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Repealing Obamacare Proving To Be Harder Than GOP Thought

congress-healthcare

The New York Times reports that Republicans on Capitol Hill are finding that repealing the Affordable Care Act isn’t going to be as easy as they thought it was going to be:

WASHINGTON — Congress’s rush to dismantle the Affordable Care Act, once seemingly unstoppable, is flagging badly as Republicans struggle to come up with a replacement and a key senator has declared that the effort is more a repair job than a demolition.

“It is more accurate to say ‘repair Obamacare,'” Senator Lamar Alexander, Republican of Tennessee and chairman of the Senate health committee, said this week. “We can repair the individual market, and that is a good place to start.”

The struggles and false starts have injected more uncertainty into insurance markets that thrive on stability. An aspirational deadline of Jan. 27 for repeal legislation has come and gone. The powerful retirees’ lobby AARP is mobilizing to defend key elements of the Affordable Care Act. Republican leaders who once saw a health law repeal as a quick first strike in the Trump era now must at least consider a worst case: unable to move forward with comprehensive health legislation, even as the uncertainty that they helped foster rattles consumers and insurers.

Insurers are threatening to exit the Affordable Care Act’s market unless the Trump administration and Congress can quickly clarify their intentions: Will they support the existing public marketplaces, encourage people to sign up and keep federal assistance flowing to insurers, or not?

“We need some certainty around the rules,” said Dr. J. Mario Molina, chief executive of Molina Healthcare, which has been a stalwart in the Affordable Care Act market and is making money under the system.

We have a few months, but we don’t have a lot of time,” he said.

With the official end on Tuesday of what was supposed to be its final open enrollment season, the Affordable Care Act is looking more resilient than it seemed just a month ago. It will still be several days before final enrollment figures are released, and although a surge of last-minute signups failed to have materialize amid talk of repeal, early indications did not point to a collapse.

At their annual retreat last week, in Philadelphia, several congressional Republicans edged away from their powerful promise to “repeal and replace” the Affordable Care Act. It would, they said, be more accurate to say they intend to fix a law that they blame for the cancellation of many insurance policies, soaring premiums and a shrinking choice of health plans in many states.

Many Republicans say their resolve to dismantle the law, a central element of President Barack Obama’s legacy, is undiminished. “We are looking to repeal this law, just like we told the voters we were going to do, just like we promised them we would do,” said Representative Jim Jordan, Republican of Ohio and a leader of the House’s most conservative wing. “After all, there was an election where that was one of the most important issues.”

But after waging and winning many elections with a promise to kill it, Republicans still have no agreement on how to replace it. They will, they say, pursue a piecemeal approach because they have no desire to supplant the giant 2010 health law with a single comprehensive Republican plan cooked up in Washington.

When Congress convened this year, Republicans immediately introduced a budget resolution clearing the way for legislation to gut the health law, with strong support from Mr. Trump, who took office 17 days later. But Mr. Trump’s rocky start has slowed the momentum, depleting his political capital and dimming prospects for bipartisan cooperation.

In addition, many senators are preoccupied with fights over the confirmation of Mr. Trump’s nominees to the Supreme Court and top jobs in his administration. What was once considered Congress’s Job No. 1 is being eclipsed for some lawmakers by more immediate matters.

Insurers say Republicans’ mixed messages and slowing pace could send premiums soaring next year while making the market much less stable. The deadline to file rates for 2018 is this spring, and insurers say they need time to decide what kinds of plans to offer and to set prices.

“We need stability and predictability,” said Marilyn B. Tavenner, the chief executive of America’s Health Insurance Plans, the main lobby for the industry.

Unless Congress continues cost-sharing subsidies, to reduce out-of-pocket costs for low-income people, and a reinsurance program, to help pay large claims, she said, more insurers will pull out of the market.

Insurers are also concerned about signs that the Trump administration may not enforce the so-called individual mandate, which requires people to have insurance or face a tax penalty. The penalty, or some way to encourage more participation, is seen as central to having enough young and healthy people sign up to keep premiums low.

