Note: I am experimenting with sending these out on Sundays instead of Thursday nights, in the interest of actually having time to write them. But I may switch back, so keep watch of your inbox!
REPLACEMENT -- THE FACTS: We finally got a look at the GOP's "repeal and replace" health care bill. It's pretty terrible, though it has a fwe non-terrible features: It keeps Obamacare’s ban on charging sick people more for insurance; the ban on annual and lifetime caps on coverage; the requirement that preventative care and other basic services be provided without copays; a cap on individual’s out-of-pocket expenses; and the permission for children up to 26 to stay on their parents’ health plans. But it changes crucial parts of Obamacare, most importantly slashing the subsidies, replacing the needs-based payments with a flat subsidy and allowing insurers to charge older people up to 5 times more than others. And while Obamacare’s subsidies phase out pretty quickly as a person’s income rises, the Republicans shell out money to families making up to $150,000. So while Obamacare gave more generous subsidies to poorer and older people, and pegged those subsidies to the actual cost of healthcare in a given area (meaning that rural areas with fewer choices tended to get higher subsidies, and as healthcare costs went up, so did subsidies), the GOP bill effectively transfers money from the poor, sick, and old to the rich, healthy, and young. “A 60-year-old earning $20,000 in Lincoln, Neb., currently gets a subsidy of $18,470 to help her buy insurance, with extra subsidies to help her pay deductibles and co-payments, according to calculations made by Kaiser. Under the new legislation, she would get a subsidy of $4,000, and no help with cost sharing.” Jonathan Cohn, on Brian Beutler’s podcast, explained the difference this way: “That’s the idea [of Obamacare]: the tax credits are supposed to be a guarantee, and they will get bigger if either you don’t have a lot of money or if insurance in your area costs a lot. The Republican tax credits are not a guarantee. They are a flat amount. They go up by age, but that’s it.”
Gone also is the individual mandate (which makes those without insurance pay a fine to the government), replaced with a 30% surcharge insurance companies can charge those who have a more than 2-month gap in coverage. (This gets it backward, of course, because with this hefty charge, only the sickest people would have an incentive to pay the charge and sign up for coverage, making the market sicker and more expensive than the existing individual market, which already skews too sick and expensive.) The other big and potentially catastrophic change would be to Medicare, whose funding would be dramatically cut starting in 2020. “Currently, Medicaid costs are shared between states and the federal government, but the funding is open-ended, so the federal government pays its percentage of whatever states spend. Under the proposed bill, the amount of federal funding would be capped on a per-person basis . . . [b]ut that per-capita amount might not grow as fast as Medicaid costs, which could leave states on the hook for an ever-increasing share of the costs of the program.” This will almost certainly lead to a widespread cut in funding and services for Medicaid patients. Most important from a GOP perspective -- and the raison d’etre of its existence -- is that the bill repeals almost all of Obamacare’s taxes -- most importantly, taxes on the rich, as well as taxes on things like medical devices, tanning salons, and -- oh yeah -- insurance executive salaries over half a million dollars. It’s a $600 billion tax cut to the rich. And the bill also drops Obamacare’s mental-health-parity and addiction treatment requirements -- but that’s fine, because we’re not in any kind of addiction crisis right now or anything.
As a result of all of these changes, Standard & Poor’s estimates that between 6 and 10 million people will lose their insurance. The Brookings Institution estimates that at least 15 million people will lose health insurance. No wonder the GOP wants to rush the bill through before the CBO has a chance to analyze it.
REPLACEMENT -- THE POLITICS: I’ve said it a thousand times: The only thing saving us from the most dire consequences of the Trump/GOP takeover of government is their staggering incompetence. This bill was rolled out on Monday, apparently before the GOP had lined up any support for it among its normal constituents. Heritage Foundation, the Club for Growth, and FreedomWorks are all against it, as are the Koch Brothers. Breitbart has been vocal in opposition, and even Fox News’ Tucker Carlson asked Paul Ryan why he included a massive tax cut for the rich (Ryan’s response: “I’m not concerned about it.”). The AARP, the American Hospitals Association, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Medical Association have all come out against the bill. Even the chief medical officer of Medicaid -- a government employee -- spoke publicly about his opposition. Four Republican senators -- Rob Portman (OH), Shelley Moore Capito (WV), Cory Gardner (CO), and Lisa Murkowski (AK) -- have written to Mitch McConnell saying they cannot support a decimation of Medicaid. (Republicans can only afford to lose two votes in the Senate). On the other hand, the uber-conservative Freedom Caucus opposes the bill because it is too generous and too much like Obamacare; Senator Tom Cotton has said the bill can’t pass the Senate. And the people who will be most hurt by this bill are the same people who voted overwhelmingly for Trump. (Example: Those set to lose $7,500 in subsidies went for Trump 58% to 39%.) All of this is to say that there is a real (relatively good) chance that this bill dies a painful death. But we have to keep pushing our reps and senators on this (I’m looking at you, Colorado residents!).
