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Republicans Claim That Obamacare Repeal Is Still On The Table, Don’t Believe Them

congress-healthcare

Just a few days after the failure of the American Health Care Act led President Trump, Speaker Ryan, and other top Republicans to say that health care reform was dead in Washington for the time being, there’s already talk of reviving efforts to repeal the Affordable Care Act:

WASHINGTON — Under extreme pressure from conservative activists, House Republican leaders and the White House have restarted negotiations on legislation to repeal the Affordable Care Act.

But efforts to revive the legislation in the House could take weeks, lawmakers conceded, as Congress moves forward with a full plate of other time-consuming issues. And the renewed push did not meet with much enthusiasm from Senate Republicans, who said they had other priorities at the moment.

Nonetheless, Speaker Paul D. Ryan vowed to renew efforts to repeal the law, despite last’s week crushing setback when House Republicans tossed aside a repeal bill because they lacked the votes to pass it.

Just days after President Trump said he was moving on to other issues, senior administration officials said they still hoped to score the kind of big legislative victory that has so far eluded the White House. Vice President Mike Pence was dispatched to Capitol Hill on Tuesday for lunchtime talks.

“We’re not going to retrench into our corners or put up dividing lines,” Mr. Ryan said after a meeting of House Republicans was dominated by talk of how to restart health negotiations. “There’s too much at stake to get bogged down in all that,” he added.

Democrats had celebrated what they thought was the demise of the repeal bill on Friday. But the House Republican whip, Steve Scalise of Louisiana, said on Tuesday, “Their celebration is premature.”

“I think we’re closer today to repealing Obamacare than we’ve ever been before, and surely even closer than we were Friday,” Mr. Scalise said.

It is not clear what political dynamics might have changed since Friday, when a coalition of hard-line conservatives and more moderate Republicans torpedoed legislation to repeal President Barack Obama’s signature domestic achievement.

“I don’t know what has changed,” said Representative Jim McGovern, Democrat of Massachusetts. “The bill went down because it was too bad for Republican moderates and not bad enough for their conservatives. I don’t know how they reconcile the divides within their own conference, never mind find any Democratic votes.”

The Republicans’ repeal bill, according to the Congressional Budget Office, would have left an additional 24 million Americans without insurance by 2026, a major worry for moderate Republicans. It would also have left in place regulations on the health insurance industry that are anathema to conservatives.

Mr. Ryan declined to say what might be in the next version of the Republicans’ repeal bill, nor would he sketch any schedule for action. But he said Congress needed to act because insurers were developing premiums and benefit packages for health plans to offer in 2018, with review by federal and state officials beginning soon.

The new talks, which quietly began this week, involve Stephen K. Bannon, the president’s chief strategist, and members of two Republican factions that helped sink the bill last week, the hard-right Freedom Caucus and the more centrist Tuesday Group.

Any deal would have to overcome significant differences about how to rework a law that affects about one-fifth of the American economy. Those differences were so sharp that they led Mr. Trump and Mr. Ryan to pull the bill just before the House was to vote on it.

Still, Republican members of Congress said they were hopeful.

“I think everyone wants to get to yes and support President Trump,” said Representative Dave Brat of Virginia, a Freedom Caucus member. “There is a package in there that is a win-win.”

Representative Raúl R. Labrador of Idaho, also a Freedom Caucus member, said he hoped the discussions would yield a compromise after a divisive debate that revealed deep fissures within the party. “I think we will have a better, stronger product that will unify the conference,” Mr. Labrador said.

To be honest, this seems like a lot of overly confident talk after the massive legislative failure that the Trump Administration and House Republicans brought about with the American Health Care Act after just seventeen days of work. Even if one agrees with the underlying premise that the Affordable Care Act ought to be repealed or at least radically changed, it seems clear from that battle the Republican Party quite simply isn’t united on what kind of alternative it wants when it comes to dealing with the health care reform.

