You cant filabuster the repeal of Obamacare?

[JEDI]

http://www.cnn.com/2017/01/05/politics/paul-ryan-planned-parenthood-obamacare/index.html

Repubs only need 50 senators and the VP?
no mention of filibuster in the article.

 

[Jhhnn]

http://www.cnn.com/2017/01/05/politics/paul-ryan-planned-parenthood-obamacare/index.html

Repubs only need 50 senators and the VP?
no mention of filibuster in the article.

Budget reconciliation. When the HOR & Senate versions of a bill aren't the same then they're reconciled through majority rules procedures. They'll hold funding for the govt hostage to get there, as usual.

 

[dullard]

1) As far as I know, the new filibuster rules for this session haven't yet been written. If I am wrong, please tell me. That means we are only assuming things about filibusters. The GOP could theoretically eliminate filibusters entirely if they wanted to.

2) As it was, senators couldn't filibuster budget reconciliation items. Budget reconciliation occurs when the house and senate approve basically the same bill but the budget is different. So, the idea is to have a must-pass bill be approved by both the house and senate who's only difference is that the house's version has a $0 budget for Obamacare (because a bill that defunds Obamacare wouldn't get through the senate filibusters). Then through budget reconciliation, the budget differences between the house and senate are fixed without the ability to filibuster. They of course would "fix" the budget differences by going entirely with the house's version.

You be left with all of the Obamacare laws and regulations but no way to pay to enforce them.

Where I'm iffy is that since Obamacare includes many different revenue generating items, there still will likely be some money coming in. So, can they legally claim there is no money to enforce the laws when there is still money?

 

[PokerGuy]

1) As far as I know, the new filibuster rules for this session haven't yet been written. If I am wrong, please tell me. That means we are only assuming things about filibusters. The GOP could theoretically eliminate filibusters entirely if they wanted to.

2) As it was, senators couldn't filibuster budget reconciliation items. Budget reconciliation occurs when the house and senate approve basically the same bill but the budget is different. So, the idea is to have a must-pass bill be approved by both the house and senate who's only difference is that the house's version has a $0 budget for Obamacare (because a bill that defunds Obamacare wouldn't get through the senate filibusters). Then through budget reconciliation, the budget differences between the house and senate are fixed without the ability to filibuster. They of course would "fix" the budget differences by going entirely with the house's version.

You be left with all of the Obamacare laws and regulations but no way to pay to enforce them.

Where I'm iffy is that since Obamacare includes many different revenue generating items, there still will likely be some money coming in. So, can they legally claim there is no money to enforce the laws when there is still money?

So basically, they'll be able to dismantle it to the point of being completely useless anyway. Whether there's some trickle down funding still remaining or not doesn't matter, it will be dead. The real question is, what are they going to replace it with? From a political perspective, you have to come up with some sort of plan to put in place. Obummercare was terrible and needs to go, but there were definitely issues with healthcare that needed addressed. This will be their chance to address some of those issues, but I doubt they will. To many hands in the pockets.

 

[dullard]

So basically, they'll be able to dismantle it to the point of being completely useless anyway.

I don't think so. They can dismantle it to the point of being terrible though.

For example, you can't use budget reconciliation to remove the requirement to have insurance or the requirements that insurances have minimum coverage. But they can remove the government subsidies. That will leave us with expensive required insurance and no help to pay for it.

Obamacare is far better than what we had, but it was still not good. It is basically a pieced together market-based GOP plan with just enough sweeteners to get democrats to go along with it. But, ultimately, it was still based on our horrible existing Human Resources-based plans. Why on Earth are the most important coverage decisions not being made by the doctor and patient, but instead by the HR department of the company the patient works at (when the select the insurance plans that they make available to their employees)? The whole thing is stupid. I hope it gets replaced by something that takes employers entirely out of the picture.

 

[fskimospy]

I don't think so. They can dismantle it to the point of being terrible though.

For example, you can't use budget reconciliation to remove the requirement to have insurance or the requirements that insurances have minimum coverage. But they can remove the government subsidies. That will leave us with expensive required insurance and no help to pay for it.

Obamacare is far better than what we had, but it was still not good. It is basically a pieced together market-based GOP plan with just enough sweeteners to get democrats to go along with it. But, ultimately, it was still based on our horrible existing Human Resources-based plans. Why on Earth are the most important coverage decisions not being made by the doctor and patient, but instead by the HR department of the company the patient works at (when the select the insurance plans that they make available to their employees)? The whole thing is stupid. I hope it gets replaced by something that takes employers entirely out of the picture.

Exactly. 'Repeal' of the ACA in this way seems to be a mix of posturing and insane irresponsibility. That's why I imagine this 'repeal' will have many, many years of delay written into it. What's most interesting is that they claim they want to replace it with something that covers the same number of people in a similar way but outside of some government run system there's literally no other way to do this other than through a system that looks an awful lot like the ACA that they claim to hate so much.

