Republican Senator Susan Collins criticizes secretive process of Senate health care replacement bill

Democrats accused President Trump of trying to sabotage the nation’s health-care system through his decision to halt payments to insurers meant to shore up the system, while Republicans countered Sunday that Trump is just pushing for a hard bargain.

Trump’s decision, announced Friday after months of criticizing the payments as an insurance industry bailout, will throw in doubt the private insurance exchanges that are part of the Affordable Care Act. Democrats vowed to use year-end negotiations on the federal agency budgets as a leverage point to reinstate the payments, vowing to pin the political blame on Republicans if premiums skyrocket next year.

“This is the equivalent of health-care arson. He is literally setting the entire healthcare system on fire just because the president is upset that the United States Congress won’t pass a repeal bill,” Sen. Chris Murphy (D-Conn.) said on “Fox News Sunday.

But Sen. Lindsey Graham (R-S.C.), who has played golf twice with Trump in the last week, said that the president called Sen. Lamar Alexander (R-Tenn.) Saturday and is “encouraging him to get a bipartisan deal that would have some flexibility” from the existing law.

“I hope that we can get a deal between Senator Alexander and Patty Murray that would allow us to continue the payments, but get reform,” Graham said on CBS’s “Face the Nation”, referencing the chairman and ranking Democrat on the health committee.

The standoff comes as Trump heads to a potentially pivotal meeting Monday with Senate Majority Leader Mitch McConnell (R-Ky.), with whom the president has publicly clashed since the Senate’s failed vote in late July to repeal the ACA. Advisers say the one-on-one talk is meant to get both sides on the same page heading into the critical fall and early winter legislative session as they tackle issues on healthcare, immigration and federal spending, among others.

Alexander and Murray (D-Wash.) have been in negotiations over ways to stabilize the ACA markets ever since Republicans failed in their bid to repeal, almost outright, the 2010 health law in late July. The bipartisan duo have signaled that they are close to a deal, but Republicans have been demanding some reforms to the ACA and conservatives in the House have grown very wary of the talks, vowing to oppose anything that they view as a bailout.

“The president is not going to continue to throw good money after bad, give $7 billion to insurance companies unless something changes about Obamacare that would justify it,” Graham said, trying to explain Trump’s announcement.

But some moderate Republicans, as well as GOP governors who support the ACA, view those payments as critical and contend that without them, millions will lose insurance and those that do not will pay dramatically more for coverage.

“What the president is doing is affecting the ability of vulnerable people to receive health care right now. This is not a bailout of the insurers. What this money is used for is to help low income people afford their deductibles and their co-pays so that their health care is available to them,” said Sen. Susan Collins (Maine), one of three Republican senators to vote against the July ACA repeal effort.

“These certainly are very disruptive moves that will result in smaller numbers of people being insured, that will make it more difficult for low income people to afford their out of pocket costs, and that will destabilize the insurance market,” she said.

Sen. Bill Cassidy (R-La.), who worked with Graham last month on a last-ditch effort to repeal the ACA, defended Trump’s actions, saying “the president’s not gutting the Affordable Care Act.”

He noted the ruling of a lower federal court that the subsidies were unconstitutional and should come from the annual spending bills passed by Congress, not an automatic payment. Cassidy said he wants reforms along the lines of his bill with Graham that would have given vast powers to states in administering the health law.

All of this is likely to come to a head in the December negotiations over funding federal agencies, one of several combustible issues that Trump and lawmakers must deal with or else risk shutting down the federal government in the holiday season.

House Minority Leader Nancy Pelosi (D-Calif.) questioned whether Trump fully understands where the Alexander-Murray negotiations stand. “I wonder if he even knows what that path is, because, from what he says, it doesn’t sound like he has knowledge, knows the facts,” she said on ABC’s “This Week with George Stephanapolous”.

Pelosi said the blame for a shutdown would rest with Trump and Republicans in control of Congress. “They have the majority in the House and the Senate and the president’s signature. They have the power to keep government open,” she said.

WASHINGTON — Republican Ohio Gov. John Kasich on Sunday blasted President Donald Trump's decision to stop funding some health care subsides during an interview with host Chuck Todd on NBC's "Meet The Press."