On one side of the debate, there’s the Freedom Caucus and other hard-core conservatives who want nothing less than the complete repeal of the PPACA, including portions that are popular with the public such as guaranteed coverage for people with pre-existing conditions, the ban on lifetime coverage caps, and the provisions which allow adult children to remain on their parents policy up until the age of 26. As far as replacement goes, this group is often rather vague at what they are aiming at, but typically what you hear from them involves returning to some kind of “free market” in health care which they apparently (and falsely) think existed before the PPACA became law, allowing insurance companies to operate across state lines, which isn’t really forbidden under current law but is also not as easy as they make it sound, and Health Savings Accounts combined with high-deductible catastrophic care coverage for things other than routine medical procedures. Most of these proposals also include tax credits designed to allow people to offset the cost of insurance, and provisions that provide that HSAs would not be considered taxable income as long as the proceeds were used for valid medical purposes. While some of these are good ideas, and could indeed be part of an overall reform package, taken alone they certainly aren’t sufficient to solve the problems plaguing health care coverage and insurance in the United States.

On the other side of the debate are more moderate Republicans who find themselves being pulled by constituents who have benefited from many of the PPACA’s provisions and who have expressed reluctance at the idea of repealing many of the PPACA’s more popular provisions. Many of these moderates, and many Republican Senators, also come from states that have relied upon the PPACA to expand Medicaid coverage and have expressed concern about how repealing the PPACA is going to impact their state and the people there who have come to rely upon expanded Medicaid coverage for their health insurance. Others have are opposed to the repeal of the popular provisions of the PPACA noted above, although they haven’t quite explained how a health insurance system that doesn’t really fine people for not having insurance, thus making insurance pools a riskier bet for insurance companies and virtually guaranteeing that premiums will increase for people who do want insurance. Finally, others in this group are concerned about the extent to which plans such as the AHCA would add to the budget deficit and what that means for future efforts at tax reform, spending reform, and infrastructure spending.

In the middle of all of this, of course, is the Republican leadership in the House which is clearly smarting from the defeat they suffered last week and eager to either move on to something else or come up with another solution on the fly that is likely to end in disaster. Many of them, like Paul Ryan, are probably closer to the GOP moderates on the specifics of that plan than the Freedom Caucus if only because they are well aware of what could actually make it through the Senate and to the President. However, they are also well aware of the fact that their own caucus would not support a bill that would accomplish that. Indeed, thanks to some of the same divisions that we see in the House it’s unlikely anything like the AHCA would pass the Senate in any case. More importantly, the leadership knows that they’ve been damaged by such a massive legislative defeat so early in the year, and are likely torn between the idea of trying to move on to something allegedly easier like tax reform, or the debt ceiling deadline coming up very soon. Bouncing back from that defeat with a quick and easy win would be ideal, but right now there doesn’t appear to be anything the House can do quickly that would allow them to get the AHCA failure behind them,

All of this suggests that when it comes health care reform, what we’re seeing right now is a lot of talk, but there’s not likely to be any real action because the Republicans on Capitol Hill simply can’t come to an agreement. That appears to be Mitch McConnell’s opinon as well:

Senate Majority Leader Mitch McConnell (R-KY) shot down the idea that Republicans would be able to revive their Obamacare repeal effort, after a House replacement bill was pulled from the floor Friday.

McConnell’s remarks Tuesday afternoon threw cold water on optimism coming from the House GOP earlier in the day that lawmakers would be able to come to a deal on the bill.

“I think where we are on Obamacare, regretfully at the moment, is where the Democrats wanted us to be, which is the status quo,” McConnell said a press conference on Capitol Hill when asked if the Senate would be able to pass major health care legislation this year without 60 votes.

“It’s pretty obvious we were not able, in the House, to pass a replacement. Our Democratic friends ought to be pretty happy about that because we have the existing law in place and I think we are just going to have to see how that works out,” McConnell said. “We believe it will not work out well, but we’ll see. They’ll have an opportunity now to have the status quo, regretfully.”

