Mick Mulvaney: The Day of the CBO ‘Has Probably Come and Gone’

During an interview with the Washington Examiner on Wednesday, Office of Management and Budget Director Mick Mulvaney trashed the Congressional Budget Office (CBO) as partisan and made a case that the country would be better off without it.

“At some point, you’ve got to ask yourself, has the day of the CBO come and gone?” Mulvaney said. “Certainly there is value in having that information, especially if they could return to their nonpartisan roots. But at the same time you can function, you can have a government, without a Congressional Budget Office.”

Mulvaney honed in on the CBO’s recently released analysis of the American Health Care Act (AHCA), passed by House Republicans last month and vociferously supported by President Trump. The nonpartisan office estimated that the AHCA will cost 23 million Americans their health insurance while dramatically increasing costs for older Americans and people with pre-existing conditions, in part because of the bill’s $834 billion cut to Medicaid over the next decade.

“Did you see the methodology on that 23 million people getting kicked off their health insurance?” Mulvaney said. “You recognize of course that they assume that people voluntarily get off of Medicaid? That’s just not defensible. It’s almost as if they went into it and said, ‘Okay, we need this score to look bad. How do we do it?’”

Mulvaney characterized the CBO’s analysis of coverage losses as “just absurd” and said, “ To think that you would give up a free Medicaid program and choose instead to be uninsured is counterintuitive.”

The CBO, however, doesn’t assume that people will “give up Medicaid.” Instead, it assumes people will lose Medicaid coverage nonvoluntarily because of eligibility lapses, raises at their jobs, and other developments that under the House Republican plan will cause them to become ineligible. Vox explains:

The AHCA would effectively end the Affordable Care Act’s Medicaid expansion by freezing federal support for it starting in 2020. Under current law, the federal government initially paid 100 percent of costs of Medicaid expansion beneficiaries, a percentage set to wind down to 90 percent in 2020 and stay at that level permanently. Under the AHCA, the federal government would keep paying for people who signed up for Medicaid expansion coverage before January 1, 2020, but not anyone who signs up after that.

Over time, this would also lead people currently enrolled to lose their benefits, and they wouldn’t be able to go back on the program thereafter. The AHCA drops funding for enrollees whose eligibility lapses for two or more months, and many working poor people cycle in and out of Medicaid as their income changes: They get a raise and no longer qualify for Medicaid; then they lose that job or take a pay cut and enroll again.

Mulvaney’s vision for a post-CBO America would involve his office taking the lead on estimating the impacts of major legislation — “I would do my own studies here at OMB as to what the cost and benefits of that reg would be,” he said.

But the danger of that approach was illustrated just last week by Trump’s budget proposal, which included a glaringly basic arithmetic error involving double-counting the estimated economic impact of tax cuts. Instead of acknowledging that double-counting the $2 trillion in savings was a mistake, Mulvaney told reporters that he and other Trump administration officials who worked on the budget did it on purpose.

When the first version of the AHCA was unveiled in March, Mulvaney tried to discredit the CBO before it even had a chance to release its analysis of the bill, arguing on ABC’s This Week that the CBO’s analysis of the Affordable Care Act (ACA) was off.

It wasn’t. FactCheck.org concluded that despite overestimating the number of people who who get subsidized insurance through ACA exchanges, the CBO “actually nailed the overall impact of the law on the uninsured pretty closely.”

The CBO “predicted a big drop in the percentage of people under age 65 who would lack insurance, and that turned out to be the case,” FactCheck.org wrote. “CBO projected that in 2016 that nonelderly rate would fall to 11 percent, and the latest figure put the actual rate at 10.3 percent.”

In short, Mulvaney, Health and Human Services Director Tom Price, and other AHCA-supporting Republicans are attacking the CBO simply because of its tough assessment of their preferred health care plan, which involves a huge tax cut for the rich.