“It’s very important to indicate how they are going to stabilize the market,” said Karen M. Ignagni, the chief executive of EmblemHealth, who was instrumental in the development of the current law.

At the very least, analysts say the uncertainty for insurers could lead to much higher rates. “2018 is a wild card,” said Deep Banerjee, who follows insurers for Standard & Poor’s.

Many insurers could simply end up walking away, warned Sabrina Corlette, a research professor at Georgetown University who recently surveyed insurers about what they might do. “At a certain point, you can’t price high enough to account for that uncertainty,” she said.

It should not come as a complete surprise to Republicans or anyone else that repealing the Affordable Care Act and replacing it with some alternative plans is not something that can easily be accomplished overnight. When President Obama was in office, of course, Congressional Republicans didn’t have to really worry about the consequences of their vote to repeal the PPACA since it was clear that any such measure would either die in the Senate or be vetoed by the President and it would be impossible to override the veto. Because of that, they were able to vote repeatedly to repeal the PPACA without offering a replacement via votes that were essentially intended to do little more than please the Republican base and as a vehicle for lawmakers to show Republican voters that they were indeed on board with achieving what had become an article of faith among Republican voters. Now that the Republicans hold all of the levers of power, though, they’re finding that the details about repeal and replace are quite complicated and that it could take some time before their goal is achieved, assuming that it ever really does happen.

For example, any attempt to repeal the law has to take into account the fact that millions of people, not to mention the entire health insurance and health care industry, has acted in reliance over the past seven years in reliance on the idea that the rules established by the PPACA and by regulatory agencies charged with its implementation and pulling the rug out from under them suddenly would be highly disruptive and potentially disastrous. For insurers and providers, it would mean having to adjust to new rules in a short period of time, which would no doubt prove costly for everyone involved and which could have devasting consequences for some providers and insurers, which would, in turn, make life difficult for patients. At the consumer level, there are many people who have acted in reliance on the rules that the PPACA put on the system such as the prohibition of denial of coverage for pre-existing conditions, the provisions that allow parents to continue providing coverage for children up to the age of 26, and the end of the lifetime cap on coverage. Additional millions are dependent on the tax and other subsidies provided for by the PPACA, which have made otherwise prohibitively expensive premiums at least somewhat affordable. Finally, the PPACA’s expansion of Medicaid has added millions more to coverage rolls and been adopted by states in reliance upon continued Federal responsibility for the additional costs of the program. If those payments are discontinued, then these states will be faced with the prospect of either monumentally huge budget deficits that, under state law, must be fixed before a final budget can be passed for a new fiscal year or forcing people off the Medicaid rolls in order to save money. Neither prospect is likely to be palatable to any politician at the state level regardless of their political party.

Because of this, it seems inevitable that any effort to repeal and replace the Affordable Care Act will have to be something nearly as detailed as the PPACA itself. Like the PPACA it will take time for even a party that controls all the levers of power in Washington to accomplish this task, and then additional time to implement the changes. This wouldn’t be unprecedented, of course. It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate. After that, there were several years that passed before most of the provisions of the new law even went into effect and, in several cases, the regulatory agencies charged with enforcing various provisions of the law used the discretion granted to them to grant extensions of one kind or another to give insurers, health care providers, employers, and consumers sufficient time to adjust to the new law. The same thing will likely have to happen with whatever it is will come out of the Republican efforts to repeal and replace the PPACA. As noted above, though, we are reaching a point where it is going to become essential that it become clear exactly what’s going to happen due to the fact that the uncertainty currently surrounding the issue, combined with increased costs, may lead to more insurers withdrawing from the PPACA marketplace, thus making it harder for consumers to find insurance coverage going forward.