I don’t know about you, but to me that sounds like McConnell admitting that the PPACA is here to stay and that health care reform is unlikely during this current session of Congress, and likely through the 2018 midterms as well.

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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. Slugger says:

    The President gave a dinner last night at the White House where he asked for Democrats to participate in revising Obamacare. This seems unlikely to achieve a Freedom Caucus friendly result. You can’t please everybody.
    On to other important priorities like cutting programs to build the wall to protect America from people willing to mow their lawns for three bucks per hour.

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  2. CSK says:

    @Slugger:

    That big, beautiful, 30-foot-high wall isn’t going to get built, either.

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  3. Pch101 says:

    At this point, the GOP is so invested in destroying Obamacare that it has no choice but to do it. The party has gone beyond the point of no return.

    When Ryan et. al. claim that “Obamacare is the law of the land”, etc., they are attempting to create leverage with the misnamed Freedom Caucus by shaming its members into supporting Trumpcare by blaming them for the continued existence of the supposedly evil ACA. But that tactic won’t work because the hard right is too angry, obtuse and narcissistic to ever feel any shame about anything.

    So eventually, the establishment GOP will capitulate to much of what the hard right wants. The establishment negotiates with terrorists because that’s just how they roll.

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  4. gVOR08 says:

    As any number of people have pointed out, it’s hard to reconcile the Freedom (sic) Caucus, who fear being primaried if they don’t kill people, with others who feel killing their constituents might be bad politics.
    The pro O’care side did a brilliant thing by publishing a list of how many people in each congressional district are covered by the Exchanges and Medicare expansion. My own Tea Party “Representative” has about 67,000.

    On the other hand, there is an opportunity here for the GOPs to marginalize the FC and govern. However, there is a paucity of evidence that they want to.

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  5. al-Alameda says:

    A few days ago the Koch’s promised big money for 2018 campaigns if the “Freedom” Caucus killed the bill. I have a feeling that Republicans actually will bring this back to the table soon.

    Bi-partisan support? That was a throwaway line; he said that so that when Democrats again don’t give him any votes he can say, “we tried to get them to un-insure 20 million people, but they didn’t want to make America great again” #bad #treason.

    I think the best Democrats would get from this malevolent crew is something like: preservation of Medicaid expansion, in block grant form, with caps and limits, which will inevitably lead to many states cutting their Medicaid-supported health programs. This is the kind of thing that causes Paul Ryan and many Ayn Rand or Back To Zero types to reflexively soil their pants.

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  6. teve tory says:

    Republicans are in a worse negotiating position now than before they tried the first time, and they couldn’t even get a bill to the floor the first time.

    No, this is going nowhere. It’s done.

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  7. Hal_10000 says:

    So seven years of passing Obamacare repeals that went nowhere is going to be succeeded by … four years of passing Obamacare repeals that go nowhere. Fun.

    Realistically, the last chance to repeal Obamacare died in 2012. Even if we say the ACA is flawed, people are *very* reluctant to give up something that they have. People who have insurance through Medicaid or the individual markets — about a quarter of Americans — are not going to want to risk parting with it because of vague promises of market forces something something cheap insurance.

    Until the GOP admits that they have to build on the current structure by overhauling/fixing Obamacare, healthcare reform is as dead as Abe Lincoln. This is the GOP insisting that it’s just pining for the fjords.

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  8. Daryl's other brother Darryl says:

    Republicans; Claim That Obamacare Repeal Is Still On The Table, Don’t Believe Them

    FTFY

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  9. CSK says:

    @Daryl’s other brother Darryl:

    Trump Tweeted that he’s going to work with Democrats to come up with a replacement that will make us all very happy.

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  10. Daryl's other brother Darryl says:

    @CSK:

    Trump Tweeted that he’s going to work with Democrats to come up with a replacement that will make us all very happy.

    And yet he hasn’t spoken to any Democrats.
    I’d love for them to get together and fix the problems with Obamacare.
    Never. Going. To. Happen.