I wouldn't be surprised if in the end they 'repeal' it and then 'replace' it with something that's not much different. They will then declare the small number of trivial differences are what make it great and what made the ACA so evil and call it a day because they've realized that Obama pretty much had it right from the beginning. (assuming a market based insurance system)

 

[dullard]

My ideal replacement would be basically (I've posted this here for years):

1) Eliminating the tax deductions for any medical expenses (employers will be given strong incentives to drop health insurance, relevant citizens will have far less paperwork when filing taxes).

2) Taxing health care coverage from employers as income (employees will be given a strong incentive to ask for higher salaries instead of wasteful golden insurance plans).

3) Use the money saved from #1 and #2 to give everyone a refundable tax credit equal to high-deductible tax insurance premiums but ONLY if you buy insurance. That way you aren't forced to buy insurance, but you would be a complete idiot not to since it would be free to you. Also it means we only are helping American citizens.

4) Eliminating useless barriers that add massive costs to the system. For example, why do we need to see a doctor for simple medicines then go to a pharmacist to get it? Eliminate that useless doctor visit and cost and let the pharmacist prescribe the drug like much of the rest of the world. Doctors diagnose, pharmacists dispense. Simple, safe, limits each to their expertise, and saves $100 a pop. Same with expanding nurse practitioner powers. Same with state-to-state differences, get rid of them and let insurance companies sell anything, anywhere. I could go on and on with examples.

5) Eliminate the requirement to treat anyone. If someone was stupid enough to turn down their free health insurance, tough for them.

6) Eliminate undergraduate school from being essentially required to get into medical school. That would save a bundle for the doctors and eliminate a bunch of useless classwork. Meaning doctors can live on a lower income just fine. Plus it increases the supply of doctors by giving each ~10% more years to do their job, which lowers costs due to lack of supply.

7) Expand medical schools and internships. The biggest cost driver is the limited supply. Get rid of that arbitrary restriction on supply.

8) Require upfront pricing. How can we keep costs down when the same drug is 10x more if you cross the street to another pharmacy and don't know the prices? Sure, some things are complex and it might need to be a price per hour or a set minimum price + add ons. But, the vast majority of items like a visit to give you a refill should have a set price up front. Then you can compare doctor A to doctor B and actually reduce costs by choosing a good value.

It would still be market-based, drastically lower costs, cover just about everyone, important decisions are between the doctor and the patient, eliminate bankruptcy from being a major drain on people and the health care system, give our economy flexibility because people can work where they are best rather than whatever they can find that includes insurance, etc.

 

[dullard]

Exactly. 'Repeal' of the ACA in this way seems to be a mix of posturing and insane irresponsibility. That's why I imagine this 'repeal' will have many, many years of delay written into it. What's most interesting is that they claim they want to replace it with something that covers the same number of people in a similar way but outside of some government run system there's literally no other way to do this other than through a system that looks an awful lot like the ACA that they claim to hate so much.

I wouldn't be surprised if in the end they 'repeal' it and then 'replace' it with something that's not much different. They will then declare the small number of trivial differences are what make it great and what made the ACA so evil and call it a day because they've realized that Obama pretty much had it right from the beginning. (assuming a market based insurance system)

I bet that you are correct. They will most likely repeal the ACA and replace it with the ACA but in a different name. The individual items in the ACA are almost all wildly popular. They will be hard to not include in any replacement. So the replacement will be nearly identical.

 

[Doc Savage Fan]

It's only fitting that reconciliation be used to effectively bring ACA to it's end.

 

[fskimospy]

It's only fitting that reconciliation be used to effectively bring ACA to it's end.

You should read the thread. Reconciliation can't bring the ACA to an end because the ACA was passed through regular order and a large amount of it isn't subject to reconciliation.

The GOP can fuck the country up by repealing select parts of the ACA but they need to either get 60 votes or eliminate the filibuster to actually end the ACA.

 

[Doc Savage Fan]

You should read the thread. Reconciliation can't bring the ACA to an end because the ACA was passed through regular order and a large amount of it isn't subject to reconciliation.

The GOP can fuck the country up by repealing select parts of the ACA but they need to either get 60 votes or eliminate the filibuster to actually end the ACA.

Is the meaning of the word "effectively" lost on you?

 

[agent00f]

Conservatives sure hate the conservative healthcare plan when libtards try to pass it. If libtards were smart, they'd champion every conservative cause.

 

[fskimospy]

Is the meaning of the word "effectively" lost on you?

Nope! Community rating, ban on underwriting, and all of the huge insurance regulation reforms can't be repealed through reconciliation, meaning the largest changes to our health care system are unaffected by it. If you think keeping the biggest changes and repealing other budget related items 'effectively' ends something then I think you might want to re-evaluate what you consider 'effective'.