What Republicans like Mulvaney are saying about the CBO during the Trump era is the opposite of what GOP members of Congress said when Bill Clinton was president. In the 1990s, Congressional Republicans demanded that the CBO score President Clinton’s budgets, dismissing his Office of Management and Budget as partisan.

During congressional testimony last week, Mulvaney, defending Trump’s budget proposal, made a case that the fiscal interests of the unborn should take precedence over the lives of present-day Americans — or at least those who rely on food stamps to eat or public schools to educate their children.

[ThinkProgress]

Reality

Mick Mulvaney trashed the CBO because they scored Trumpcare saying it would kick 24 million people off of their healthcare. That’s totally crazy because Mulvaney’s Office of Budget Management did their own calculations and came to the exact same conclusion.

It would be nice if The Washington Examiner called Mulvaney on his bullshit.

Donald Trump Thinks Health Insurance Costs $15 a Month

Donald Trump, the President of these United States of America, either believes that health insurance currently costs $15 a month or he believes that’s how much it should cost. This is according to an interview he did with The Economist on May 4, the same day the American Health Care Act passed the House. A transcript of the interview was published yesterday.

The interview was about economic policy, but they also discussed healthcare and the AHCA. One of the Economist editors pointed out that “some people will look at this bill and say, ‘hang on, a lot of people are going to lose their coverage.'” In Trump’s response, he said [emphasis added]:

You’re going to have absolute guaranteed coverage. You’re going to have it if you’re a person going in…don’t forget, this was not supposed to be the way insurance works. Insurance is, you’re 20 years old, you just graduated from college, and you start paying $15 a month for the rest of your life and by the time you’re 70, and you really need it, you’re still paying the same amount and that’s really insurance.

But I believe it’s very important to have this. Because one thing Obamacare did, is it gave that and it was a concept that people hadn’t heard of. And now I don’t want to end it. I don’t want to end it for somebody that…first of all I don’t want to end it for the people that already have it. And I don’t want to end it for somebody that hasn’t been buying insurance for all of his life where he has a guarantee that for all of his life he’s been buying the insurance and he can buy it inexpensively when he turns 65 or 70 years old. So we put in a tremendous amount and we’re…you know, for the pre-existing conditions. We are going to have a great pool for pre-existing conditions.

Before we even talk about the $15 figure, it bears repeating that the AHCA guarantees coverage for pre-existing conditions in name only, not in practice: The version that passed the House said people couldn’t be denied coverage but that states could choose to let insurers charge people more if they have pre-existing conditions. It would also let insurers charge older people up to five times more than younger people (the current limit is three times more). Trump and other Republicans swear up and down that additional money for high-risk pools will prevent people from being priced out, but multiple think tanks say it’s not nearly enough money.

Now, back to premiums. Trying to decipher exactly what Trump means is often a fool’s errand, but this response seems to have several possible interpretations. Is Trump confusing health insurance with life insurance, which could cost a healthy, 20-something person about $15 a month, according to Mother Jones? Possibly.

Or maybe he thinks people pay $15 a month for health insurance right now, but that is demonstrably false. The average monthly premium for people buying their own insurance was $235.27 in 2013, according to the Kaiser Family Foundation, and many people’s premiums have increased since then. But if it is $15 then why would premiums need to be lower, a point he’s been hammering since the start of his campaign? He even parroted that line later in his response to the question about people losing coverage, saying: “We’re going to have much lower premiums and we’re going to have much lower deductibles.”

Yet another possibility is that this is how much he thinks health insurance premiums should cost, as Sarah Kliff argues at Vox. Fifteen-dollar-premiums would certainly be much lower than what people are paying now, but it’s totally unrealistic and suggests he has no idea what he’s talking about. Unless, of course, he wants to bring something like Australia’s universal healthcare system to the US. After all, he told the Australian prime minister that it’s better than what we have.

[VICE]

Trump Attacks News Media Over ObamaCare Repeal Coverage

President Trump attacked the news media Friday night on Twitter over perceived negative coverage of the House GOP’s passage of legislation aimed at repealing and replacing ObamaCare.