Many Republicans on Capitol Hill seem to be well aware of all of this, and it explains why movement on the repeal of the law has not been as quick as many people seemed to think it would be once President Trump took office. In the House, the GOP Leadership and most of the Republican members of the relevant committees at least seem to be committed to coming up with a serious alternative rather than just taking another vote to repeal the law and sending it to the Senate. In the Senate to itself, meanwhile, Republicans would still have to deal with a possible Democratic filibuster of those parts of any repeal and replace bill that couldn’t be voted on via the reconciliation process as well as the fact that their caucus isn’t necessarily united. Several Republican Senators, such as Kentucky’s Rand Paul, have said that Republicans should not move forward on repealing the PPACA until they have agreed on a replacement that addresses both the issues that would accompany repealing the PPACA and the fact that the pre-PPACA status quo was neither ideal nor sustainable in its own right. Given that, Republican voters will likely find that it could be some time before they get what they want as far as the PPACA is concerned.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. Joe says:

    If there were a replacement, we would have seen it by now. The Republicans have had years and nearly unlimited political and economics resources to plan it out. The idea that they have been too busy in the last month to think one up is ridiculous. Can we just say we replaced it – hell, call it Trump care – and go to work on fixing it? Can we focus on the policies instead of the politics yet? No? Oh well. Never mind.

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  2. Tim D. says:

    If I didn’t have friends and family who rely on Obamacare, I’d laugh at the predicament they’ve gotten themselves into. It’s just tough to imagine this Congress passing a replacement that is generous enough to keep 20 million people insured. One way or another you have to spend real money to keep most of those people insured. The usual talking points about malpractice reform or national markets or “skin in the game” or HSAs just won’t get you there. I suppose the fall back is for Trump or Spicer to attack the media for “lying” about millions losing their insurance, but hard to see that working out for them in the real world.

    And if they do the smart thing and end up sticking with something more or less similar to Obamacare, you just have to wonder what the point of it all was?

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  3. MarkedMan says:

    It started with Gingrich but only got worse since then: the modern Republican congresscritter is a loudmouth do-nothing, elected only because they could out bluster their betters, snarling and contemptuous of those who you know, got stuff done. And of course, constantly fluffing their billionaire overlords. The Republicans now have complete control over the executive and legislative branches and the Supremes, already compliant when it comes to big business, will shortly be firmly in their hands too. They own their mess, 100%. And what have incompetents historically done when they are about to get shown up for what they are truly worth? War.

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  4. grumpy realist says:

    The devil is ALWAYS in the details….

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  5. steve says:

    This is chaotic for the insurance industry. It also injects chaos into making plans for health care providers. At our network level, we really have no idea how to plan for what is coming. We are pretty sure that Medicaid will be cut (hard to go wrong predicting that the GOP will cut benefits to the poor), but beyond that we just don’t know. Our latest guest speaker, our CEO is pretty right wing, though not rabidly partisan, was from a large marketing group and announced himself as a lifelong Republican. Then went on to explain why he expects the current administration to engage in blunt price controls. Was entertaining, if a bit scary. However, at the end he concede that no one knows for sure. The lack of preparation on this major issue (18% of GDP) is appalling.

    Steve

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  6. Pch101 says:

    Republican “free market” theories for healthcare make no sense. They won’t become any more sensible over the next few months.

    I am expecting that they will create a new system in which relatively healthy people can get fairly priced plans; those with minor needs and the occasionally non-chronic mishap won’t have it so bad.

    But when those policyholders stop being so healthy, then they will find themselves with some fairly lousy alternatives (very high premiums and/or compelled to move into high-risk pools that don’t pay for much.) Everyone will theoretically be able to get insurance, but we’ll essentially end up with a version of the old system in which preexisting conditions create virtual ghettos of non-coverage.

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  7. michael reynolds says:

    There has always been one, overriding reason for Republicans to kill Obamacare: racist spite.

    Everything else is camouflage and misdirection. The essential, compelling need, the reason for their desperate haste, is the need to tear down what the black president created. The black president must be erased.

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  8. MikeSJ says:

    The Republican plans for health care almost seem like a religious or cult like belief system.

    Somehow the almighty power of the FREE MARKET will cure whatever ails health insurance.
    (how this works for a person with out money is a bit of a mystery to me; guess I’m not a true believer)

    Of course there’s no other countries in the world where this actually occurs but that doesn’t stop them from believing with all their hearts this will work.

