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The GOP's "Really, Really Good" Healthcare Reset is Really, Really Worse



 "The [GOP healthcare bill] is getting better and better"

 “A lot of people like it.”

 “Things are going very well.”

These are President Trump’s most recent pronouncements about the GOP’s American Health Care Act (AHCA).  Let’s hope for the sake of our nation’s seniors (and all Americans) that the President’s statements are wildly optimistic.  The White House is pressuring Congress to vote on the AHCA this week – lest the first 100 days of Trump’s presidency expire without a single major legislative victory.  Never mind that the healthcare of 24 million Americans hangs in the balance.

The National Committee and other seniors’ advocates rightly breathed a sigh of relief when the bill was pulled from the House floor last month for lack of GOP votes.  The Republican healthcare bill would have gutted Medicaid, weakened Medicare, and allowed insurers to charge older Americans up to five times as much as young adults, among other travesties.  But just when everyone thought the AHCA was dead, some House Republicans have revived it, zombie-like, to stalk Capitol Hill again.  This week, representatives from the right-wing Freedom Caucus and the moderate Tuesday Group let it be known that they were hovering around a deal to get the AHCA passed

The supposed “deal” would amend the bill to allow states to seek waivers from requiring insurers to provide “essential benefits.”  If a state (say a Red one, for instance), didn’t want insurers to be forced to cover hospitalization in all health plans, they could ask the Department of Health & Human Services (led by Obamacare nemesis Tom Price) for permission to waive that requirement.  States could also request waivers so that insurance companies could force sicker patients into “high risk pools” where the premiums would be sky high.  Meanwhile, all of the really harmful parts of the original bill for seniors would remain intact.  President Trump says the GOP healthcare bill has “gotten really, really good.”  But in truth, the latest changes make a really bad bill even worse.

Here’s the good news, though:  all of this talk about a deal and bringing the AHCA to a vote within President Trump’s first 100 days may be magical thinking.  Just because the head of the Freedom Caucus, Rep. Mark Meadows (R-NC), and Tuesday Group co-chair, Rep. Tom MacArthur (R-NJ), seem to be close to agreement does not guarantee that their members will fall in line, especially House moderates who probably know that the new amendment endangers essential benefits coverage and that high risk pools could cost their constituents dearly (which could cost these moderates dearly in the 2018 congressional elections).  Congress-watchers have noted that there is no legislative language for the proposed amendment yet, and wonder how it could be produced so soon. Also, the plan to bring healthcare to a vote next week may be overly ambitious, considering the House must also craft an appropriations bill before April 28th to avoid a government shutdown.  This is why Democratic sources on the Hill say “no way” is healthcare going to come up for a vote next week.

Here's how National Politics Reporter M.J. Lee summed up the prospects for a quick vote on CNN this afternoon:

"If the White House wants a vote, they will have to win over many members of Congress who are skeptical about tackling this again." - M.J. Lee, CNN
 

President Trump insists (to no one’s surprise) he wants it all:  funding for his border wall AND passage of the American Health Care Act – a demand that, like his pronouncements that “a lot of people like” the GOP healthcare bill and “things are going very well,” are likely only loosely based on reality. 

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Note to Paul Ryan: Let Sleeping Healthcare Bills Lie

Speaker Paul Ryan made some extraordinary statements on today's CBS This Morning – even for him.  First, he chastised President Trump for offering to work with Democrats on health care reform, saying it was “hardly a conservative thing” to do.  The reason:  “Democrats are not for repealing Obamacare. We are.”  Clinging to ideology over reality, Ryan declared, “I don’t want government running healthcare.”  Oh really?  Has he heard of a program called Medicare? Oh, that’s right - he wants to privatize it.   Ryan hasn’t gotten around to turning Medicare into a voucher program just yet, but at least seniors can rest easier knowing that the GOP health plan went down in flames.

Less than a week later, a rift seems to be opening between the President and the Speaker on this issue.  President Trump may have finally realized that the only way to get a real healthcare fix through Congress is to work with Democrats and stop coddling right-wingers in the House.  He even fired off a tweet this morning aimed squarely at the ultraconservative House Freedom Caucus, which helped defeat the Republican plan:

"The Freedom Caucus will hurt the entire Republican agenda if they don't get on the team, & fast. We must fight them... in 2018!” – Trump Tweet, 3/30/17

Of course, Democrats won’t work with Trump unless he gives up on repealing Obamacare and pivots toward fixing its flaws.  That’s something Ryan and the House Republicans have refused to do during the entire seven years that Obamacare has been “the law of the land.”  In fact, Republicans have taken measures both on the Hill (and in the new Trump White House) to actively undermine the law.  Trump’s offers to work with Democrats won’t mean much unless his HHS Secretary and his administration refrain from manipulating regulations to stifle Obamacare.