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  11. CSK says:

    @Daryl’s other brother Darryl:

    Of course it’s not.

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  12. Pch101 says:

    If you want to see the fantasyland in which the GOP resides, then just read this op-ed from the Heritage Foundation:

    https://www.washingtonpost.com/opinions/republicans-shouldnt-give-up-on-health-care-just-yet/2017/03/28/02ef2540-13c5-11e7-9e4f-09aa75d3ec57_story.html

    It’s complete tripe, with no grounding in reality and hardly a truthful point to be found. American conservatives have literally no idea how healthcare economics work.

    The basic challenge of healthcare is delivering expensive services with minimal delay to the vast majority of the population who can’t afford it. Nobody can use “free markets” to make heart surgery cheap because heart surgery will never be cheap — the very nature of the product requires dedicated facilities and high-cost labor that ensure that it won’t be a bargain under the best of circumstances.

    With most products, the free market works just fine because free markets provide a simple answer — if you can’t afford it, then you go without. If you can’t afford lobster, then you may have to live with tuna. If you can’t afford a new Ferrari, then a used Honda may have to do the trick. If you can’t afford artisan bread, then you get by with Oroweat.

    If you need chemotherapy, then there is no $9 solution at Walgreens to fix your problem. Your required course of treatment is not dictated by how much you can spend. And you can’t just go without, because the alternative is death. The GOP simply has no means of addressing that basic economic problem.

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  13. Kylopod says:

    @CSK: @Daryl’s other brother Darryl: He’s clearly smarting from the humiliating defeat last week and pining for revenge. What “I’m going to work with Democrats” really means is “I’m gonna somehow pass an Obamacare repeal that erases Obama’s legacy and pisses off liberals but still gets a smidgen of Democratic support so that I can boast it’s a bipartisan bill just to piss off liberals even more.” Of course, like most other things he says, it’s an empty boast he has no intention of following through on. He just says it to piss off liberals.

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  14. CSK says:

    @Kylopod:

    Well, he’s already blamed the House Freedom Caucus.

    His fans have come up with an even better rationalization than that he was an innocent manipulated by the evil Paul Rasputin. To wit: “He’s a businessman. He couldn’t be expected to know how complicated these things are.”

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  15. Moosebreath says:

    Linking to comment I earlier placed in previous thread, which discussed how Obamacare reform cannot work so long as the primary goals are tax cuts for the rich and cutting social services for the poor (aka class warfare on behalf of the upper class)

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  16. grumpy realist says:

    @Kylopod: I think Trump is more eager to punish the Freedom (!?) Caucus at present.

    If I were a Dem, I wouldn’t trust any of Trump’s promises because we know how he was carried them out in the past.

    I also think that Trump can’t understand why people who he has lobbied epithets at (“clown” is the mildest) aren’t that eager to turn around and negotiate with him, especially since he never apologizes for anything.

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  17. Bob@Youngstown says:

    @Pch101:

    American conservatives have literally no idea how healthcare economics work.

    I’ve been spending some time thinking about healthcare economics, so if you’ll pardon a slight OT question?

    Do healthcare insurers have any interest in lowering the cost of actual healthcare (ie doctor bills, hospital bills, medical device costs, drug costs etc) ?

    I theorize that healthcare insurers actually benefit from high origin costs – here’s why: The average profit margin for the healthcare insurer is about 3.3%. of which it is “suggested” that two-thirds of that 3.3% is earned by short-term investments of the billions of dollars that an insurer churns every month. If this is so, the more money (from higher origin costs) the insurer churns the greater the gross profit, meaning that lowering the origin of actual healthcare would actually be detrimental to the insurer.

    Any thoughts?

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  18. CSK says:

    @grumpy realist:

    I agree that Trump is most eager to avenge himself on The Freedom Caucus, at least today. After all, he gave them their marching orders, via Bannon, and they disobeyed him.