“Wow,the Fake News media did everything in its power to make the Republican Healthcare victory look as bad as possible,” Trump tweeted. He also predicted the Republican plan would be “far better” than the Affordable Care Act.

In a second tweet, Trump questioned why the news media “rarely reports” that ObamaCare “is on its last legs and that insurance companies are fleeing for their lives?”

“It’s dead!” Trump declared, reiterating a longstanding position.

(h/t The Hill)

Reality

Maybe the Republicans should have put forth a bill that didn’t kick 24 million people off of healthcare, raise rates for the elderly, and allow insurance companies to discriminate based on preexisting conditions?

The reality is, when the CBO had a chance to score the first version of Trumpcare, it was very clear the insurance markets are stable. This idea that Obamacare is in a “death spiral” is pure fiction.

 

 

 

House Passes American Health Care Act

I think today is a good day to have a conversation with our friends and family who vote Republican, and find out why they would support such a heartless effort to remove healthcare for 24 million people, allow insurance companies to deny coverage for preexisting conditions, push the sickest of us to underfunded high-risk pools, while giving a massive tax break to the millionaires and billionaires.

Ask them why they think that making the AHCA even more cruel, by removing protections for preexisting conditions, was the only way Republicans in the House were able pass an Obamacare repeal?

Do they know that if they are over 50 years old, Obamacare regulated the insurance industries so they could only charge 3 times more than the lowest bronze plan, and now the Republicans made a change so insurance companies can charge them 5 times more than a bronze pan? Why would they want to support Republicans who just raised they insurance premiums?

Do they know without preexisting condition protections, it will be inevitable that a percentage of people without healthcare will die. That’s right, they won’t be able to have access to insurance and will die. Did they cheer? Were they happy?

Do they know Obamacare is funded mostly by millionaires and billionaires? If they make $250,000/year or more they’ll pay about $250/year for Obamacare, otherwise they pay right now $0 in taxes for Obamacare. That’s right. All of those protections are free!

Obamacare was debated on for 18 months, had a transparent and open debate. Republicans had no plan after 8 years, cobbled together pieces of Paul Ryan’s 2012 health care reform in a secret room that fellow Republican Rand Paul couldn’t even get in to, and they rushed the legislation through so fast the Congressional Budget Office did not have time to score it. Did they know Republicans were so sure of the negative effects of their plan they shielded themselves with exemptions?

The Senate will now take up the bill and only 2 Republicans need to say “no” in order to kill this bill, and send it back to the House. But once it returns, the House Republicans will no longer have the budget reconciliation process used to shove the ACHA through. There is a limited time between now and that Senate vote. And it would be nice to know where your Republican friends and family stand on the health of their friends and family.

Trump: ObamaCare Will Die Without ‘Big Money’

President Trump said early Sunday that ObamaCare will die “far sooner than anyone” thought if it doesn’t receive federal funds to keep it going.

The president’s message comes just days before the Democrats and Republicans must agree on a federal budget or face a government shutdown.

Both parties are pushing for funding of their own priorities. The White House is pushing for funds to build a wall along the Mexican border and enhance border security, while Democrats hope to make more inroads in healthcare coverage.

White House officials have been publicly talking about the negotiations Sunday morning.

Office of Management and Budget Director Mick Mulvaney said Sunday that a government shutdown is not a “desired end.” He dodged questions about what would be acceptable to the administration in negotiations.

Secretary of Homeland Security John Kelly said the president will be “insistent” on border wall funding.

Congress must pass a spending bill by Friday to avoid a government shutdown.

Reality

This is an apparent threat to the possibility of ending federal subsidies to help lower-income people buy health insurance. This will remove 24 million people from health care.

 

Trump Sunday Morning Tweet Promises ‘Love and Strength’ of GOP Will Eventually Take Away Obamacare

President Donald Trump was off and running on Twitter Sunday morning, once again attacking the media for saying his plan to repeal and replace Obamacare is “dead.”