    Reality is not going to be kind to them. My hope is states that have the expansion get to keep it and the exchange’s are maintained. I simply don’t see them coming up with any alternatives to what we have now.

    Well, besides worthless high risk pools and millions with out coverage, which is the current default plan for them.

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  9. dxq says:

    And what have incompetents historically done when they are about to get shown up for what they are truly worth? War.

    indeed, at least one senator recently said he thinks the Trump/Bannon administration wants war with Iran.

    War. With. Iran.

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  10. JohnMcC says:

    @michael reynolds: Whew! I know how Lily Tomlin felt when she said ‘no matter how cynical I get, I can’t keep up.’ (Quoted from memory)

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  11. Just 'nutha ig'rant cracker says:

    @Tim D.: I believe that one congressperson expressed it along these lines back during the debate: We (the GOP) have lots of good ideas, but are being excluded from the discussion [they didn’t and weren’t, but hey, alternative facts] and we don’t want to try to get them included, because if they are, then Obama will get credit for our proposals and we don’t want him to succeed at anything.

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  12. Terrye Cravens says:

    I live in Indiana and we got the news a couple of days ago that our Governor has asked for a three year expansion of the Medicaid Expansion that goes into HIP {Healthy Indiana Plan}. How odd is that? Pence took that money that is part of Obamacare and put into the state plan and now his Republican successor wants to 3 more years. It does not sound like they think the ACA is going anywhere.

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  13. Pch101 says:

    @MikeSJ:

    The Republican plans for health care almost seem like a religious or cult like belief system.

    Almost?

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  14. Tyrell says:

    Here are some ideas to start with: remove the mandate – people who can’t afford the cost and don’t qualify for a subsidy should not get hit with a IRS penalty. Add more plans with differing deductibles, co-pays, and coverages. Some people want or need a basic, simple plan that is inexpensive, without a lot of frills. Add some incentives to attract the young, healthy people.
    Eliminate all the forms and paperwork that doctors are complaining about. And a patient should not have to spend their time filling out 3 – pages of questions and information.
    Adjust the income index so more people can get a subsidy.
    Those are a few, simple ideas.

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  15. Scott F. says:

    @Tim D.:

    Since so many Republicans, including Trump, are now on the record promising no one covered now should lose their access to health care, I think the GOP may win some minor battles, but the war is lost to them – they’ve as much as conceded that health care is a right.

    Now, once they get into the details and it becomes clear that there is no magic in HSAs, buying insurance across state lines, block grants and limits on medical malpractice, people will remember they liked a great deal about the ACA. Whatever weak substitute the Republicans come up with needs to be known as forever as Trumpcare. It will not be popular and I don’t think it will last.

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  16. Pch101 says:

    @Tyrell:

    Add more plans with differing deductibles, co-pays, and coverages.

    Nickel Plan: $20,000 deductible, $21,000 annual cap.

    Copper Plan: $50,000 deductible, $51,000 annual cap.

    Papier Mache plan: $1 million deductible + One free consultation with a psychic healer/ Nancy Reagan astrologist

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  17. steve says:

    “Eliminate all the forms and paperwork that doctors are complaining about. ”

    We had that before Obamacare. Most of that comes from the private insurance sector. Billing through Medicare is so much easier. There are systems where that is very streamlined (France is a good example), but then you really need a single payer or the equivalent.

    ” Add more plans with differing deductibles, co-pays, and coverages. ”

    Already allowed. Insurance companies don’t want to do that. Are you suggesting that we force them?

    What incentive would get young healthy people to sign up?

    Steve

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  18. gVOR08 says:

    It should not come as a complete surprise to Republicans or anyone else that repealing the Affordable Care Act and replacing it with some alternative plans is not something that can easily be accomplished overnight.

    Unless, of course, they’re stupid. Or blinded by ideology and partisanship, which amounts to stupid.

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  19. Tyrell says:

    @Pch101: I would add the Titanium Plan: no deductible, no copay, no limits, covers gym memberships, spas, cosmetic surgeries, dental, vision, personal trainer. Now that would get a lot of young people interested !