This afternoon, Congressman Luis Gutierrez (D-IL) told CNN, “[Obamacare] needs to be modified to give more people coverage. If Trump wants to do that, I’m all for working with him.”

It’s hard to believe, but in this case Trump – not Ryan – may be taking the more politically savvy approach.  Here’s why:  the American people by and large loathe the defeated GOP healthcare bill.  A new Associated Press poll indicates 62% of Americans dislike the dead GOP legislation.  Here’s an even more eye-opening number:  8 in 10 Republicans oppose the provision that would have allowed insurers to charge seniors 5 times as much as younger people.  President Trump’s spider sense has told him to move toward the middle on health care. Meanwhile, Paul Ryan threatens to bring the moribund GOP healthcare bill back to life.  He would be wise to study those poll numbers and let sleeping bills lie. 

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If you missed our Facebook Live discussion with Social Security champion, Rep. Jan Schakowsky (D-IL), you can watch it here. 

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Disability Insurance is Part of Social Security Whether Mick Mulvaney Likes It or Not

The President’s budget director can’t seem to help casting doubt on the administration’s commitment to keep its hands off Social Security and Medicare. Appearing on CBS Face the Nation this weekend, Mick Mulvaney openly questioned whether disability insurance should be part of Social Security.

"Let me ask you a question, do you really think that Social Security Disability Insurance is part of what people think of when they think of Social Security?” he asked. “I don’t think so... It’s a very wasteful program and we want to try and fix that.” – Budget Director, Mick Mulvaney 3/19/17

The moderator cut to a commercial right after that statement, so Mulvaney was not asked to elaborate on what he meant by “fixing” Social Security Disability Insurance.  We can only assume that “fixing” really means cutting benefits.  His remarks demonstrate a disregard for the facts about Social Security Disability Insurance (SSDI), and its very history.

Nearly 11 million Americans currently collect Social Security Disability Insurance benefits. Disability insurance has been part of Social Security since 1956. During the two decades after Social Security was created in 1935, a consensus evolved that not only retirees – but the disabled – require social insurance to stay out of poverty.  It was a natural extension of the philosophy underpinning Social Security that President Franklin D. Roosevelt so eloquently summarized as protecting the population against “the hazards and vicissitudes of life.”

A few dangerous myths underlie Mulvaney’s statements about Social Security disability insurance.  Here are the facts:

*SSDI is not a handout.  The truth is that anyone receiving SSDI must meet the same basic qualifications as other Social Security beneficiaries do.  Beneficiaries – or their parents – must have worked and contributed payroll taxes to Social Security in order to collect disability benefits.  

*There’s a stringent set of parameters that SSDI applicants must meet.  Only 40% of applicants actually qualify for disability benefits.

*SSDI beneficiaries do not have minor disabilities. 28% of beneficiaries have serious musculoskeletal disorders; 28%, serious mental illness; 9%, nervous system disorders and 9% circulation disorders, among others.  

In case the seriousness of these conditions is still in doubt, consider this:  a beneficiary collecting disability benefits beginning at age 50 only lives an average of 8 years past that point. Some 8,000 applicants died in Fiscal Year 2016 waiting for a decision on their disability claims – due to backlogs at the Social Security Administration caused by draconian budget cuts. 

When an official like Mulvaney makes comments about “fixing” Social Security Disability with the benefit cuts that implies, he is playing off of worries about the solvency of the Social Security Disability Insurance (SSDI) trust fund.  The SSDI trust fund is separate from the retirement (OASI) trust fund, and is projected to remain solvent until 2022 if Congress takes no action to fortify it.   The National Committee supports Congressman John Larson’s Social Security 2100 Act (to be re-introduced in the House later this month), which – among other things – combines OASI and SSDI into a single, more durable Social Security Trust fund.  This, along with legislation proposed by Senator Bernie Sanders and others, could preserve the solvency of Social Security well into this century without cutting benefits – including the ones that help people with serious disabilities maintain their financial security and their dignity. 

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Trump Snubs Seniors in Speech to Congress

Millions of current and future retirees were no doubt hoping that President Trump would use last night’s speech to Congress to reaffirm his promises not to touch Social Security and Medicare.  Instead, the President ducked and covered.  He did not even utter the words “Social Security” or “Medicare” in his entire hour-long address.  As for Medicaid – which millions of American seniors rely upon for skilled nursing care – the President only touched on it once, with a veiled reference to converting guaranteed benefits into block grants, which would hurt beneficiaries.   

