The White House ran an internal examination of the potential impacts of the American Health Care Act and found that the number of Americans who would be uninsured within 10 years could actually be closer to 26 million, not the 24 million projected by the Congressional Budget Office (CBO).Wowsers! That's enough to give anyone political heartburn, and for some officeholders it would be walking the plank.
Business Insider
The White House's estimate of coverage losses under the GOP's health care plan is even larger than the CBO
Madeleine Sheehan Perkins
38 comments:
Just think of how much fiat we could save if we eliminated Medicaid and Medicare all together ! No worries about taking care of sick people because deregulation and competition would drive down prices and folks always have the option of paying with chickens.
Seriously, if Trump has half a brain he'll use the CBO report as an excuse to walk away from Ryan-Care.
If R's do nothing, O-Care may indeed go into a death spiral, which is already happening in some rural areas, and never mind folks like me who are currently uninsured. So eventually something will have to be done. But if Trump can't come up with a constructive plan now then I'd just as soon punt until 2018 and let the election be a referendum on health care reform.
Trump may well be trying to torpedo Ryan
One wonders why this story was leaked to the press? Cui bono? Was it a deliberate leak intended to set certain wheels in motion?
Ryan is looking sucky right now. Trump is looking sucky because he endorsed Ryan's plan. But no one is coming forward with an alternative plan.
Breitbart is attacking Ryan, big time
Grab your popcorn.
How much longer before Ryan wakes up with a horse's head in his bed? :-)
The best thing Drumpf can do now is seriously give Paul Ryan a verbal smackdown, give him one of those "you're fired!" speeches. Will he have the balls to do it? Probably not. What a disaster.
Is anyone surprised this is a shit show?
Congress is waiting for the proof of wiretapping. Now Spicer is using quotation fingers. Kelly Ann is talking about microwaves that turn into cameras.
Meanwhile, the rich get richer and the poor get sicker.
MAGA baby.
The CBOs accounting method does not allow them to look at a refundable tax credit as functionally the same as a transfer payment... so this leads them to say "people will lose coverage" as they cannot recognize how USD balances would be be available to providers to pay for care under the GOP plan...
They accrue on the right and use cash basis on the left.... taxes are on the left so they can't accrue the refundable credit... to CBO, 0 -(-2) still = 0. CBO can't use negative integers on the left....
If they used Cash Basis then they would have to say the GOP plan would increase the "deficit!" and it would be a non-starter for both parties....
Matt, you're not clear. What are you saying?
CBO uses a unique accounting methodology termed Modified Accrual Accounting... no one else uses this...
http://www.investopedia.com/terms/m/modified-accrual-accounting.asp
So they cant accrue the financial effect of the 46M people previously uninsured before Ocare now getting an advanceable refundable tax credit of average $3k annual (so that is about $150B annual total if you were to accrue it but since it is a tax issue, the taxes are on the left so they cant accrue the if you will "Trumpcare Tax Refund Payable" because they use Cash Basis on the left...) which in Cash Basis on the DTS is going to increase the right side line item "IRS Tax Refunds, Individuals" by potentially over $150B/yr....
So the GOP idea is to advance this tax credit monthly into a person's HSA and then have the providers debit the HSAs for an advance monthly payment for coverage...
Last year, the Ocare 'Marketplace Payments' were only $40B (cash basis) so this potential $150B credit advanced would be a huge increase to USD leading flows over Ocare...
Could be a moonshot if people sign up...
Though might effect Medicaid flows if those flows previously went to uninsured people...iow if previous Medicaid recipients can get coverage under Trumpcare, then the providers wont have to submit a Medicaid clain against that patient anymore.... so Medicaid flows might go down...
This is why these morons are always going around saying "US is bankrupt!" as they accrue the right side liabilities which is a large number but use cash basis on the left side which only can use the present period tax receipts which are small....
Susan Hennessey @Susan_Hennessey 9h
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Matt's "moonshot" equates to the probability of half the country having health care.
The Whitehouse wants more negotiating and work on the bill or they would not have leaked. Simple as that. This happens when architects don't put enough gold in the grand lobbies, no doubt.