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  20. Scott says:

    My first thought is that any new system should be tried out on Congress and see if they like it.

    Also, I think Trump should immediately rescind the OPM subsidies for Congress and their staffs. Since that was an Obama Administration rule and not a law, it should be pretty easy.

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  21. Tyrell says:

    @Scott: I have one on that!

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  22. Slugger says:

    We have restricted trade with Cuba since 1962. We have seen pushback against Roe v Wade since 1973. I predict that the 2052 GOP presidential campaign will promise an immediate end to Obamacare.

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  23. Blue Galangal says:

    @steve: Moreover, the last time I had to fill out three pages of paperwork at the doctor’s office, it was one page of insurance information and two pages of health history. I don’t mind filling out two – or three – pages of health history. Who in their right mind would?

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  24. george says:

    Speaking from the comfort of Canada, I can envision one possible benefit to the GOP repealing Obamacare, and its an excellent one. Unfortunately its also a terrible long shot.

    If Obamacare is gone, and the Democrats take the presidency and congress in 2020 (did I mention long shot?), they could do what they should have done in 2008 – put in public health. Obamacare is better than nothing, but its still a long way short of even a problematic public health such as Canada’s (great for serious issues, long waits for elective surgery, but everyone gets it and its paid for out of taxes).

    Except, the Dems being who they are, even if they win everything in 2020, they’ll just bring back the ACA or its equivalent. Still better than what was there before, but I can’t help but think that if the GOP is having that much trouble repealing Obamacare, how they’d be completely stuck trying to get rid of public health.

    Even the most conservative gov’ts in Canada won’t touch public health (some suggest allowing a private option, following the model of some excellent systems in Germany), but not a single one even wants to talk about getting rid of public health. Once people experience it, no one, not even 90% of the most conservative people in the country, want to lose it.

    Public health makes as much sense, and is as beloved, as public police. Once in its almost always safe.

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  25. Barry says:

    @MikeSJ: “Reality is not going to be kind to them. ”

    Reality will definitely not be kind to us; I hope that they get a taste.

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  26. Joe says:

    Nothing stopped these ball-less republicans from campaigning on the “promise” to repeal obamacare, and from benefiting from making those hollow promises. This is what career politicians do; make false promises to get elected and then fail utterly to keep them once in office. It’s why we had to elect a non-career politician as President to even have the chance to drain the swamp in DC. Stop electing and re-electing career politicians, the absolute scum of the earth.

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  27. eamonkelly says:

    barry and the mutants didn’t pass a ‘health-care’ bill, they passed tax legislation.

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  28. Mike Slay says:

    @JohnMcC: It’s actually, “No matter how cynical I get, I can’t seem to keep up.”

    This sentence from the article fits that to a T. – “It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate.”

    Someone actually wrote that.

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  29. Rick Zhang says:

    @george:

    It’s a great concept but practical politics always get in the way of implementation.

    Don’t get me wrong. I love single payer. It takes a huge load of burden off of individuals and companies and detaches health from employment. Why be forced to work until the arbitrary age of 65 (67 now) to get health insurance?

    The problem is that any sudden change will be insanely disruptive to existing profitable industries who will lobby hard for their privilege. Since Republicans have shown their true colours by being the enemy of big business (via Trumpinomics), when Dems next gain power they will be hard pressed to change things since health insurance companies are overwhelming contributors to their victory.

    A more realistic and deliciously Machiavellian event would be Trump dismantling Obamacare and replacing it with single payer – a true Nixon goes to China event! I would love to see Ryan and McConnell contort themselves into defending that version of Trumpcare.

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  30. David M says:

    @Mike Slay:

    “It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate”

    I’m not sure what you are trying to say with your objection to that statement.

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  31. David M says:

    As a public service reminder, Trump knows nothing about Obamacare or how it works, other than its use as a tool to fool the rubes into voting for him. Secondly, the public wants health care to cost less and have lower deductibles. The GOP wants it to cost more and have higher deductibles. Eventually those two directly opposing views will collide.

