In it, but not of it. TPM DC

Former President Barack Obama said Wednesday that repeated Republican attempts to repeal his eponymous health care legislation are “aggravating” and would cause “real human suffering.”

“The legislation that we passed was full of things that still need to be fixed. It wasn’t perfect. But it was better,” Obama said, speaking at an event hosted by the Gates Foundation in New York.

“And so when I see people trying to undo that hard-won progress, for the 50th or 60th time,” he added, to laughter, “with bills that would raise costs or reduce coverage or roll back protections for older Americans or people with pre-existing conditions — the cancer survivor, the expecting mom, or the child with autism, or asthma, for whom coverage once again would be almost unattainable — it is aggravating.”

Obama said attempts to repeal the Affordable Care Act are “being done without any demonstrable economic or actuarial or plain common-sense rationale.”

“It frustrates. And it’s certainly frustrating to have to mobilize every couple of months to keep our leaders from inflicting real human suffering on our constituents,” he said.
“But typically that’s how progress is won, and how progress is maintained on every issue.”

Obama said progress “is never inevitable” and can “often be fragile.”

“It’s in need of constant renewal,” he said. “And our individual progress and our collective progress depends on our willingness to roll up our sleeves and work, and not be afraid to work.”

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A new report released Wednesday morning reveals just how much states could lose under the Senate GOP’s latest Obamacare repeal bill—in total, a decrease of $215 billion dollars in federal health care spending by 2026 and more than $4 trillion cut by 2036, according to the report by the health care consulting group Avalere.

The Senate could potentially vote next week on the Graham-Cassidy bill to repeal much of the Affordable Care Act and convert Medicaid into a dwindling block grant. The bill’s Republican backers acknowledge that there will be winners and losers under the plan, but they are planning to bring the bill to a vote without getting a complete analysis from the Congressional Budget Office of its cost and expected coverage losses, making independent assessments like Avalere’s among the few data points for analyzing the bill’s impact.

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Cameron Joseph contributed reporting.

The Senate has less than two weeks, and just a handful of working days, to repeal Obamacare and block-grant Medicaid with a mere 50 votes.

“This vehicle that we’re using turns into a pumpkin on September 30th if we don’t get something else done,” Sen. Mike Rounds (R-SD) warned Tuesday.

With the clock ticking, Senate Republicans have thrown together a crude imitation of regular order in an attempt to quickly check all the necessary boxes and win over their colleagues who are sticklers for process. Next week, they plan to plow through a single hearing, receive an incomplete analysis from the Congressional Budget Office, and if they shore up the votes, take it to the Senate floor for a whopping 90 seconds of debate before launching into a vote-a-rama.

Some Republican lawmakers are less than pleased.

“That’s problematic because that is part of the problem of short-circuiting the process,” Sen. Susan Collins (R-ME) complained, lamenting that the last-minute repeal effort is having the side effect of killing the bipartisan health care stabilization bill she and others have spent months negotiating.

Despite their paeans about respecting “regular order,” and barring any surprise defections or changes, this is the process the GOP will use over the next week to take one last run at repealing the Affordable Care Act.

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The American Hospital Association on Tuesday said it opposed the latest Republican proposal to repeal Obamacare, and predicted that “tens of millions of Americans” will be at risk of losing coverage under the proposed legislation.

“This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term,” Rick Pollack, the organization’s president and CEO, said in a statement. “In addition, the block grant to provide support for the expansion population expires in 2026, thereby eliminating coverage for millions of Americans.”

“For these reasons, we oppose the Graham-Cassidy plan,” Pollack said. “We continue to urge senators to work in a bipartisan manner to address the challenges facing our health care system.”

The repeal bill introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) is Republicans’ last best shot to dismantle Obamacare in the current Congress.

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Sen. Lindsey Graham (R-SC) tried to build momentum Tuesday for his last-ditch effort to repeal Obamacare, attempting to paper over complaints about the shortcut legislative process and warning that the GOP majority in Congress would not continue to “prop up” Obamacare.

“You can have different opinions about the quality of this bill. At the the end of the day, this is the only process left available to stop a march toward socialism,” Graham, the lead author of the bill, told reporters in the Capitol.