    I don’t think he quite gets that this is not Celebrity Apprentice: Capitol Hill.

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  19. HarvardLaw92 says:

    @Bob@Youngstown:

    Insurance profits are a combination of unrecouped premium payments and investment returns on the premium pool.

    The less that insurers pay out to medical providers, the more that they get to keep for themselves. They have every incentive in the world to minimize payouts – heck, HMOs and PPOs were intended from the outset as a way for insurers to control (and minimize) payouts relative to what they had been paying out under the historical 80/20 model.

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  20. Pch101 says:

    @Bob@Youngstown:

    Do healthcare insurers have any interest in lowering the cost of actual healthcare (ie doctor bills, hospital bills, medical device costs, drug costs etc) ?

    Theoretically, they do. If they could reduce premiums, then they could sell more policies. (Most of your premium pays for patient services.)

    In practice, they can’t because they need to build networks. In the US, providers have the ability to opt out of networks that don’t pay enough, so the insurer is ultimately beholden to the provider.

    Networks are a sort of tragedy of the commons. They may seem to reduce costs because insurers trade access to their policyholders in exchange for a lower service fee. But networks ultimately raise service costs because providers can play insurers against each other, which leads to higher prices. Network building also increases overhead, since insurers have to devote a lot of time, money and effort haggling with providers and trying to win them over.

    Systems outside of the US reduce costs by buying in bulk. The US has multiple pools, some of which are very small, so the pools compete against each other for scarce supplies — Americans have engineered a system that is inherently more expensive because it doesn’t use a single pool as leverage to push down costs.

    Costs can also be reduced by pushing off some costs onto cheaper providers such as nurses and pharmacists. The US largely avoids this, making things even more expensive.

    In any case, “insurance” is a bad way to address healthcare. With everything else, insurance is a product that you aren’t supposed to use — your life insurer won’t pay if you go out of your way to end your own life, while your car insurer will respond to your bad driving by cancelling your policy or jacking up your rates.

    For healthcare, we really need benefits administrators that provide customer service to patients and that can keep hypochondriacs under control, not insurers that punish you for seeing a doctor who you need to see as age catches up with you. Insurance is not a solution.

    Healthcare is actually not that complicated, but the answers baffle conservatives because the best path defies their theories.

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  21. cian says:

    Why would anyone want to get into a deal with Trump?

    For the slow learners, the last 64 days have been a crash course in the man’s incompetence and treachery. He has zero interest in working hard on anything that doesn’t involve his own interests and was shocked to discover something wouldn’t just land on his desk for him to sign without ever having to read or think about it. When that didn’t happen he turned on whoever was nearest and took a dump on them.

    You can be certain the word is going out- work with this guy and you’ll get burned to the ground.

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  22. grumpy realist says:

    Digby points out that healthcare debacle is going to be repeated with a tax reform debacle.

    The fact is, Trump just isn’t that bright. Nor is he able to concentrate attention and effort for the sufficient time necessary to get any of his “big projects” completed. You can’t just dump the whole project off on a project manager you bully when things go wrong.

    (I’d say that “Trump has the attention span of a butterfly” except that I’ve seen some pretty persistent butterflies. “Attention span of a gnat” is more accurate.)

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  23. JohnMcC says:

    @Bob@Youngstown: At the blog balloon-juice-dot-com there is a front-page writer currently using the name David Anderson. He is an actual actuary (always wanted to say that!) and writes on stuff like that. There is an archive if you dig around. And garden tips. And recipes. And John Cole’s love life. But good stuff, too.

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  24. DrDaveT says:

    @Pch101:

    The GOP simply has no means of addressing that basic economic problem.

    Sure they do. It’s the answer Auric Goldfinger gave to James Bond:

    Bond: Do you expect me to talk?
    Goldfinger: [laughing] No, Mr. Bond. I expect you to die.