Ten days after House Majority leader Paul Ryan (R-WI) pulled his Trumpcare bill in the face of certain defeat and Trump administration officials said the president was moving on to budget and tax matters, Trump declared on Sunday that he still intends to get rid on Obamacare.

The president then asserted the real story the press should be covering is “surveillance and leaking.”

“Anybody (especially Fake News media) who thinks that Repeal & Replace of ObamaCare is dead does not know the love and strength in R Party!” Trump tweeted before adding, “Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck.”

Trump’s mention of “love and strength in the R party” strikes a conciliatory tone from his recent Twitter attacks on the hard right Republican Freedom Caucus that torpedoed Trumpcare.

On Saturday, Trump’s social media director Dan Scavino called for the defeat of Freedom Caucus Rep. Justin Amash (R-MI) to be defeated at the polls.

You can see Trump’s Sunday tweets below:

(h/t Raw Story)

Trump: ‘Nobody Knew That Healthcare Could Be So Complicated’

President Trump said Monday that “nobody knew that healthcare could be so complicated,” as Republicans have been slow to unite around a replacement plan for ObamaCare.

“I have to tell you, it’s an unbelievably complex subject,” Trump said after a meeting with conservative governors at the White House.

The GOP governors were in town this weekend for their annual conference and met with Trump to talk about a variety of things, but it’s likely the conversation largely focused on healthcare.

Governors have been split on what should be done with ObamaCare’s Medicaid expansion, which brought health coverage to many even in deep-red states.

Trump didn’t publicly address that issue Monday morning, but said ObamaCare’s repeal and replacement will give states more flexibility “to make the end result really, really good for them.”

“We have come up with a solution that’s really, really good I think. Very good.”

Trump also dismissed polls that show support for ObamaCare is at an all-time high.

The latest tracking poll from the Kaiser Family Foundation showed that 48 percent view the law favorably compared to the 42 percent who don’t.

“People hate it but now they see that the end is coming and they say, ‘Oh ,maybe we love it.’ There’s nothing to love. It’s a disaster, folks.”

(h/t The Hill)

Trump’s Tweet That ObamaCare Doesn’t Work Is Full Of Shit

Trump sent out an early morning tweet blasting the Affordable Care Act, also known as ObamaCare, by pointing out the increases in average prices from last year using one state as an example:

People must remember that ObamaCare just doesn’t work, and it is not affordable – 116% increases (Arizona). Bill Clinton called it “CRAZY”

However Trump used a state that decided not to fully implement ObamaCare, by neglecting to set up its own state-run insurance marketplace, which lead to higher rates. So this isn’t because of the design of ObamaCare, but how some mostly Republican states refused to fully implement it.

For comparison, states who fully implemented ObamaCare, such as California, saw only a 2% or less increase in rates, while Massachusetts and Indiana’s implementation was done so well they will actually see a drop in prices this year. States that were adversarial to a full implementation of Obamacare, like Arizona and Pennsylvania, will see the biggest price hikes, driving up the national average to a 22% increase nationally.

So don’t blame Obama for a massive price hike, but your state’s Republican governor.

But what Trump is also neglecting is that most Obamacare participants won’t feel the full price hike or anything near it, even in his cherry-picked state of Arizona.

Nationally, 85% of those enrolled receive a tax credit, which is based on the price of the second-lowest cost silver plan and an enrollee’s income. These subsidies put a limit on how much you have to pay.

Enrollees can also use their subsidies to buy lower-priced bronze or silver plans. That will allow more than three-fourths of current enrollees to pick a plan for $100 or less a month on the federal Healthcare.gov exchange.

 

Repeal Obamacare? Maybe Not, Says Trump

The “repeal” of Obamacare had been the top priority for the incoming Trump administration in the chaotic week after his surprise win.

Maybe not so much now.