Asked whether the bill’s supporters planned to address Sen. John McCain’s (R-AZ) concerns about regular order, which sank Republicans’ last effort to repeal Obamacare, Graham said the Senate Finance Committee had a hearing scheduled for Monday to discuss the proposal.

“There will be a public hearing, what John has been asking for,” he said.

Graham said Republicans who vote against the bill are voting “against federalism.”

“At the end of the day we need 50 votes, and if you’re a Republican, chances are you believe in federalism, because if you don’t you probably are not a Republican,” he said. “If you’re a Republican and you vote against federalism, you’ve got to explain to people back home why Washington knows better.”

Graham said Senate Majority Leader Mitch McConnell (R-KY) and Republican leadership have “done everything we’ve asked and then some,” and House Speaker Paul Ryan (R-WI) said his chamber would pass the proposal if it cleared the Senate.

“Paul Ryan told me to my face,” he said. “You pass it, we pass it.”

Graham said President Donald Trump was “very excited” about the idea of a “state-centric health system.”

“I’ve talked to the President five times in the last two days,” he said. “He is focused like a laser.”

Graham said Trump told him he was “not going to throw good money after bad,” an apparent reference to cost sharing reduction payments, subsidies that support coverage of low-income people with severe health needs.

The non-partisan Congressional Budget Office on Thursday predicted that premiums will go up in 2018 because of ongoing uncertainty about whether Trump’s administration will cut off support for those subsidies.

Graham indicated that Ryan also said he was unwilling to hold a vote on a bill that “props up” Obamacare by continuing to support cost sharing reduction payments.

“Here’s what the speaker of the House told me: ‘I will not bring up a bill for a vote in the House that props up Obamacare because that is not why I came here and that is not what our majority wants to do,'” Graham said. “And the President of the United States is committed to repealing and replacing this bill, not propping it up.”

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The American Medical Association, the United States’ largest advocacy group for doctors, on Tuesday urged the Senate to reject Senate Republicans’ last-minute effort to repeal Obamacare.

“I am writing to express our opposition to the Cassidy-Graham-Heller-Johnson Amendment,” the group’s CEO and executive vice president James L. Madara wrote in a letter to Senate Majority Leader Mitch McConnell (R-KY) and Senate Minority Leader Chuck Schumer (D-NY).

“We also urge the Senate to reject any other legislative efforts that would jeopardize health insurance coverage for tens of millions of Americans,” he said.

Madara said the latest proposal, introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), “violates the precept of ‘first do no harm.'”

“We believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care,” he said.

Madara said the group is also concerned the bill would “convert the Medicaid program into a system that limits federal support to care for needy patients to an insufficient predetermined formula based on per-capita-caps” and “would allow insurers to charge unaffordable premiums” to patients with pre-existing conditions.

Read the full letter:

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Senators who have been working for months on a bipartisan bill to stabilize Obamacare’s individual market and take away one of President Trump’s ways to sabotage it are throwing in the towel, saying the GOP’s last-minute effort to repeal the Affordable Care Act has ruined their chance of passage.

Health, Education, Labor and Pensions committee chair Sen. Lamar Alexander (R-TN) announced Tuesday evening in a written statement that he has “not found the necessary consensus” to advance his bill.

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Senate Majority Leader Mitch McConnell (R-KY) had plenty of words of encouragement Tuesday for his Republican colleagues’ recent efforts to rally the votes for an Obamacare repeal and replace bill, but stopped short of full-on endorsing the legislation.

Speaking from the Senate floor, McConnell criticized Sen. Bernie Sanders’ (D-VT) recent roll-out of a single-payer health care bill, calling it a “massive expansion of a failed idea” and saying the Graham-Cassidy-Heller-Johnson legislation will provide a better alternative.

Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) “rolled out a health-care proposal of their own last week,” he said. “It would repeal the pillars of Obamacare and replace that failed law’s failed approach with a new one: allowing states and governors to actually implement better health-care ideas by taking more decision-making power out of Washington.”

He said the notion that governors and state legislators would have the chance to make health care decisions for their own constituents is “an intriguing idea” that has a “great deal of support.”

But after the late-night surprise defeat of Senate Republicans’ last “skinny repeal” plan in July, McConnell appears to be unwilling to throw his full weight behind the new bill until he knows he has the votes. So instead he offered warm words of encouragement as the whipping for votes continues. 