REPLACEMENT -- THE STUNNING HYPOCRISY AND BULLSHIT: I basically just want to quote this entire Jonathan Chait piece, which you should all read. Here’s a big excerpt:
The national health-care debate began in 2009. Republicans have had eight years since then to draw up and unify around a plan of their own. They have spent this time insisting they could do so easily. For most of the year, in fact, House Republicans have been running a television ad assuring the public they already “have a plan” with wonderful features: “Health insurance that provides more choices and better care, at lower costs. Provides peace of mind to people with preexisting conditions … without disrupting existing coverage.” Eventually they had told the lie so long it became impossible for them to abandon it. And so Republicans have found themselves frantically scrawling out a hopelessly inadequate solution in order to meet a self-imposed deadline driven by their overarching desire to cut taxes for the rich.
Ezra Klein writes, “It is difficult to say what question, or set of questions, would lead to this bill as an answer. Were voters clamoring for a bill that cut taxes on the rich, raised premiums on the old, and cut subsidies for the poor? Will Americans be happy when 15 million people lose their health insurance and many of those remaining face higher deductibles?”
The Republicans have been lying about Obamacare for 7 years. They said it was “shoved down our throats” and passed in the dead of night. In fact, it went through a full year of painstaking, exhausting, nerve-wracking debate and negotiation and compromise and votes. Meanwhile, the GOP passed its replacement bill out of committee at 4:30 in the morning. Seriously. They spent years complaining about Obamacare’s cut to Medicare -- and then they pocketed those cuts in their own bill. They spent years insisting that premiums and deductibles were too high, and then wrote a bill that will cause out-of-pocket costs to soar. They complained that Obamacare delayed many of its provisions to juice its CBO score. But their bill puts off its Medicaid cuts for two years, and the GOP now insists that the CBO is stupid and worthless and doesn’t matter, and they are moving forward with passing the bill before even knowing what the CBO says it will do to the deficit or to the number of insured.
- "I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now." [Sept. 2015]
- “You will end up with great health care for a fraction of the price and that will take place immediately after we go in. Immediately! Fast! Quick!” [Feb. 2016]
- “You will have the finest health care plan there is. . . . Obamacare is a total disaster and not only are your rates going up by numbers that nobody’s ever believed, but your deductibles are going up. So that unless you get hit by a truck, you will never be able to use it. It's a disastrous plan and it has to be repealed and replaced.” [Oct. 2016]
- “We’re going to have insurance for everybody,” Mr. Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” [Jan. 15, 2017]
LIAR IN CHIEF, PART 10,000: How amazing that it was just last Saturday that Trump tweeted out that he had “found out” that Obama had wiretapped Trump’s phones during the election? And then the White House promptly refused to answer any questions, instead calling for a congressional “investigation” into what the president had already asserted was a fact? Yeah, that was insane. Why am I not surprised that there’s been essentially no follow up? It is now just taken as a given that we have a president who serially lies -- about some of the most important and urgent issues conceivable -- in public, with no repercussions or consequences or shame. The House Intelligence Committee is now asking for Trump to turn over his “evidence” about this by tomorrow. That’s obviously never going to happen and also no one will care because nothing matters. The introduction of the dumpster fire GOP “replacement” plan was the biggest gift to Trump he could have ever hoped for, because heaven forbid we concentrate on two things at once.
PUT ON YOUR RADAR: Here’s yet another thing to put in the panic file. House Republicans are advancing a series of bills that would make it dramatically harder for consumers and employees to file lawsuits against corporations and others that have wronged them. “One proposal would limit monetary awards in medical malpractice suits to $250,000 for noneconomic damages, which include pain and suffering,” while another bill “would permit class-action lawsuits to proceed in federal court only if every person in the class had ‘an injury of the same type and scope.’” These are dramatic measures. The idea that, no matter the injury, a plaintiff would face an automatic (and really very low) cap on damages is really outrageous. And the class action bill could make it infinitely harder to pursue bad actors: “It could sharply restrict membership in a class, for example, to women who had been sexually harassed in the same way by the same manager.”
Must Read: One of my all-time favorite writers Richard Lawson (who usually writes about movies and pop culture) wrote a brilliant and insightful and a Hell Yes! column on why Bush nostalgia is so disgusting. Please read it!
Best Video of the Week Ever: I’m sure by now you’ve all seen this glorious 2 minute video of a BBC interview being interrupted by some insanely adorable children. If not, rectify that situation IMMEDIATELY. And then read this play-by-play that makes the video even more hilarious and winning than it already is. (And people say these newsletters are depressing!)
Bonus Video: Kate McKinnon’s Jeff Sessions is my new favorite part of SNL. This week’s is not to be missed.
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