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  32. SD Harms says:

    It is NOT HARD. Just pass a bill that says it is repealed and let Trump sign it. Afterall, we have to pass the bill to see what is in the bill.
    It is just that these yahoos think they have to micromanage the health care market. GET OUT OF THE WAY. it will sort itself out. there are providers, patients and companies willing to “insure” against loss. Let them sort it out.

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  33. Tyrell says:

    @Blue Galangal: I can understand questions like your address, medications, allergies. But “do you have pets ?” “Do you rent or own ?” “Are you on city water or well ?”. After I answer stacks of those, then the doctor spends the time putting more information into a laptop. Where does all that information go? Who has access to it? And I have to fill out the same stuff if I go to a specialist.
    Why don’t these doctors just share the information?

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  34. Matt says:

    @Tyrell: Pets can aggravate or be a vector for disease/illness. I could post pages of information on how pets effect your body including the immune system.

    Well water isn’t treated or monitored like city water is. There are many potential problems with consuming well water that just don”t exist if you’re using city water.

    You clearly are out of your realm here and you should re-consider your opinion on this subject.

    Putting hospitals on the path of sharing information was a core component of the ACA. ACA being the real name of what some people call Obamacare.

    The stuff you’re talking about is subject to change on a whim. Thus it would be better to ask that every time to ensure that there have been no changes.

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  35. george says:

    @Rick Zhang:

    You’re right, that’s both more realistic (though still highly unlikely, even if he once said he liked Canada’s healthcare system), and much more entertaining if it happened.

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  36. Pch101 says:

    Given the circumstances of the American system, the smart thing to do would have been to get the business community rallying behind having Medicare for everyone age 40 and above, with businesses understanding that they would pay the Part B portion. This would reduce healthcare cost exposure to large companies, most of whom would rally behind the savings that would come from reduced costs and impositions on their HR departments.

    Get that through the system, and it becomes next to impossible to dismantle. With half of the US adult population enrolled in this plan, the supposed horror stories get harder to sell to the public, since people will be using it and experiencing few issues.

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  37. Mike Slay says:

    David M says:

    @Mike Slay: “It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate”

    I’m not sure what you are trying to say with your objection to that statement.

    In that “roughly a year and a half” people were so adamantly opposed to Obamacare that the Dems lost Teddy Kennedy’s Senate seat in Massachusetts. Thus, they had to use reconciliation to pass the OLD bill in the House because they couldn’t get the votes in the Senate to pass it any more.

    Describing that as, “emerging in a form capable of being passed by both the House and the Senate,” is the precise opposite of the truth.

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  38. Zachriel says:

    @Mike Slay: In that “roughly a year and a half” people were so adamantly opposed to Obamacare that the Dems lost Teddy Kennedy’s Senate seat in Massachusetts.

    Actually, there were two bills. The Patient Protection and Affordable Care Act was passed through the normal process, with a supermajority in the Senate required to overcome a filibuster. That was followed by Health Care and Education Reconciliation Act, which dealt with related budgetary issues, which was passed through reconciliation.

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  39. David M says:

    @Mike Slay:

    Thus, they had to use reconciliation to pass the OLD bill in the House because they couldn’t get the votes in the Senate to pass it any more.

    OK, that’s the nonsense you were pushing. There’s several variations of the GOP lies about how Obamacare was passed, so I couldn’t be sure which one you were referring to. As Zachriel pointed out, your claim was not true.

    The fact that the GOP still lies about facts as basic and easily verifiable as how a bill was passed, is part of how we ended up with Trump in office.

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  40. Mike Slay says:

    @David M:

    OK, that’s the nonsense you were pushing. There’s several variations of the GOP lies about how Obamacare was passed, so I couldn’t be sure which one you were referring to. As Zachriel pointed out, your claim was not true.

    The fact that the GOP still lies about facts as basic and easily verifiable as how a bill was passed, is part of how we ended up with Trump in office.

    You make my point. Neither you nor Zachriel made a defense of the statement, “It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate.” Instead, you nit pick details that are essential to my point.