This is why these morons are always going around saying "US is bankrupt!" as they accrue the right side liabilities which is a large number but use cash basis on the left side which only can use the present period tax receipts which are small....
Sp the "solution" is to cut spending to reduce liabilities or increase taxes too increase assets to offset liabilities.
The GOP strategy is to reduce liabilities by cutting social spending (waste) and increasing taxes, not by increasing the tax rate, but by cutting taxes and assuming that the ensuing growth will generate more tax revenue.
In his campaign against Reagan for the 1980 nomination, G. W. H. Bush called it "voodoo economics."
Reagan was the Trump of the Day and Poppy Bush was Pence.
It comes down to whether Trump can get the volume discount he thinks he can get thru " scale and guarantees" .... MBAs think "scale and guarantees" compared to economists who think "supply and demand".. Trump is not an economist in this scenario he is the MBA...
For all the complaining you guys do about economists you sure are the first to believe their dogmas when you don't understand something adequately...
If he can get some discounting thru scale and guarantees, the $14k annual advances per family might be more than enough for complete coverage...
They have to do this through reconciliation since they don't have a large enough margin to overcome filibuster in the Senate. That means that they have to have everyone on board. So far, that is not the case, and won't be as long as there are any subsidies in the deal. That appears to be a deal breaker.
Btw, there are now rumors of Paul Ryan being ousted as speaker. He is apparently under attack on this.
It's all voodoo economics Tom....
There are no subsidies in the deal via CBO accounting methodology... that's how it "saves!" 337B...
This helps politically with the "debt!" phobes...
The problem with the Ryan plan is as follows.
The tax credit can go to pay for preventive health or catastrophic insurance coverage. The trick is to balance what goes where. Most people will misallocate, and end up being under or uninsured for catastrophic situations. Then their whole life savings are in jeopardy, and very likely end up on medicaid - which by then will be grossly underfunded. The answer could well be a single payer system (whether insurance - or a medicare for all) on the catastrophic side, and a tax credit on the preventative side.
Further, for its goals, the Ryan plan appears to be underfunded.
Right the issue is the amount of the credit i.e. Whether it is adequate...
Imo Trump is relying on his experience in getting prices from vendors down using scale and guarantees in his purchasing strategies...
Trumps plan is similar to Warrens only he is trying to avoid using transfer payments for political purposes and perhaps the annual USD amounts are a bit below Warrens....
Hence no sniping on the Trump plan from the MMT elite peanut gallery so far....
There are no subsidies in the deal via CBO accounting methodology... that's how it "saves!" 337B...
This helps politically with the "debt!" phobes...
That's not what those opposed are saying, Matt. Just because they are not called "subsidies" it doesn't mean they are not. These people don't want others getting any money they don't work to get, simple as that. That is the bottom line of economic liberalism.
They don't need unanimity Tom.... this should give them enough political cover to get over the top...
Ryan is spinning it as "tax cuts" and "competition" , "freedom of choice " "deficit reduction" .... these are all words libertarians love to hear... they will have to vote yes...
Trumps plan is similar to Warrens only he is trying to avoid using transfer payments for political purposes and perhaps the annual USD amounts are a bit below Warrens...
Good luck trying to disguise "refundable tax credits" as something other than transfers. The hardliners are not falling for it. As far as I can see, they want a repeal of the ACA and a return to the status quo ante.
The GOP has to keep everyone aboard to pass the final bill through reconciliation. They don't have that and the bill as written will fail in the Senate. The push is on politically for the House not to forward a bill to the Senate that won't pass.
"Good luck trying to disguise "refundable tax credits" as something other than transfers"
They don't have to disguise anything all they have to do is point to the CBO accounting... it's not a transfer according to CBO it's a negative tax and they can't accrue on the left side so it projects as "deficit!" reduction....
They are not smart enough to figure this out they just take the CBO as gospel...
Hence no sniping on the Trump plan from the MMT elite peanut gallery so far....
The elite sniping from the MMT community is about the 24-26 million projected to be left uninsured, which Ryan says is a plus since they will "join the free market" and bid down prices.
Matt, I am just saying what Ted Cruz and Rand Paul are saying: It's not going to pass in the Senate in reconciliation, so don't don't send it up here.