"What I don't understand, Chuck, is what are they doing?" the governor asked. "Are they just passing these things and people are praising what the president did because of politics? I mean, do they understand the impact that this has on families, on people?"

On Friday, President Trump announced that his administration was ending the key Affordable Care Act payments to insurers that are aimed at off-setting the costs of helping lower premiums for low-income Americans — also known as "cost-sharing reduction payments."

The president and many other Republicans have called these subsidies a "payoff" to health insurers.

Kasich slammed that suggestion on "Meet The Press," saying, "these were payments to insurance companies to make sure that hardworking Americans, who don't make a lot of money, can have their co-payments taken care of."

But the governor didn't go as far as to say the president's action was a purposeful attempt to sabotage Obamacare. "I can't read people's minds," Kasich said.

Trump's move this week came after multiple attempts by the Republican-led Congress to dismantle the Affordable Care Act.

There is nothing wrong with the democrats working with Trump and the republicans if they were trying improve on Obamacare. For example a (public option) or (single payer medicare for all) are just a couple of examples. There may also be some other good fixes that may expand Obamacare. So, when you say the Democrats would refuse under any circumstances to work with Trump on healthcare, you are sadly wrong. Now, as far as dismantling Obamacare, the republicans are on their own. It would be insane, irresponsible, cold hearted and downright evil for anyone that assists the republicans in dismantling Obamacare.

orolloy doesn't seem to understand the GOPs plan to cut Medicare by $1 trillion dollars to give bigger tax cuts to the wealthy.

I agree there is no logic for American voters voting to reelect these republican representatives that are working to take away their health insurance. Who knows, maybe the American voters will finally see the light and vote to remove these republican senators and representatives. We can always hope.

Senate Minority Leader Chuck Schumer urged a quick vote on a bipartisan health care bill he said has the support of every Senate Democrat, but Majority Leader Mitch McConnell said he’ll bring it to the floor only if he’s confident President Trump will sign it.

“I would urge Sen. McConnell to put it on the floor immediately this week. It will pass, and it will pass by a large number of votes,” Schumer said Sunday on NBC’s “Meet the Press.”

The bill is supported by “all 48 Democrats” as well as 12 Republicans, enough for a 60-vote majority, Schumer said.

The legislation was negotiated in a deal between Tennessee Republican Lamar Alexander and Washington Democrat Patty Murray. It is a short-term fix rather than a sweeping overhaul of the health care system, and would fund subsidies to insurance companies that Trump announced plans to end. Without those subsidies, insurers have said that premiums would soar.

Trump has sent mixed signals on the deal, at one point saying he opposed it as a bailout to insurance companies but also calling it a “good start” he was open to supporting.

McConnell said he’ll bring the legislation up for a vote only with Trump’s clear support.

“What I’m waiting is to hear from President Trump what kind of health care deal he might sign,” he said on CNN’s “State of the Union.”

“We need a bill the President will actually sign. I’m not certain yet what the President is looking for here, but I’ll be happy to bring a bill to the floor if I know President Trump would sign it.”

Schumer said his Republican counterpart should call a vote immediately.

“This is a good compromise,” he told NBC. “Let’s not forget, what this bill does is prevent premiums from going up 20%, even more in some states. That falls on everybody’s back. And if Republicans think that if premiums go up they’re going to avoid the blame, if Sen. McConnell thinks that, he’s wrong.”

He said Democrats were not interested in re-negotiating the deal to gain more GOP support. “We are sticking to the agreement we have,” he said.

Schumer hit Trump for his waffling on the agreement.

“The right wing attacks it, and he backs off,” he said. “That’s the whole problem. The President is not leading on issue after issue after issue.”

WASHINGTON — Most people think of the term “bailout,” as a political pejorative, often involving hundreds of billions of taxpayer dollars being funneled to failing companies. It’s now become one of President Trump’s oft-repeated rhetorical cudgels against the Affordable Care Act and federal payments to insurance companies.