    I’m no expert on the parliamentary procedures used to pass the bills but I remember the Massachusetts Senate campaign that Scott Brown won, and stopping Obamacare was clearly THE issue of the campaign. He failed to stop it, even though the Dems no longer had 60 seats in the Senate, and that surprised virtually everyone. No one said, during the campaign, that Scott Brown winning won’t actually make any difference to Obamacare. It could easily have kept the seat for them. In fact, as soon as it didn’t matter any more, they won the seat back.

    That’s still the exact opposite of, “It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate.”

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  41. Mike Slay says:

    @Mike Slay: I meant to say, “that aren’t essential to my point.”

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  42. David M says:

    @Mike Slay:

    If anything, the “roughly a year a and a half” statement is underestimating the time, as it was extensively debated during the Democratic primary and then the general election season as well, before the House passed the identical bill as the Senate on March 21, 2010 and it was signed into law by President Obama on the 23rd. It’s pretty easy to verify these facts, so I’m not sure what you think you are gaining by disputing them.

    if your confused by the absence of a reconciliation bill in the above history, it was a separate bill that modified the existing law, passed by the House on the 21st, the Senate on the 25th and signed by the President on the 30th.

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  43. Mike Slay says:

    @David M:

    You’ve now conceded the point. The bill did not “emerge” any different from the older senate bill, as you note.

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  44. David M says:

    @Mike Slay:

    English, m—er-f—er, do you speak it? You just tried to use the fact that the House passed the identical bill as the Senate as evidence that the The Senate and House didn’t pass the same bill.

    Lies and deceit are the defining character traits of the modern GOP and Trumpkins, which is why it’s so important to call out this BS and not let them defile our country by rewriting history.

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  45. Mike Slay says:

    @David M:

    Of course they passed the same bill. But it was NOT “in a form capable of being passed by both the House and the Senate.” By that time, it couldn’t pass the Senate.

    Therefore, this statement is false. ““It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate.”

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  46. David M says:

    @Mike Slay:

    Um, I’m pretty sure the fact that it passed the Senate is proof it could pass the Senate. Your argument is moronic gibberish at best, but more likely intentional dishonesty intended to harm political discourse and by extension the United States of America.

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  47. Mike Slay says:

    @David M:

    Let me give a simpler explanation. If, somehow, the author could prove that the Obamacare bill could have passed the Senate that existed in, say,1976, (or even did pass the Senate back then) would it be correct to say, “It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate.”?

    Of course not. Over Obama’s first year, the Senate changed and the bill went from being a bill that could be passed by both the House and the Senate, to a bill that couldn’t. That’s why I say that the statement, “It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate,” is the exact OPPOSITE of the truth.

    Over that time period, the bill did not GAIN the ability to be passed by both the House and the Senate, it LOST the ability to be passed by both the House and the Senate.

    The key words in the author’s error are, “before it could”. Change that to “until it could no longer,” and it’s correct.

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  48. Zachriel says:

    @Mike Slay (quoting): “It took roughly a year and a half for the PPACA to make its way through Congress before it could emerge in a form capable of being passed by both the House and the Senate.”

    The basic form of the bill dates to 2007, but work on the actual bill began at the start of the 111th Congress. From that point to final signing was about 14 months. It obviously emerged in a form capable of being passed by both the House and the Senate during that period.

    @Mike Slay (quoting): Thus, they had to use reconciliation to pass the OLD bill in the House because they couldn’t get the votes in the Senate to pass it any more.

    That is not correct. The Senate PPACA bill was passed over a filibuster, not through reconciliation. It was expected that the Senate bill and the House bill would be modified through the normal House-Senate conference. As the special election of Brown in Massachusetts meant the Democrats could no longer overcome a filibuster, the House agreed to pass the Senate’s version of the PPACA, as long as there was a second bill, the HCERA, passed through reconciliation to address budgetary issues of concern to House members.

    The PPACA could not have been passed through reconciliation. There were two bills. The Senate-passed version of the PPACA, and an amendment to that bill, the HCERA, dealing with budgetary issues, and passed through reconciliation.

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