Also, it's not clear at this point that the GOP will have 50+ votes for the 'repeal and delay' strategy anyway as several members have come out and (rightly) said what a stupid idea it is. Maybe they will come around but it seems that reality is already starting to bite.

 

[ivwshane]

Lol! Governing is hard! The dems just need to sit back and watch the show.

 

[Bitek]

Is the meaning of the word "effectively" lost on you?

It's doing nothing of the sort. Try reading the fine print sometime.

The actual bill gives budgeting instructions to the various controlling committees for items impacting the budget.

Even then they can only effect parts of the law. Enough to cause chaos for actuarials and set fire to the insurance market, and defund Medicaid expansion, but the requirements and core provisions remain.

Then if you assume they actually put the gun to their heads and pull the trigger, it's going to be a race against the riots to unfuck the healthcare system with a plan nobody can articulate beyond a few bullet points (most of which involve keeping the core Obamacare elements, but somehow "cheaper".)

GLWT.

 

[Brainonska511]

It's amazing that these deficit scolds and "lower budget" folks are willing to support blowing a trillion dollar hole in the budget and blowing up the deficit. How quickly and conveniently they forget their positions when they secure a majority.

My ideal replacement would be basically (I've posted this here for years):

1) Eliminating the tax deductions for any medical expenses (employers will be given strong incentives to drop health insurance, relevant citizens will have far less paperwork when filing taxes).

2) Taxing health care coverage from employers as income (employees will be given a strong incentive to ask for higher salaries instead of wasteful golden insurance plans).

3) Use the money saved from #1 and #2 to give everyone a refundable tax credit equal to high-deductible tax insurance premiums but ONLY if you buy insurance. That way you aren't forced to buy insurance, but you would be a complete idiot not to since it would be free to you. Also it means we only are helping American citizens.

4) Eliminating useless barriers that add massive costs to the system. For example, why do we need to see a doctor for simple medicines then go to a pharmacist to get it? Eliminate that useless doctor visit and cost and let the pharmacist prescribe the drug like much of the rest of the world. Doctors diagnose, pharmacists dispense. Simple, safe, limits each to their expertise, and saves $100 a pop. Same with expanding nurse practitioner powers. Same with state-to-state differences, get rid of them and let insurance companies sell anything, anywhere. I could go on and on with examples.

5) Eliminate the requirement to treat anyone. If someone was stupid enough to turn down their free health insurance, tough for them.

6) Eliminate undergraduate school from being essentially required to get into medical school. That would save a bundle for the doctors and eliminate a bunch of useless classwork. Meaning doctors can live on a lower income just fine. Plus it increases the supply of doctors by giving each ~10% more years to do their job, which lowers costs due to lack of supply.

7) Expand medical schools and internships. The biggest cost driver is the limited supply. Get rid of that arbitrary restriction on supply.

It would still be market-based, drastically lower costs, cover just about everyone, important decisions are between the doctor and the patient, eliminate bankruptcy from being a major drain on people and the health care system, give our economy flexibility because people can work where they are best rather than whatever they can find that includes insurance, etc.

4) I just don't see states unifying their laws in such a way as to allow insurance companies to sell across state lines. The way it's touted now (interstate insurance sales), it seems like you'd get what you see with CCs - incorporation in low regulation states and everyone else gets screwed.

6) I like this idea - why can't they just make it a 5-6 year program total? You get an undergrad degree + medical training.

 

[fskimospy]

It's amazing that these deficit scolds and "lower budget" folks are willing to support blowing a trillion dollar hole in the budget and blowing up the deficit. How quickly and conveniently they forget their positions when they secure a majority.

That's because their position was never actually that the budget deficit/debt was too high, it was that they don't like social welfare spending. They were just too dishonest and cowardly to actually articulate that position so the deficit/debt was convenient. Don't worry, they will become VERY concerned about the debt/deficit right about the time that the Democrats retake power. You can set your watch to it.

4) I just don't see states unifying their laws in such a way as to allow insurance companies to sell across state lines. The way it's touted now (interstate insurance sales), it seems like you'd get what you see with CCs - incorporation in low regulation states and everyone else gets screwed.

The problem with selling across state lines isn't really about state regulations. I mean it is some, but the real issue is that building networks of doctors and hospitals that you can get favorable rates from takes a lot of work. In fact in the past several states have explicitly passed laws to align regulations and promote selling of insurance across state lines. Know how many insurance companies took them up on it? Zero.

 

[dullard]

The problem with selling across state lines isn't really about state regulations. I mean it is some, but the real issue is that building networks of doctors and hospitals that you can get favorable rates from takes a lot of work. In fact in the past several states have explicitly passed laws to align regulations and promote selling of insurance across state lines. Know how many insurance companies took them up on it? Zero.