In April, the president accused Democrats of wanting to “bail out insurance companies from disastrous #ObamaCare.” In July, he threatened to end “BAILOUTS for Insurance Companies” if Congress did not repeal and replace the Affordable Care Act. And in a speech Tuesday night to the conservative Heritage Foundation, Mr. Trump urged Congress to “find a solution to the Obamacare mess instead of providing bailouts to insurance companies.”

But his use of the word is

“Bailout” typically refers to financial assistance offered to prevent the bankruptcy of a company or industry. The 2008 Troubled Asset Relief Program (which Mr. Trump largely supported) was a bailout because it provided $700 billion for the Treasury Department to buy troubled securities from banks that were at risk of collapse.

The funds Mr. Trump now refers to, on the other hand, are more accurately characterized as a reimbursement that the government pays to the insurance companies. It is done not to save the companies from financial ruin — unlike the banks in 2008, they are not in danger of failing — but to cover the cost of cheaper health care for low- and moderate-income Americans.

Under the Affordable Care Act, insurers must offer plans with reduced out-of-pocket costs, like deductibles and co-payments, for people who have purchased a silver-level plan and who have incomes of 100 to 250 percent of the poverty level (about $24,600 to $61,500 for a family of four). About seven million people, or about 58 percent of all marketplace enrollees, qualified for that financial assistance this year.

The government then compensates insurers for these cost-sharing reductions. The Congressional Budget Office estimated in January that the payments would amount to $10 billion this fiscal year and reach $135 billion over the next decade.

“The insurers don’t make any money off of this,” said Timothy S. Jost, an emeritus professor at the Washington and Lee University School of Law and a contributing editor at Health Affairs Blog. “They don’t even cover administrative costs. It’s simply a dollar-out, dollar-in reimbursement.”

In 2014, the Republican-controlled House sued the Obama administration, arguing that the payments were unlawful as they were not appropriated by Congress, which is the branch of government that is authorized with spending public money. Last year, a federal judge sided with the House, but the Obama administration appealed.

Mr. Trump opted to stop paying the insurers last week, citing the ruling. Insurers, legally obligated to offer the cost-sharing subsidies but with no way of funding them, responded by increasing premiums to offset the costs.

Senator Lamar Alexander, Republican of Tennessee, and Senator Patty Murray, Democrat of Washington, announced on Tuesday they had reached a compromise bill to continue the subsidies funding for two years. A draft of the legislation indicates that the plan would appropriate the sums “necessary for payments for cost-sharing reductions” beginning in December 2017 and lasting through 2019.

Mr. Trump, after initially appearing to approve the senators’ efforts on Tuesday, modulated his support in a Twitter post on Wednesday that again invoked the specter of a bailout.

Mr. Alexander concurred that “C.S.R.s should benefit consumers and not insurance companies” — referring to the potential for insurers to “double dip” by profiting from both cost-sharing reduction payments and higher premiums. The bill he is sponsoring with Ms. Murray seeks to prevent that, and gives states several options to address the issue, including rebates to consumers.

Had the insurance firms actually double-dipped into both funding streams, the subsidies might have been more accurately been characterized as a “bailout.” But on their own, the cost-sharing reductions to insurance firms were not.

Sarah Huckabee Sanders, the White House press secretary, signaled on Wednesday that the president opposes the compromise Senate bill as it is currently written, and again repeated the misleading notion of a bailout.

“We’ve said all along that we want something that doesn’t just bail out the insurance companies but actually provides relief for all Americans,” she said. “This bill doesn’t address that fact.”

In Senate testimony on Tuesday, budget director nominee Rep. Mick Mulvaney (R-SC), said he would cut Social Security and Medicare spending.

In this era in which the Orwellian manipulation of language by politicians to say the opposite of what they mean has reached a fever pitch, we should be especially wary when conservatives hide their plans to cut Social Security and Medicare benefits behind a smokescreen of euphemism.

Jared Bernstein, a fellow at the Center on Budget and Policy Priorities and a former chief economist to Vice President Joe Biden, has put in a plea to journalists to call out policy makers when they pull this stunt—and not to empower politicians by doing the same thing.