I wrote, "These people don't want others getting any money they don't work to get, simple as that. That is the bottom line of economic liberalism."
This is key to "It's your own money, not the government's money," wrt to taxes.
These people don't reason things through and don't do math. They are ideologues. Money comes from "working." Credit is moral turpitude.
It's very simple. "You work. You get paid. You do with your money what you want. It's your money you worked for, not the government's money." The low-information base understands that. That is the GOP base.
Another big issue that is emerging is that cutback in Medicare are going to affect the middle class in a big way, since under the present arrangements when a person in a nursing home runs out of funds, Title 19 kicks in to pick it up and that is paid for under Medicare.
Ryan wants this passed ASAP so there is no discussion of these issues. That doesn't look like it is going to happen. There been a firestorm of opposition locally and some GOP officeholders have stopped holding town halls because of it.
Exactly. GOP health care is dead.
Too bad we can't say the same thing about the most of the political / corporate class.
The problem for Trump, GOP and Dems alike is that we don't care about the word games and accounting anymore or which party is to blame. Maybe a small partisan base finds it amusing. These are local issues that directly impact our daily lives and households. Washington can't fail.
It's equivalent to a famine or not responding to a foreign invasion. Basic services. We see it as a failure of not only the elected officials but the government and Constitution itself.
Tom: "The hardliners are not falling for it. As far as I can see, they want a repeal of the ACA and a return to the status quo ante."
That's about the size of it. All the huffing and puffing by Trump and his supporters does nothing to obscure that central fact. Whatever healthcare plan Trump's dreamt up in between tweets and staring at his daughter's enticing curves, doesn't change the political reality of a GOPher party which has become a slave to its own rhetoric. The Tea Party monster should have been a warning, but the Baron Frankensteins of the GOP miscalculated, and now their diabolical creation is going to wreak its revenge. Unrequited love's a bitch, or in this case a monster. Go townhallers!
A pity there's no left to capitalise on this and push for single payer, the preference of most Americans.
Ryan: "The problem for Trump, GOP and Dems alike is that we don't care about the word games and accounting anymore or which party is to blame."
This issue just cannot be ignored any longer. Pre-Obamacare was a disaster. Obamacare is a disaster. Unsurprisingly, Trumpcare makes about as much as Obama spying through a microwave oven. Ryancare is pre-Obamacare but worse. It's a perfect storm. People can endure a lot before they finally revolt or figure out that single payer is the only solution that can work for any country. Perhaps Americans will endure another four or eight or twenty years of this state subsidised privatised medicine fiasco, but it's time is surely up. The question is who will do the intelligent thing and make single payer, or universal Medicare, or call it what you like, the central issue for their party. The GOPhers will never do it. As for the dumb Dems...
Well where is the Democrat President that will take on the libertarian nut-jobs in the Democrat party?
MIA....
At least Trump is going to war with GOP libertarians... outcome yet TBD... he might still get it thru...
The WH is backing it but saying not to call it "Trumpcare." Pretty tepid backing.
The CBO estimates 24M uninsured. The WH estimates 26M.
dont worry if it works out well he'll start calling it Trumpcare....
Matt: "dont worry if it works out well he'll start calling it Trumpcare...."
Don't worry, it won't work (the pussy-grabbing racist birther simpleton blurted out that he didn't realise healthcare could be so difficult!) and he'll blame someone else when it becomes quickly apparent that Obamacare 2.0 is unpopular. That's been his life's modus operandi: never apologise and blame anybody but yourself, although in this case it'll prove more difficult than Trump "University", birtherism, Ted Cruz's father's involvement in the JFK assassination...
I can't wait for the press conference in which the Trumpcare fiasco tips the pussy-grabbing birther over the edge and he explodes. It's impossible to miss the pussy-grabbing birther's volcanic temper about to erupt over NOTHING. He'll erupt soon enough. Healthcare may be the trigger. Saying it'll be "terrific" isn't going to play. It'll either be Obamacare 2.0 or a full repeal. Whichever he chooses, he's going to get a kicking. And given that it's almost certain that the most he's going to do is tweak Obamacare here and there, thus going back on his promise to repeal Obamacare, there's gonna be hell to pay in the town halls...
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