The president-elect has a Republican-dominated House and Senate in Congress to help him try, but experts say full repeal won’t be so easy. And it may not be what the new administration even wants now.

The Trump transition team posted a policy website with a skeleton rundown of priorities.

“A Trump Administration will work with Congress to repeal the ACA (Affordable Care Act)and replace it with a solution that includes Health Savings Accounts (HSAs), and returns the historic role in regulating health insurance to the states,” it reads.

But Trump told the Wall Street Journal he would consider keeping two of its most popular provisions — one that allows adult children to stay on their parents’ health insurance plans, and another that would forbid insurance companies from refusing to cover “pre-existing conditions.”

“I like those very much,” the newspaper quoted Trump as saying Friday.

The Obama administration is still talking up the law, announcing via Twitter on Thursday that 100,000 people signed up for coverage on the “Obamacare” exchanges on Wednesday, the day after the election.

The ACA, widely known as Obamacare, has been the signature achievement of Obama’s two terms. It sought to transform the unruly, expensive and inefficient U.S. health care system by stopping what were widely considered insurance company abuses, such as dumping people when their health conditions got too expensive to cover and refusing to pay for pre-existing conditions.

The ACA requires health insurance companies to pay for cancer screenings, wellness checks and vaccinations with no co-pay, and it allows children to stay on their parents’ policies until age 26.

It puts into place gradual incentives to move from a system where people pay piecemeal for health treatments and, instead, reward doctors and hospitals for keeping patients well and managing their diseases. And most of all, it sought to provide health insurance to the 15 percent of Americans who did not have it before the law passed.

It’s gone a long way to doing that. Only 8.9 percent of Americans now lack health insurance.

Republicans actually like many of these aspects of Obamacare, which was loosely based on Mitt Romney’s plan for Massachusetts when he was the Republican governor there.

“The Administration recognizes that the problems with the U.S. health care system did not begin with — and will not end with the repeal of — the ACA,” the new Trump policy statement reads.

Much of the public debate has come because the average person does not understand what Obamacare does and what it doesn’t do, said Timothy Jost, an emeritus professor at the Washington and Lee University School of Law and an expert on health care.

“Frankly, everything that has gone wrong with the health care system for the past six years has been blamed on Obamacare,” Jost said. “Everything that goes wrong with the health care system for the next four years will be blamed on Trump care. People who think we can just repeal Obamacare and everything will be great are in for a very, very, very rude surprise.”

Unlikely to lose coverage in 2017

For one thing, the Trump administration is going to worry about the political risks of leaving 20 million people suddenly without health insurance.

“The number of uninsured is expected to grow to about 50 million people with ‘repeal and replace’,” PriceWaterhouseCoopers (PwC) says in a report released this week. “Trump’s challenge will be to lower that number through his replacement proposals.”

Trump cannot do much alone.

“The White House is just one part of a much larger machine. To really put his stamp on health policy, Trump must work with a patchwork of federal lawmakers, regulatory agencies, trade and advocacy groups, and the Supreme Court. These institutions will either accelerate or decelerate Trump’s agenda,” PwC said.

The people who now have coverage on the exchanges — including people signing up right now during open enrollment — are unlikely to lose their coverage in the coming year, experts from all political viewpoints agree.

“The new administration is going to want to do something fast to show that they are keeping their promise to fundamentally change the federal role in the health care system,” said Michael Sparer, a professor of health policy and management at Columbia University.

One thing a new Republican administration could do immediately is drop appeals against last May’s federal court ruling that said the Obama administration was illegally paying insurance companies to help keep health insurance costs down for low-income clients.

These so-called cost sharing reductions reimburse health insurers for charging lower co-pays and deductibles for more than 60 percent of Obamacare customers. Congress refused to allocate money to do that, and a federal district judge ruled in May that the administration couldn’t spend that money. The federal government kept on doing so while it appealed.

Symbolic moves

A new administration could stop fighting that right away, although it’s not a particularly sexy issue for voters. And it might irritate health insurance companies, Jost said.