“Though many policy makers want to cut these social insurance programs, they rarely say ‘cut,’” he writes. “Instead, because the programs are so highly valued by recipients, policy makers say ‘reform,’ ‘overhaul,’ ‘change,’ ‘revamp,’ and ‘fix’ the program. In the vast majority of these formulations, these verbs are euphemisms for cuts, and it’s very important for journalists to call them out as such…. Please stop the obfuscation. When policy makers are talking about cutting entitlements, call it like it is.”

We second the motion. We’ve been particularly wary of plans described as “fixes” to Social Security and Medicare. As we’ve observed, these are invariably “fixes” in the same sense that one “fixes” a cat. But several other such weasel words surfaced in coverage of the confirmation hearing for Rep. Mick Mulvaney (R-S.C.), President Trump’s budget director-designate. NPR reported that Mulvaney “wants to overhaul” Social Security, Medicare and Medicaid. CNN said that he “wants to overhaul” the programs and believes they “need revamping to survive”—a journalistic twofer!

Let’s not allow these euphemisms to obscure Mulvaney’s true opinions about these programs. He proposes to raise Social Security’s normal retirement age to 70 (it now tops out at 67 for those born in 1960 or later), and to means-test Medicare. These are benefit cuts any way you define them.

Mulvaney also has described Social Security as a “Ponzi scheme,” a term he tried to evade during his Jan. 24 confirmation hearing. He said he was just trying to explain Social Security’s cash flow, which “takes money from people now in order to give money to people now.” That’s not a Ponzi scheme. Moreover, that’s not a full and accurate description of Social Security’s cash flow, which collects money from people now and banks some of it to provide benefits for people in the future. (Do we really want a budget director whose understanding of one of America’s most important fiscal programs is so vacuous?)

As Bernstein pointed out, politicians understand that Social Security and Medicare are beloved by Americans, and for good reason: They represent value for money. Both programs incur rock-bottom administrative costs while delivering more than a trillion dollars a year in benefits to tens of millions of American retirees and families.

Republicans and conservatives have plotted for decades to turn this flow of cash over to Wall Street via privatization. Financial firms would skim billions off the top, administrative costs would soar, and to make up for the diversion benefits would shrink. The promoters of these schemes can’t tell the truth about this, of course, so they talk about “reforming,” “revamping,” and “overhauling,” as though they’re dressing a crumbling old house with a new coat of paint.

As Kathy Ruffing, a consultant to the CBPP, points out, the group George W. Bush empaneled to put over his privatization scheme in 2001 was called the “Commission to Strengthen Social Security.” Luckily for millions of Americans whose retirements were saved when the effort failed, most people weren’t fooled.

The privatizers and benefit-cutters haven’t stopped trying. They still cloak their plans in the mantle of “reform” and “rescue.” The House GOP’s latest package of proposed Social Security cuts, unveiled in December, was described by its sponsor, Rep. Sam Johnson (R-Texas), as a “plan to permanently save Social Security.”

Iowa on Monday withdrew a request to waive some Obamacare rules to help shore up its struggling healthcare insurance market, marking a setback in efforts by Republican-governed states to sidestep requirements of the Obama-era law.

With open enrollment for the Affordable Care Act - better known as Obamacare - set to start in just over a week, the state announced it would no longer wait to hear if federal officials would approve its request aimed at cutting individual healthcare insurance premiums and widening coverage.

The withdrawal prompted a leading U.S. Senate Republican to urge Congress to approve a bipartisan fix to Obamacare, which President Donald Trump has vowed to scrap.

Iowa was viewed as a test case by some for other states that submitted similar, if far less-reaching, waivers and of how the Trump administration would respond to such requests.

Iowa Governor Kim Reynolds said the law had not been flexible enough to accommodate the state's request.

"Ultimately, Obamacare is an inflexible law that Congress must repeal and replace," the governor said in a statement, adding that premiums under Obamacare had increased by 110 percent for Iowans since 2013.

Iowa sought the waiver after its individual healthcare marketplace shrank to only one insurer for next year, Minnesota-based Medica.

Some of the state's requests were similar to provisions included in Republican repeal and replace bills this year. For instance, the waiver sought to replace Obamacare's income-based tax credits with flat age-based credits and eliminate insurer payments that Trump cut off earlier this month.