“As we continue to discuss that legislation, I’d like to thank Senator Graham and Senator Cassidy for all of their hard work. They know how important it is to move beyond the failures of Obamacare. They know that our opportunity to do so may well pass us by if we don’t act soon.”

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The AARP, a major seniors group, called Tuesday for senators to reject the latest Republican proposal, introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), to repeal Obamacare.

In a statement, the AARP said the proposal currently on the table would “increase health care costs for older Americans with an age tax, decrease coverage, and undermine pre-existing condition protections.”

The AARP also said it would be “irresponsible” for the Senate to vote on a bill “without information on the potential consequences.”

The non-partisan Congressional Budget Office announced Monday that it would not be able to “provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.”

“Should this bill be brought to the Senate floor for a vote, we strongly urge all Senators to vote NO,” the AARP said.

Republicans’ ability to pass the repeal bill via reconciliation, with 50 votes rather than 60, will expire at the end of September.

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Speaking from the Senate floor Tuesday, Sen. Chuck Schumer (D-NY) blasted his Republican colleagues’ latest effort to rush an Obamacare repeal and replace bill through the Senate, especially before the Congressional Budget Office (CBO) has a chance to make projections on the cost of the bill and the numbers of people who would lose insurance coverage.

To consider a bill like this without a full CBO score is worse than negligent, it’s grossly irresponsible,” he said. “We were told yesterday that the CBO may be able to provide a baseline estimate of the cost of the bill, but not the coverage numbers or a detailed analysis of how the bill would affect Americans’ health care choices.”

Schumer outlined his party’s concerns with the new Graham-Cassidy-Heller-Johnson legislation, which would repeal much of the Affordable Care Act and convert Medicaid and Obamacare subsidies to block grants controlled by individual states.

He said the plan will cost “millions” their coverage and will “radically restructure” Medicaid, the program that aids the poor, elderly and disabled.

He’s concerned it will allow insurance companies to discriminate against people with pre-existing medical conditions, throw the individual market into “chaos” and would eliminate consumer protections that give Americans access to things like affordable maternity care, he said.

By Senate rule, Republicans have until the end of September to pass Obamacare repeal with only 50 votes.

Read his full speech from the Senate floor below:

There is a possibility that by the end of next week, the Senate will have a vote, again, on a Republican healthcare bill that was assembled in the dark of night, by one party, without a full account of what that bill would do. It would be shameful, shameful return to the same process that the Majority used to try to ram a bill through in July, unsuccessfully.

To consider a bill like this without a full CBO score is worse than negligent, it’s grossly irresponsible. We were told yesterday that the CBO may be able to provide a baseline estimate of the cost of the bill, but not the coverage numbers or a detailed analysis of how the bill would affect Americans’ health care choices.

Now Mr. President, we are talking about 1/6 of the economy; we are talking about the health care of the nation, we’re talking about the lives, day in and day out, of millions of Americans who need health care, and we’re not going to know what the legislation really does? Senators will be voting blind? You know they say justice is blind, but the Senators on the other side of the aisle should be walking around here with a blindfold over their eyes, because they don’t know what they’re voting on.  Maybe they don’t care. I don’t know how any Senator could go home to their constituents and explain why they voted for a major bill with major consequences to so many of their people without having specific answers about how it would impact their state.

What we do know is that this new Trumpcare bill, the Graham-Cassidy legislation, is worse in many ways than the previous versions of Trumpcare.

The new Trumpcare would devastate our healthcare system in five specific ways:

First, it would cause millions to lose coverage. Second, it would radically restructure and deeply cut Medicaid, ending the program as we know it. The dream of the hard right—get rid of Medicaid—could happen, even though that’s a program that affects the poor and so many in the middle class.  Nursing homes, opioid treatment, people who have kids who have serious illnesses.

Third, it brings us back to the days when insurance companies could discriminate against people with pre-existing conditions.  The ban on discriminating against people with pre-existing conditions would be gone. We had a lot of promises from the other side.  ‘They’d never vote for a bill that didn’t protect people with pre-existing conditions.’  That seems to be going by the wayside, in a headlong rush to pass a bill so you could claim a political victory.  And what about that mom, or dad, who finds out his son, or her son/daughter, has cancer? The insurance company says ‘Yeah, we’ll cover you. It’ll cost you $50,000.’ They don’t have it, and they have to watch their child suffer.  This was an advance that almost all Americans supported. It’s an advance that most people on the other side of the aisle claimed to believe in. Gone.