    The Republicans’ real problem is that they can’t tell their voters the truth about how they want healthcare to (not) work. Anyone with half a brain can infer it, but that rules out enough GOP voters that pretending to care about healthcare while eviscerating it still works.

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  25. Daryl's other brother Darryl says:

    The best thing that can happen is that, because of Comb-over Donnie’s massive health care fail, states that previously didn’t expand medicaid now will. Kansas is in the process of doing that which will add some 150,000 people to insurance. Even that crazy guy in Maine has seen the writing on the wall.

    “Oh, yeah, yeah, so let’s keep hurting the American people,” LePage said on the “George Hale Ric Tyler Show” on WVOM Maine radio. “That’s about as sensible as go jump off a bridge. That makes no sense. If you are telling people let it fail so the American people can get hurt more and when they get hurt more maybe we’ll do something, why don’t you go jump off a bridge? That’s just about as sensible.”

    LePage is smarter than Trump. ‘Nuff said.

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  26. Scott says:

    @JohnMcC: David Anderson and his older alter ego Richard Mayhew writes really well on health insurance. Wonky yet understandable. I’ve learned a lot.

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  27. teve tory says:

    The Republicans’ real problem is that they can’t tell their voters the truth about how they want healthcare to (not) work. Anyone with half a brain can infer it, but that rules out enough GOP voters that pretending to care about healthcare while eviscerating it still works.

    yep. And the GOP ‘policy wonk’ is a former wannabe fitness instructor hopped up on Ayn Rand and George Gilder.

    The Party of Stupid™

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  28. Bob@Youngstown says:

    @Pch101:

    Theoretically, they do.[have an interest in lowering patient medical costs]. If they could reduce premiums, then they could sell more policies. (Most of your premium pays for patient services.)

    Please don’t take my reply as a criticism, it’s not meant that way and in many ways I agree with much of what you said.

    80% of the premiums must be paid out in patient services, thanks to the PPACA. It definitely follows that if patient costs were reduced, premiums would follow. However I’m not all that sure that the insurer would sell proportionally more premiums. For example if the average patient cost were reduced by 50%, I really doubt that the insurers would sell twice as many policies.

    In any event, that is not what I am bemusing, What I am suggesting is that insurers actually benefit more with higher patient costs as it translates to a larger gross to invest the money that is in the insurer’s “hand’s” prior to payout to a medical provider. (churning) – My suspicion is that this “churn” is where the insurance company derives the bulk of their profit.

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  29. Pch101 says:

    @Bob@Youngstown:

    I’m not all that sure that the insurer would sell proportionally more premiums. For example if the average patient cost were reduced by 50%, I really doubt that the insurers would sell twice as many policies.

    That’s true with most products, and does not change the fact that lower costs may be passed on to the customer. The resulting increase in demand would not be linear, nor would anyone expect it to be.

    My suspicion is that this “churn” is where the insurance company derives the bulk of their profit.

    Insurer behavior suggests otherwise. They would prefer that you choose the cheaper option when possible and that you require a minimum of services.

    Insurance is about risk management. The optimal outcome for an insurer is that you require fewer resources than what would have normally been expected of someone who fits into your actuarial category. In practice, health insurers expect you to use some services and price the policies accordingly, but they don’t want to be exposed to too much if they can help it.

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  30. gVOR08 says:

    @JohnMcC: I read Balloon Juice every morning. I’ll second your endorsement.

    Trivia, but FYI David Anderson is his real name. He was using the alias Richard Mayhew, but he explained a few months ago that he got a new job where he won’t get fired for contributing to a liberal blog. (I started going by gVOR08 for the same reason.) He’s well worth reading on health care issues.

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  31. MarkedMan says:

    @Daryl’s other brother Darryl: Argh! I knew I should have gotten here earlier. Your “Republicans…Don’t believe them” is spot on.