Senator Lamar Alexander, Republican of Tennessee, said the move by Iowa demonstrated the need for repairs to Obamacare that he and Democratic Senator Patty Murray have proposed aimed at stabilizing insurance markets. It would also provide states more flexibility in reshaping some parts of Obamacare.

Trump has sent mixed signals over whether he would support the bipartisan fix. Senate Majority Leader Mitch McConnell said on Sunday that he was willing to bring up the proposal for a vote but needed to know where Trump stood.

Alexander said the bipartisan repair proposal would allow the federal government to approve Iowa's waiver.

Alexander told reporters that the Congressional Budget Office, a nonpartisan scorekeeper, would soon announce its analysis of the bipartisan repair legislation, possibly on Tuesday.

WASHINGTON — The House’s leading tax writer on Friday opened the possibility that Congress’s push to cut taxes could mesh with its so-far failed effort to repeal the Affordable Care Act, saying the tax bill could include a measure to do away with the health law’s mandate that most Americans have health coverage.

Representative Kevin Brady of Texas, the chairman of the House Ways and Means Committee, said no decision had been made about whether to include repeal of the so-called individual mandate. But he said President Trump wants its inclusion, and he indicated that Republicans wanted to evaluate the fiscal effects of taking that step.

“The president feels very strongly about including this at some step before the final process,” Mr. Brady said Friday at an event hosted by Politico, adding that there were “pros and cons” to repealing the mandate as part of the tax overhaul.

Repealing the individual mandate could help Republicans with the difficult math they face with their tax bill, which can add no more than $1.5 trillion to federal budget deficits over a decade. The Congressional Budget Office said last year that eliminating the mandate would reduce deficits by a total of $416 billion by 2026, since fewer Americans would obtain insurance that is subsidized by the government.

At the same time, such a step would substantially increase the number of people who are uninsured, according to the budget office.

Republicans are looking for other ways to squeeze more dollars out of the bill. On Friday, Mr. Brady released an amended version of the tax bill that will reduce the value of the income tax cuts for individuals by $90 billion over the course of a decade and slightly shrink the estimated cost of the legislation.

The amended bill includes a technical change that immediately adopts a revised measure of inflation, known as “chained CPI”, which would change how inflation is calculated, thus slowing the speed at which tax brackets grow with inflation. As a result, Americans would more quickly find themselves in higher marginal tax brackets — jumping from a 12 percent top bracket to 25 percent, for example — as their incomes increase.

The chained measure would also slow the value growth of some inflation-adjusted tax benefits, such as the Earned Income Tax Credit.

Getting rid of the individual mandate has been a core component of Republican proposals to dismantle major parts of the Affordable Care Act, a goal that remains unfulfilled after the Senate was unable to assemble the votes to pass a repeal measure this year.

Congressional Republicans have now turned their focus from health care to taxes, and House Republicans on Thursday unveiled a sweeping tax proposal that party leaders hope to pass through the chamber by Thanksgiving. The Ways and Means Committee plans to begin holding formal bill-drafting sessions on Monday.

Adding the repeal of the individual mandate to the tax overhaul is an alluring but risky move for Republicans, who are still smarting from their failure to fulfill their promise to voters that they would repeal and replace the Affordable Care Act.

By ripping out a major component of President Barack Obama’s health law, Republicans could claim at least a partial victory on an issue that has stymied them all year. Mr. Trump has already declared his support for the idea, writing on Twitter this week:

But injecting the delicate politics of health care into discussions about a tax overhaul could make an enormously difficult legislative task even harder, especially in the Senate.

Mr. Brady offered a warning along those lines on Friday.

“Importing health care into a tax reform debate has consequences, especially one where the Senate has yet to produce 50 votes on anything related to health care that I’m aware of,” Mr. Brady said.

WASHINGTON -- The House's leading tax writer on Friday opened the possibility that Congress's push to cut taxes could mesh with its so-far failed effort to repeal the Affordable Care Act, saying the tax bill could include a measure to do away with the health law's mandate that most Americans have health coverage.