Fourth, the bill gets rid of the consumer protections that guarantee Americans access to affordable maternity care, substance abuse treatment, prescription drugs.  All of those could be out of any plan. Pay a lot for a plan and not get much for it under this bill.

And fifth, it would throw the individual market into chaos immediately, increasing out-of-pocket costs for individual market consumers and resulting in 15 million people losing coverage next year.

On the first point –Trumpcare would cause millions to lose health insurance in two ways: first by undoing the Affordable Care Act’s major coverage expansion under Medicaid and premium and cost-sharing assistance, instead putting that into an inadequate and temporary block grant, and second, by radically restructuring and cutting the traditional Medicaid program through a per-capita cap.

We don’t have a CBO score yet, and may not get one in time, but previous CBO scores of similar schemes have shown that more that 30 million Americans could lose coverage under this bill. 30 million Americans, 10 percent, approximately, of our population.

On the second point – the new Trumpcare would end Medicaid as we know it by converting Medicaid’s current federal-state financial partnership to a per-capita cap, which cuts current Medicaid funding on an annual basis.

This is a direct blow to nursing home patients, folks in opioid treatments. And CBO has said that 15 million fewer people would receive Medicaid in similar proposals.

On the third point – the new Trumpcare actually brings back the ability for insurers to discriminate against folks with pre-existing conditions, as I mentioned.

Fourth – the new Trumpcare would no longer guarantee consumers affordable access to maternity care, substance abuse, and prescription.

And fifth – like the previous repeal and replace bills, it would immediately eliminate the individual mandate, which would raise the number of uninsured by 15 million relative to current law in 2018 and increase individual market premiums by 20 percent.

So, if you vote for this bill, right away, 15 million lose coverage, premiums go up by 20 percent.  People who vote for this bill are not going to be happy with its results.

Mr. President, each one of these five things represents a major step backwards for our healthcare system. Bringing back discrimination against folks with pre-existing conditions? Ending Medicaid as we know it? These are overwhelmingly popular with Democrats, Independents, Republicans. The hard right doesn’t like it. The big financiers of the other party.

We’re going to go backward, backward.  We’re going to go backward and not even know exactly the effects.  I think the other side, why are they rushing this through? They’re ashamed of it.  They need to have that political scalp, ‘See? We abolished Obamacare!’ But what they’re putting in its place, even for those who don’t like Obamacare, is worse. They don’t want to know that. And the joy that they will have, misplaced joy in my opinion, of abolishing Obamacare will evaporate quite soon when their constituents feel the effects of this bill, and they hear about it from people, average folks, who are so hurt.

The Washington Post summed up Graham-Cassidy yesterday. They said the bill “[Graham-Cassidy] would slash health-care spending more deeply and would probably cover fewer people than the July bill — which failed because of concerns over those details.”

Republicans could not garner 50 votes for their various healthcare plans earlier this year because of how much damage those plans did to Medicaid; how they rolled back protections for pre-existing conditions. And some opposed because the process was such a sham. Well Mr. President, all three of those conditions are here again with this bill. Cuts to Medicaid. No guarantee of protections for pre-existing conditions. Sham of a process.

Now there is a better approach. Right now, Chairman Alexander and Ranking Member Murray are working in a bipartisan way – holding hearings, working through the committee, coming back and forth between the parties with discussions—each side’s going to have to give, that’s how it works around here, or should work—and trying to get a proposal that will improve things. That’s the kind of legislating many members of the Senate have said they want to get back to. That’s the kind of process worthy of the world’s greatest deliberative body.

But after a rancorous, divisive health care debate that took up the better part of this year, Democrats and Republicans were working, have been working, in good faith to come to a bipartisan agreement on healthcare in the HELP Committee. The Republican Majority will toss all of that progress away if they pursue Graham-Cassidy next week the way they’re pursuing it: returning to reconciliation, not working through the committees, no full CBO report, making a mockery of regular order.

Mr. President, I hope — for their sake and for the country’s — that my Republican friends turn back from this new Trumpcare, and join us again on the road of bipartisanship. We’ve seen bipartisan sprouts bloom in the last month.  Graham-Cassidy would snuff them out.  Nobody wants that, nobody.

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