A state here or a state there just isn't enough incentive for insurance companies to do that upfront work. But a nationwide system (the federal government sets minimum standards in order to be given the tax credit or to be given the government-sponsored plan) would for the most part eliminate state-to-state differences. Then rather than building networks of doctors and hospitals, the insurance companies merge. BCBS of Alabama merges with BCBS of Arizona, which merges with BCBS of Arkansas etc. It would be a major consolidation of thousands of separate insurance companies into a few dozen that do have the networks already built.

 

[herm0016]

sounds close to what i think would be good dullard, but im not sure the government will ever do anything to reduce the complexity of the tax code or regulations on anything that makes them money ex: all the different certs and such that each type of medical professional needs, or reduce the need for state funded instutions like undergrad schools.

 

[Doc Savage Fan]

It's doing nothing of the sort. Try reading the fine print sometime.

The actual bill gives budgeting instructions to the various controlling committees for items impacting the budget.

Even then they can only effect parts of the law. Enough to cause chaos for actuarials and set fire to the insurance market, and defund Medicaid expansion, but the requirements and core provisions remain.

Then if you assume they actually put the gun to their heads and pull the trigger, it's going to be a race against the riots to unfuck the healthcare system with a plan nobody can articulate beyond a few bullet points (most of which involve keeping the core Obamacare elements, but somehow "cheaper".)

GLWT.

When the mandates and subsidies are eliminated, ACA is effectively dead.

 

[Brainonska511]

That's because their position was never actually that the budget deficit/debt was too high, it was that they don't like social welfare spending. They were just too dishonest and cowardly to actually articulate that position so the deficit/debt was convenient. Don't worry, they will become VERY concerned about the debt/deficit right about the time that the Democrats retake power. You can set your watch to it.

Yep. None of these clowns ever cared about spending issues, it was just a convenience to block things they didn't like.

The problem with selling across state lines isn't really about state regulations. I mean it is some, but the real issue is that building networks of doctors and hospitals that you can get favorable rates from takes a lot of work. In fact in the past several states have explicitly passed laws to align regulations and promote selling of insurance across state lines. Know how many insurance companies took them up on it? Zero.

Yeah, I thought about this being an issue too - particularly for smaller insurance companies. They'd effectively be locked out by the national chains if such a scheme was implemented.

 

[fskimospy]

When the mandates and subsidies are eliminated, ACA is effectively dead.

Except of course for the community rating part. Now with the ACA 'dead' you have a private insurance market where no one can be denied coverage but where no healthy people need to sign up. What does that equal? Premiums that are thousands of dollars a month, making the private insurance market basically inoperative. You can't have community rating without a mandate and you can't have a mandate without subsidies. They are now just keeping community rating. This is of course why the GOP plan for repealing parts of it through reconciliation are so incredibly stupid.

A 'dead' law can singlehandedly render the entire private health insurance market nonviable if the Republicans decide to 'kill' it. Pretty impressive for something that's dead!

 

[fskimospy]

A state here or a state there just isn't enough incentive for insurance companies to do that upfront work. But a nationwide system (the federal government sets minimum standards in order to be given the tax credit or to be given the government-sponsored plan) would for the most part eliminate state-to-state differences. Then rather than building networks of doctors and hospitals, the insurance companies merge. BCBS of Alabama merges with BCBS of Arizona, which merges with BCBS of Arkansas etc. It would be a major consolidation of thousands of separate insurance companies into a few dozen that do have the networks already built.

But the main supposed benefit of selling across state lines is to lower costs through increased competition. Your example does either nothing to improve this or in some cases makes it even worse.

 

[Doc Savage Fan]

Except of course for the community rating part. Now with the ACA 'dead' you have a private insurance market where no one can be denied coverage but where no healthy people need to sign up. What does that equal? Premiums that are thousands of dollars a month, making the private insurance market basically inoperative. You can't have community rating without a mandate and you can't have a mandate without subsidies. They are now just keeping community rating. This is of course why the GOP plan for repealing parts of it through reconciliation are so incredibly stupid.

A 'dead' law can singlehandedly render the entire private health insurance market nonviable if the Republicans decide to 'kill' it. Pretty impressive for something that's dead!

You assume that these issues will not be addressed in some fashion. That said, my point stands...ACA as we know it is going to effectively die.

 

[fskimospy]

You assume that these issues will not be addressed in some fashion. That said, ACA as we know it is going to effectively die.

In what way will they be addressed? Some magical, nebulous, secret way no doubt.

EDIT: It seems reasonably likely that the ACA as we know it isn't going anywhere as there's really no other way to do a market based insurance system except pretty much as the ACA did it. I'm not sure why conservatives never seemed to grasp this fact.