condition? Our minds aren't wired to think like this, though...
all we see is a higher bill and want someone to blame, so we vote Republican.

I could go on. ACA did a lot, but it didn't do enough to encourage competition
and control costs. Clearly. A public option and "death panels" would have
helped a lot, but of course these were dropped to encourage bipartisan support
for the bill... which it didn't get. Oh well.

