Hands on the Plow Edition
FIRST, LET’S BUCK UP: On Tuesday, Democrats lost yet another special election in a safe, reliably GOP seat -- this time in the safe, reliably GOP district of the Georgia 6th. These special elections have all bee in safe GOP seats because their former occupants were picked by the Trump administration to serve in various positions -- and were picked in part because their seat was reliably Republican. Still, the loss hurts. And I was feeling drained and exhausted and disappointed on Wednesday morning. So it was a nice kick in the pants to be directed to this (short) thread, which I highly encourage everyone to read right now. (HT: Paul Kremer). I’ll wait. Seriously. Go read it.
Good, right? But before we move on and put our hands to the plow of healthcare, a quick reflection on those races: Chait says that the current Dem funk “might be the worst Democratic freakout ever.” “As Dave Wasserman points out, in the four special elections, they have overperformed the partisan baseline in their districts by an average of 8 percentage points.” Let’s also remember that after Barack Obama’s 2008 victory, Republicans didn’t score a win until the Scott Brown election of 2009, a year after Obama’s win. And at the time, everyone was saying that this augured well for the Democrats. And yet we remember the Tea Party sweep of 2010, right? The point is that special elections in districts handpicked to not flip do not tell us much about the national mood and our chance to win back the House 16 months from now.
IT’S ALL ABOUT HEALTH CARE: So we now have the Senate bill in front of us. As I said on Thursday night, it is in many ways more drastic and more cruel than the House bill. The CBO will release its “score” of the bill early this coming week, which will show how much it is projected to cost (or save), how many people will be insured under it compared to the current baseline (ie, compared to Obamacare), and what premiums and other costs are expected to be. We’ll know a lot more about the bill with that score. But for now, here’s some basics about the bill:
- The subsidies available to those buying insurance through the exchanges would be slashed by the equivalent of about 15%. This means that your out-of-pocket expenses (premiums and deductibles) would increase substantially. Median deductibles would rise from about $3500 to $6300. When you remember that the GOP’s entire anti-Obamacare stance was supposedly about lowering premiums and deductibles, this seems like a pretty blatant failure.
- The expansion of Medicaid to those making up to 138% of poverty level would be forced to end by 2023. Separate and apart from the expansion, the Senate bill would “permanently restructure Medicaid,” cutting around $800 billion from the program over the next decade.
- And wouldn’t you know it, but along with slashing health care spending on the working poor, the disabled, children, and the elderly by $800 billion, the Senate bill gives a tax cut of about $1 trillion, almost all of which goes to the richest Americans. Probably just a coincidence. Oh and the best part is that it makes the tax cut on investment income (capital gains and dividends) retroactive. “This provision in particular is heavily loaded toward the richest of the rich. According to the Tax Policy Center, 90% of the cut goes to the top 1% (those with income of $699,000 or more); they’d get an average tax benefit of about $25,000. And almost two-thirds goes to the top 0.1% (with income exceeding $3.8 million); they’d get an average $165,000.”
- States will be able to relatively easily waive essential health benefits and reinstitute annual and lifetime caps on insurance, even for those on employer-based plans. “This may be the most insidious provision of the repeal bill, and certainly is the most deeply hidden.” (If you want a searing (and brief) portrait of what those caps can mean in real life, please read this.) The House bill allowed States to apply for waivers to ACA’s current rule requiring coverage of essential benefits and banning caps; the Senate bill essentially requires the HHS Secretary to approve all such waivers, without discretion. “As a result, states would be able to eliminate the essential health benefits that all health plans must provide under the ACA — including hospitalization, prescription coverage, maternity care and substance abuse and mental health treatment. Since only essential health benefits are subject to the ban on lifetime and annual benefit limits, high-cost patients such as cancer victims and sufferers from chronic diseases could permanently lose their benefits early in their treatment.”
- The Senate bill (like the House bill) eliminates both the individual and employer mandate, meaning that large employers would no longer be required to provide insurance and individuals would no longer have to have insurance (but could still buy a policy, with federal subsidies, when they got sick -- which seems sort of against the whole “personal responsibility” shit the GOP is always peddling).
- It raises costs on people 50-64 (ie, pre-Medicare) substantially, allowing insurers to charge older people 5 times more than it charges younger (as opposed to the currently-permitted 3:1 ratio).
- Subsidies are slashed. Currently, people on the individual market qualify for subsidies if their income is anywhere up to 400% of the poverty line. The Senate bill lowers that to 350%. This is another way older people get screwed: “Under existing law, the most that anyone within 400% of the poverty line can pay for a qualified health plan is 9.5% of their income. Under the Senate bill, buyers age 60 or older within 350% of the poverty line would pay as much as 16.2% of income — and those over 350% of poverty would get no help at all.”