    It is very bad for the country that the Republican Party has become the Liar’s Party. But their coalition is based on such overflowing barrels of runny bull shite that I just don’t see any way they can change at this point. Once again, it points to my lack of imagination and predictive abilities: I can’t see how they can continue on this path and I can’t see how they can change…

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  32. grumpy realist says:

    @MarkedMan: They can continue onwards doing just what they have been doing as long as they have sufficient marks around.

    Remember that only a small percentage of the Republican Party is actually trying to do something. The rest of them are in cahoots with the conservoentertainment complex and simply want to keep the game continuing.

    I think that for a lot of them it will be a relief if the Republican Party loses power in the midterms. It’s much easier to be an opposition party that never has to actually deliver on anything.

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  33. Pch101 says:

    @DrDaveT:

    Remember that only a small percentage of the Republican Party is actually trying to do something.

    Republican ideas are so out of touch with reality that it’s difficult to tell how much of it is intended to fool us and how much of it is the result of them fooling themselves.

    I find it funny how Paul Ryan is regarded as some sort of wonk when his ideas simply don’t work.

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  34. MarkedMan says:

    @grumpy realist: You may well be right. The Republicans stuck to the BS Republifacts path in CA, did a heck of a lot of damage to the state, but eventually ended up giving the Dems a supermajority and the governorship, so no one is required to listen to their nonsense any more. But however much that contains the short term problem of a major party being unconnected to reality, in the long run it’s not good for CA and it wouldn’t be good for the US to only have one party.

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  35. DrDaveT says:

    @Pch101: Um, that wasn’t me — that was @grumpy realist. I actually believe that all of the Republican party is actively trying to do something — namely, stay in power. It’s all they care about. Using that power to ‘accomplish’ things is the hobby of a minority of them.

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  36. Ratufa says:

    @Bob@Youngstown:

    “Patient costs” is a somewhat fuzzy concept, in practice. In general: Hospitals have a “chargemaster”, which is a list of all services the hospital provides, along with wildly-inflated prices for each service. For hospitals, the inflated prices serve (at least) two purposes: they provide a basis for charging very high prices to people without insurance, and they provide a negotiating starting point when dealing with insurers. Insurers negotiate with hospitals to avoid paying the chargemaster price for the procedures they cover. Insurers do not benefit from actual (as opposed to chargemaster-based) high patient costs. They negotiate with hospitals in order to lower the costs they pay. Arguably, insurers do benefit from the inflated chargemaster prices , because stories about uninsured people getting outrageous medical bills encourage people to buy health insurance and help justify high premiums.

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  37. gVOR08 says:

    @Pch101:

    I find it funny how Paul Ryan is regarded as some sort of wonk when his ideas simply don’t work.

    The supposedly liberal MSM don’t do policy. If Ryan looks like a wonk and vaguely sounds like a wonk, that’s sufficient.

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  38. mom of 4 says:

    I think a lot of what drive up health care costs is the ridiculous charges for simple things. I will never forget when we saw the bill for our last child (May 2001) that included a charge for a box of surgery gloves. $42 for the whole box! First of all, there is no way a whole box was used during the time I was in the hospital for a normal vaginal delivery. Secondly, today I can buy a box of 100 gloves for less than $10 on Amazon…16 years later…and I’m sure the hospital got a bulk discount. Imagine how many times they charged $42 for the SAME box…

    So I get the Rs idea that if people are more in charge of their healthcare that “market forces” that people would balk against stuff like $42 box of gloves, and that by having health insurance which pays for everything except co-pays (my HMO does) that we don’t really care how much stuff costs. While it bugged me to be charged $42 for that box of gloves, all we were really out was the hospital co-pay of $50 maybe? I think our hospital co-pay is now $200 (at least it is for emergency care) and $20 for primary care, $30 for specialty care, generic prescription $10 and up to $35 for non-generic. When what the individual pays is so cheap, who cares what the actual bill is. (Yeah, I know…we have awesome insurance…).

    In no version of the healthcare bills I have seen have health care costs been addressed. Obamacare doesn’t even really address this. Too bad none of the politicians are seriously addressing this issue.

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