HomeStuff2017 . 03American State-Run Health Care (Updated) - Sketchbook

American State-Run Health Care (Updated)

American Politics



Trump, in his address to Congress:

Tonight, I am also calling on this Congress to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs, and at the same time, provide better Healthcare.

Here was his outline (my highlight here and throughout the page):

First, we should ensure that Americans with pre-existing conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the healthcare exchanges.

Secondly, we should help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts — but it must be the plan they want, not the plan forced on them by the Government.

Thirdly, we should give our great State Governors the resources and flexibility they need with Medicaid to make sure no one is left out.

Fourthly, we should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance – and work to bring down the artificially high price of drugs and bring them down immediately.

Finally, the time has come to give Americans the freedom to purchase health insurance across State lines — creating a truly competitive national marketplace that will bring cost way down and provide far better care.

Two things are on the table: health care for people who can afford it, and health care for people who can’t. The sticky wicket of this revision (and every revision) of American State-Run Health Care is the question of how care should be provided to the people who can’t.

One way to provide health care to people who can’t afford it is Medicaid, mentioned in Trump’s address and even qualified with “to make sure no one is left out.” But another way is to provide a refundable tax credit. A tax credit is “refundable” if people can get that amount of money from the government, even if they don’t owe taxes. Trump mentioned tax credits, but he wasn’t specific about whether or not they were refundable — which is great fun, because:


Team “Speaker Paul Ryan”:

“In his address, President Trump embraced a health care replacement plan that, among other important reforms, includes a tax credit to help individuals buy a health plan that fits their needs,” Ryan spokeswoman AshLee Strong wrote in an email. “These comments demonstrate that the White House and Congress are coalescing around a particular approach that will help us keep our promise to the American people to repeal this broken law and replace it with a better system.”

The approach she is suggesting around which Trump and Congress are coalescing is that of refundable tax credits, a component of Ryan’s plan. Trump wasn’t specific. Has he really sided with Team Ryan?

Ryan thinks so. Ryan on CNN, speaking about Trump’s address:

We’re all working on the same page and I thought [Trump] did a fantastic job. He articulated exactly the response that we’re working on that we all believe is necessary to repeal and replace ObamaCare with a much better system.


Team “Senator Ted Cruz” thinks so, too. From The Hill:

Three GOP senators are adding an extra hurdle to the looming fight over nixing the Affordable Care Act, arguing they want a "full repeal" of ObamaCare.

Sens. Rand Paul (Ky.), Ted Cruz (Texas) and Mike Lee (Utah) each pointed to the Senate's 2015 repeal bill as the "bare minimum" for the 2017 repeal legislation.

“2 yrs ago, the GOP Congress voted to repeal Obamacare. That 2015 repeal language should be the floor, the bare minimum,” they each tweeted, along with the hashtag “FullRepeal.”

—along with the House Freedom Caucus:

The public resistance Team Cruz is offering to the Trump/Ryan plan is broad, but they specifically disagree with the creation of a refundable tax credit. Quoting a little more from The Hill:

The bill would dismantle core aspects of the healthcare law and replace them with a system centered on a new tax credit . . .

Rep. Mark Meadows (R-N.C.) appeared to take a shot at the plan on Twitter, noting that without "substantial" changes he couldn't support it.

“There is nothing conservative about a plan that ultimately amounts to a new entitlement program and a new tax increase,” he said.

Note. Some context on the refundable tax credit. It’s usually described by Conservatives as a new entitlement program, but it’s also been called worse: Yes, Marco Rubio’s Obamacare Replacement Plan — Tax Credits — Is An Individual Mandate.


Team Axe.

The links in this post are mostly from articles and tweets posted over the last few days. You might wonder if someone hit the Obamacare beehive. Why, yes — yes they did:

Exclusive: Leaked GOP Obamacare replacement shrinks subsidies, Medicaid expansion

Politico’s analysis is interesting, if imperfect, but the part that continued to buzz and sting conservatives wasn’t any part Politico emphasized, but this:

In place of the Obamacare subsidies, the House bill starting in 2020 would give tax credits . . .


Politically, I’m usually aligned with Ted Cruz; but Rand Paul looks flummoxed and lost, and so do I. How is it that legislators are reading about Obamacare’s replacement on Politico? And being surprised by its structure?

Let’s end by wandering around buildings, looking for legislation.

Sen. Rand Paul (R-Ky.) on Thursday blasted House Republicans for keeping their ObamaCare repeal and replace legislation under wraps.

“I have been told that the House Obamacare bill is under lock & key, in a secure location, & not available for me or the public to view,” Paul tweeted.

“This is unacceptable. This is the biggest issue before Congress and the American people right now.”

. . . Paul later said he’s been told the draft of the repeal bill is "take it or leave it."

“I think that's why it’s top secret,” he said. “Why don't they want us to see it? The only copy we've seen is from the media — does that sound to you backwards?”

“We saw a leaked copy that the media was given that we weren’t given,” he continued. “Now we’re told that it’s being classified, that the hearing is like a security clearance hearing, you have to have a clearance and permission.”

Sen. Rand Paul tried unsuccessfully to wrest a draft of the House GOP's Obamacare bill from a secure room in the Capitol on Thursday, an escalation of his opposition to the party’s health care plans.

The bill had apparently been moved from the room, which was guarded by Capitol Police — or was never there at all — by the time Paul got there. But his decision to stomp over to the House side with dozens of reporters in tow, highlighted conservatives’ concerns about an opaque process as the GOP races to repeal Obamacare.

. . . Republican aides said they believed the room on the first floor of the Capitol was at one point being used for Energy and Commerce members to read the bill, but by the time Paul got there, it appeared that was no longer the case. Rep. Paul Tonko (D-N.Y.), a committee member, said he also was not able to read the bill and was told it was not available.

“They said that this room was a holdover room, Tonko said. I said: ‘Where’s the room number?’ And they didn’t know. I want to read the bill because it’s affecting one-sixth of the economy.”

Update. Another account of the Time of Wandering.

“I am heading to the secure location where they are keeping the House Obamacare bill,” Paul tweeted. “I will demand a copy for the American people.”

And so he went.

What followed was a surreal scene on the first floor of the U.S. Capitol that quickly drifted toward farce. Trailed by a scrum of reporters and cameras, Paul sought—and was denied—entry into the Republican office where, he was told, the draft Obamacare bill was being kept.

“I think there’s a bill in there. It’s the secret office for the secret bill,” Paul told the reporters. As Paul was speaking, a House Democrat, Representative Paul Tonko of New York, slid past him to try to get into the office. But he, too, was denied. Tonko told reporters that staffers in the office had told him there was no bill inside.

Then came Representative Steny Hoyer, the second-ranking House Democrat, who broadcast his effort to “find the bill” on Facebook Live. By the time it was over, frustrated GOP staffers had flung open the doors of the otherwise nondescript office suite to prove to reporters that was not, in fact, the repository of major legislation hidden from public view.

Take it to the bank, GOP leaders



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