WHAT IS OUR POLITICAL STRATEGY: First, the strategy is call, call, call; mobilize, mobilize, mobilize. I hope everyone was able to make some calls last week and will keep it up this week. It’s easy and it really does make a difference. Why do you think that, for the first time ever, 100% of Democrats are standing united on this, firm in their opposition to Trumpcare? It’s because of us. That’s major. Second, I think the Democratic leadership is actually doing a pretty good job. Although I would like to lead more with the “this is just a tax cut for the rich funded by slashing health care for working families” angle, I think overall their strategy has been good and is working. I recommend listening to Pod Save America’s interview with Senator Schumer from earlier this week (20 minutes total). Starting at 30:45, the hosts ask him about whether, in our messaging about Trumpcare, we should focus on the fucked up process of the bill (ie, written in secret by 13 men, without a single hearing, no input from experts, and no discussion with Democrats -- and shown to lobbyists before it was shared with the rest of the GOP caucus, let alone the rest of the Senate) or the substance of the bill (ie, it will kill a lot of people by stripping health insurance from millions of Americans and making the insurance others actually have crappier and less protective). Here’s Schumer’s answer:
“It’s a three-step dance. One: They are using unprecedented dark room, back room processes to move this forward. Why? They’re ashamed of the bill. I said on the floor today, if they liked this bill, they’d have a brass band marching down the streets with the bill through every town in America. But why are they ashamed? And then you give the substance: the fact that so many covered people will lose coverage, 23 million under the House bill; preexisting conditions; women’s rights -- women’s health care; opioid addiction; nursing homes; you name it. We’re trying to combine those arguments into one coherent three-sentence paragraph, and it’s working.
I like that. And Schumer emphasized that there is no reason to lose hope: “We’re close. There are 2 Republicans who it looks like they’re going to vote no. . . .We get one more, we win the whole damn fight. Don’t be discouraged -- we’re right on the edge!”
WHAT IS THEIR POLITICAL STRATEGY: It is increasingly clear that the only strategy the GOP has to pass this bill is to literally and flagrantly lie about it, the more brazen, the better, apparently. Today, HHS Secretary Tom Price declared that under the GOP bill, “We would not have individuals lose coverage.” That’s a lie. (He also had the balls to complain that, under Obamacare, 28 million Americans remain without insurance -- not optimal, but still the lowest uninsured rate in American history, and a figure that will rise dramatically under the GOP plan). Kellyanne Conway today declared that the bill’s Medicaid cuts “are not cuts to Medicaid.” That is a lie. Senator Tim Scott: “Medicaid is not being cut from our perspective.” Don’t care what perspective you’re using -- that’s a lie. Sen. Pat Toomy: “The Senate bill will codify and make permanent the Medicaid expansion.” Yeah, that’s a lie. THESE ARE INSANE LIES, PEOPLE. Don’t let the GOP gaslight you.
SO DO THEY HAVE THE VOTES? With Dems united in opposition to the bill, Mitch McConnell can afford to lose exactly two votes (which would take him to 50 votes, and Pence can break the tie). Right now, two GOP senators have come out pretty strongly against the bill -- for opposite reasons. On Friday, Nevada Senator Dean Heller, the GOP’s most endangered member who’s up in 2018, announced his opposition in relatively forceful language: “I’m telling you right now, I cannot support a piece of legislation that takes insurance away from tens of millions of Americans, and hundreds of thousands of Nevadans.” By grounding his opposition in the fact of millions losing coverage, Heller leaves himself very little room to get on board with minor tweaks. That millions lose coverage is not some accidental by-product of the GOP legislation; it’s its whole raison d’etre. So that was extremely encouraging. Then Mike Lee, the uber-conservative from Utah, wrote on Medium that he would not support the bill “as drafted,” which seems to leave more wiggle room. Still, his critique was pretty stinging: “Far short of “repeal,” the Senate bill keeps the Democrats’ broken system intact, just with less spending on the poor to pay for corporate bailouts and tax cuts. A cynic might say that the BCRA is less a Republican health care bill than a caricature of a Republican health care bill.” On the other hand, he writes that he asks “only that the bill be amended to include an opt-out provision, for states or even just for individuals.” I have no idea what that means: How could an individual opt out of regulations, or federal subsidies? But it does seem like he’s creating a way to accept cosmetic changes to the bill. Senators Rand Paul, Ted Cruz, and Ron Johnson have also spoken out against the bill; Ron Johnson said today “there’s no way we should be voting” on the bill this week. And Senators Lisa Murkowski and Susan Collins have talked about their misgivings, although they have no locked themselves into anything.
LIVES ARE ON THE LINE: Guys, defeating this IS DOABLE. We have to fight as hard as we can, because lives -- millions of lives -- literally depend on it. If you want to really hear about how this stuff impacts real lives, take 8 minutes and watch this interview with Mike Phillips, a man with severe disabilities, and his mom.
Endorsements:
- Last week, three different police officers escaped guilty verdicts for killing unarmed black men. The hung jury that failed to convict Philando Castile’s killer is a particularly bitter pill to swallow, and the exchange was caught entirely on camera and the aftermath was famously filmed by Mr. Castile’s girlfriend, as he lay dying in the front seat of his car. The Daily Show’s Trevor Noah speaks quite eloquently about the trial here.
- Compression socks
- “The Big Sick,” a new movie written by Kumail Nanjiani and his wife Emily Gordon. This movie has so many laughs and so much heart. It was really great.
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