Trumpcare Passes House: Today's News for Cinco de Mayo

"So they did it! 'Obamacare is finally officially dead,' is something they can say once the bill goes to the Senate, then gets out of committee, is debated on the floor, where amendments can be added, then the Senate votes on their bill, which is sent to conference committee, where the difference between the two bills are ironed out, then voted on in the House and Senate again, then sent to the White House for the president to sign. Which is why Republicans were chanting, 'We're number one...third of the way through a very complex process!'"--comedian Stephan Colbert

Kudos to Stephan Colbert for nailing the TRUTH in this story. The House's passage yesterday of the American Health Care Act is only the beginning of a very long story.

However, there is a lot to learn from this story...

NPR:

Here Is What's In The House-Approved Health Care Bill

Here's a rundown of key provisions in the American Health Care Act and what would happen if the Senate approves them and the bill becomes law.

Buying insurance

The bill would no longer require people to buy insurance through the marketplaces created by the Affordable Care Act, also known as Obamacare, if they want to use federal tax credits to buy coverage. It also would eliminate the tax penalty for failing to have health insurance coverage, effectively doing away with that requirement altogether.

In place of that mandate, the bill encourages people to maintain coverage by prohibiting insurance companies from cutting them off or charging more for pre-existing conditions as long as their insurance doesn't lapse. If coverage is interrupted for more than 63 days, however, insurers can charge people a 30 percent penalty over their premium for one year.

This does seem to be a better compromise between the insurers and the insureds for dealing with coverage lapses.

Tax credits

The House Republican plan would eliminate the income-based tax credits and subsidies available under the Affordable Care Act, replacing them with age-based tax credits ranging from $2,000 a year for people in their 20s to $4,000 a year for those older than 60.

...Both Kaiser and the Congressional Budget Office found that, on average, older people with lower incomes would be worse off under the Republican plan than under the Affordable Care Act.

Why on earth would anyone assume the closer you get to 60, the more capable you are to afford health insurance premiums?

Tax cuts 

The bill eliminates nearly all the taxes that were included in the Affordable Care Act to pay for the subsidies that help people buy insurance. Those cuts, which add up to about $592 billion, include a tax on incomes over $200,000 (or $250,000 for a married couple); a tax on health insurers and a limit on how much insurance companies can deduct for executive pay; and a tax on medical-device manufacturers. 

I never met a tax cut I didn't like.

Medicaid

The AHCA would make dramatic changes to Medicaid, the federal-state health program for the poor and disabled.

Basically, they shuffled the Medicaid deck a lot, so fewer people will eventually be on it. This leads to:

The Congressional Budget Office estimated in March that the bill would cut Medicaid spending by $880 billion. 

Continuing:

Pre-existing conditions 

The AHCA maintains protections for people with pre-existing conditions, with some important exceptions (see waivers, below). That means that someone with high medical expenses pays the same premium for the same policy as anyone else his age in his area.

Same as Obamacare. If the house is burned down, the new insurer still has to replace it. This is no longer insurance, so let's quit pretending it is.

However, states can opt out of the pre-existing conditions part:

State waivers
This section of the bill essentially amounts to an optional, state-level full repeal of Obamacare. It would give states the ability to apply for a waiver that lets them opt out of most of the regulations and consumer protections that were included in the Affordable Care Act.

States could apply for waivers that would allow insurance companies in their states to do three things: 1. Charge older people more than five times what they charge young people for the same policy; 2. Eliminate required coverage, called essential health benefits, including maternity care, mental health and prescription drugs, that were required under the Affordable Care Act; and 3. Charge more for or deny coverage to people who have pre-existing health conditions, such as cancer, diabetes or arthritis.

....States that get waivers would very likely see insurance companies offer many more policy options, some with fewer benefits and lower premiums.

Before you consider this good or bad, there is a disclaimer:

Those states [that get waivers] would be required under the law to create some other way to ensure that people with expensive illnesses are able to get health care, and the law provides up to $138 billion over 10 years for such programs, typically called high-risk pools. 

However, an analysis released Thursday by consulting firm Avalere Health concludes that that amount would be inadequate for providing full health coverage for the number of people who now buy insurance in the individual market and have medical problems.

What you would most likely see are high risk pools with a prohibitive amount of hoops to jump through in order to gain coverage, somewhat comparable to Social Security disability today.

The full cost to the American people of NOT passing this bill:

The CBO report from March concluded that over 10 years, 24 million fewer people would be covered under the bill who otherwise would have had insurance under current law. 

That analysis also predicted that the House bill would cut the federal deficit by $337 billion over those same 10 years. 

In other words, insuring those 24 million people will cost us about $1,400/year/person. If you have ever paid for your own health insurance, you know that isn't the full cost of a health insurance policy's premiums. This is clearly a case of low income people not being able to buy health insurance without the government subsidies.

Whether this bill is good or bad is entirely a matter of opinion. Personally, I oppose it for the same reason I opposed Obamacare: It redefines insurance to a third party health care payment system, rather than an emergency safety net.

Personally, I recommend Dilbert's Scott Adams' analysis:

The insurance companies are keeping the healthcare topic confusing because that’s how you keep margins high. If Congress or the public ever started to understand healthcare, we would know which buttons to push to lower the profit margins in the industry. But by keeping things complicated, no one can explain to anyone else what needs to be done for the public good.

My recommendation to the public is to refuse to re-elect any politician who votes for a healthcare bill that YOU don’t understand. If you don’t understand a healthcare bill, that means it is designed to screw you. 

In other news...

AFP (via Yahoo News):

Russia, Turkey, Iran sign deal to set up Syria safe zones

Russia, Iran and Turkey on Thursday signed an agreement on setting up four safe zones in Syria that the United Nations described as a promising step to wind down the brutal six-year war.

The United States however gave an extremely cautious welcome, citing concerns over Iran's role as a guarantor, even as it expressed hope that the deal could set the stage for a settlement.

It is surprising the U.S. response would be as mild as "cautious":

Fox News:

Report: Russia says Syria safe zones will be shut for US warplanes

Russian news agencies reported on Friday that U.S. and coalition warplanes will not be allowed to fly over safe zones in Syria.

Putin on Wednesday said he had a “very good” conversation over the phone with Trump, and that his U.S. counterpart agreed to a proposal to establish Syrian safe zones to protect civilians in the war-torn country.

But the White House only confirmed that the two leaders discussed the safe zones, not that there were any agreements.

It is unclear how Russia would enforce this reported no-fly zone for coalition forces.

There is only one way for Russia to enforce it, and that gets ugly if it happens. However, President Trump's apparent acceptance of this is a positive, since it indicates this might be a good thing, since it will effectively remove the U.S. from fighting in Syria.