“I don’t think anyone disagrees that it would be the insurers left holding the bag,” Jost told NBC News.

A new administration could also stop fighting lawsuits against the mandate that employers pay for birth control for women covered under their insurance plans, Sparer said. That might be popular with conservatives who said the requirement forced them to violate their religious beliefs.

There could be symbolic moves, also. The new Republican-led Congress may immediately vote on a repeal that will almost certainly be stopped by a Democratic filibuster in the Senate. While the Democrats do not have a majority in the Senate, they have enough seats to stop some legislation with a filibuster.

“I think the only grand gesture they can make is to blame Democrats for filibustering their attempts to repeal the Affordable Care Act,” said Jost.

Sparer agreed that is likely. Republicans could campaign to get more seats in the Senate in the 2018 elections. “That gives them a couple of years to think about what the replacement plan they want to come up with is,” Sparer said.

A new Trump Health and Human Services Department could also stop promoting open enrollment onto the Obamacare exchanges, which closes at the end of January —10 days after Inauguration Day. Enrollment usually spikes right at the deadline, and simply stopping outreach could hit numbers.

In fact, doing nothing could accomplish a lot, said Jost.

“It has been a full court press by the Obama administration since 2010 to get this thing implemented and it has taken a Herculean effort,” Jost said. “As soon as it stops moving forward, it could start moving backward pretty quickly. Almost just by doing nothing there could be some very negative effects.”

Tevi Troy, president of the American Health Policy Institute, says Republicans plan to use the budget process to tweak the law. “I would look to the reconciliation package,” he told NBC News. “This is the mechanism for how we move forward on this.”

Re-branding with a new plan

Budget issues can pass the Senate with a simple majority, bypassing Democrats who may object, although they must go through a lengthy process involving committees.

Troy said the GOP has been discussing ways to provide a transition period so as not to throw the health insurance and health care industries into chaos.

“What I always hear is that Republicans have no plans on replacing the Affordable Care Act. I think that is not only untrue, but unfair,” Troy said.

An immediate target may be the unpopular exchanges, the web-based system for buying health insurance. Troy says they are unnecessary, and changing them up would be an easy way for Republicans to re-brand Obamacare. “People can get health care without exchanges,” he said.

Trump has put forward the idea of allowing people to buy health insurance across state lines, and Troy said that could lower costs by creating more competition, although it will be a messy task to undertake since insurance is now firmly regulated by states.

Trump’s also advocated the use of health savings accounts and tax credits to help people pay for health insurance, although experts such as Jost say it’s not clear how those would help low-income people.

The mandate to buy health insurance is another obvious target for a new administration, even though Republicans originally supported the idea. It’s there to try to ensure that enough healthy people buy health insurance so that companies can profitably pay for the sick, but it’s been seen as onerous.

And it hasn’t worked well as an incentive, said Caroline Pearson of consultancy Avalere Health. Simply dropping enforcement of the mandate would be popular and easy, while causing little damage to existing coverage.

(h/t NBC News)

Trump Wants ‘Special Session’ to Repeal Obamacare, but Congress Is in Session

Donald Trump on Tuesday vowed to immediately repeal and replace President Barack Obama’s signature health care law if he’s elected president next week.

“When we win on Nov. 8 and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare. We have to do it,” Trump said Tuesday afternoon in an address on the Affordable Care Act in King of Prussia, Pennsylvania.

“I will ask Congress to convene a special session so we can repeal and replace,” he continued. “And it will be such an honor for me, for you and for everybody in this country because Obamacare has to be replaced. And we will do it, and we will do it very, very quickly. It is a catastrophe.”

(h/t Politico)

Reality

But should Trump win, Congress would already be in session by the time he took the oath of office; lawmakers return to work on Jan. 3, while the presidential inauguration is Jan. 20. Those dates were enshrined into the Constitution with the 20th Amendment.
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