This begs the question – why the silence on Social Security and Medicare?  After all, during the campaign the President broke with Republican orthodoxy and repeatedly promised not to cut either earned benefit program. “I am going to protect and save your Social Security and your Medicare.  You made a deal a long time ago,” he told a crowd of supporters in November.  The most likely explanation for omitting America’s retirement security programs from last night’s speech is that the President knows his fellow Republicans on Capitol Hill vehemently disagree with him.  

There are proposals in both the House and Senate to cut and privatize Social Security and Medicare.  In fact, voucherizing Medicare is one of Speaker Paul Ryan’s highest priorities.  Perhaps the President did not want to unnecessarily ruffle feathers on the Hill last night.  If so, his refusal to recommit to protecting Social Security and Medicare is not an encouraging sign. If he’s afraid to even mention his position in a speech to Congress, he may roll over on campaign promises under pressure from the Congressional GOP.

President Trump may also be leaving himself wiggle room in negotiations with Congress over Social Security and Medicare.  The problem is, any compromise on his promise will hurt seniors and people with disabilities who depend on these programs, whether it’s cutting benefits, raising the retirement age, or trimming COLAs.  He may also be setting up a dodge, where the Congress agrees not to cut Social Security or Medicare for current retirees while leaving open the possibility of downsizing or privatizing both programs for younger Americans.  This approach is based on the falsehood that cutting benefits for future retirees doesn’t hurt current seniors, and cynically pits one generation against the others for political expediency. Mark Miller of Reuters has an excellent piece today explaining this ploy:

"The [Republicans’] political goal will be to defang public opposition, since younger workers tend not to focus much on retirement when it is several decades away. But that approach is not going to work. Retirees and their advocacy groups will fiercely resist cutting benefits down the road, because they understand the critical importance of Social Security and Medicare benefits. They also care about the future retirement of their own children.  - Mark Miller, Reuters

Social Security and Medicare are commitments that the government made to working class Americans who paid into the system most of their lives.  The President could have confirmed that commitment last night and comforted seniors who are worried about losing their retirement security and healthcare.  His silence on Capitol Hill was not reassuring.

 

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Democrats Challenge Price over Medicare and Medicaid Funding

Democrats concerned about seniors, children, the disadvantaged and disabled took HHS Nominee Tom Price to task in his first day of Senate confirmation hearings Wednesday before the Committee on Health, Education, Labor and Pensions. Price faced withering questions from committee Democrats which he sometimes struggled to answer or simply evaded. Skeptical about Price’s statement at the beginning of the hearing that, “Nobody’s interested in pulling the rug out from under anybody,” Democrats held his feet to the fire where his record contradicts that promise.   

Senator Elizabeth Warren (D-MA) confronted Price (a Republican member of the U.S. House) about his past proposals to slash Medicare and Medicaid.  “You would have cut Medicare by $449 billion… and would have cut Medicaid funding by more than $1 trillion dollars, correct?” Warren asked Price.  “You have the numbers before you,” he said.  When Warren asked if Price would honor President-elect Trump’s pledge not to cut Medicare or Medicaid by even one dollar, the nominee would not commit – insisting that the amount of funding is the “wrong metric.”

“The millions of Americans who rely on Medicare and Medicaid are not going to be reassured,” warned Senator Warren, suggesting that Price print out Trump’s pledge and post it above his desk.  “Americans will be watching to see if you follow through on that promise.”

Senator Patty Murray (D-WA) also confronted Price about the future of Medicare and Medicaid in the new administration.  “You have said you plan to overhaul Medicare in the first 6-8 months of this administration in a way that would end the guarantee of full coverage.” 

Senator Al Franken (D-MN) expressed concerns about Price’s policies and priorities, especially his fierce opposition to the Affordable Care Act.   “I see you as someone who is there for the doctors,” Franken chided.  (Price is a physician as well as a Congressman.) Franken told Price that repealing the Affordable Care Act “is going to unravel something that has given a lot of Americans peace of mind.”

Democrats also grilled Price about personal stock transactions affected by his decisions as a legislator.  "Do you believe it is appropriate for a senior member of Congress, actively involved in policymaking in the health sector, to repeatedly personally invest in a drug company that could benefit from those actions?" Murray asked. "That's not what happened," said Price.

Republicans on the committee were largely cordial and complimentary to Rep. Price.

Committee Chairman Lamar Alexander (R-TN) allowed each member only one round of questions with a 7-minute time limit, prompting complaints from Democrats that important hearings were being rushed and the American people denied sufficient time to learn about the nominees.  Price will have another hearing before the Senate Finance Committee on January 24th

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