Health Care

Don’t Take Skinny Repeal Lightly — The Dangers of “Just Pass Something” Mentality

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As I write this, the Senate is moving in a somewhat haphazard way to a vote on what has been called a “skinny” repeal of the Affordable Care Act. Not only do we not know exactly what will be included in the skinny repeal, but we, like members of the Senate, are uncertain about the point of passing such a bill.

Skinny Repeal as Trojan Horse

Most observers of the Senate believe that the goal of enacting a skinny repeal bill is simply to keep the process of repealing, or repealing or replacing, the Affordable Care Act alive. If the Senate acts on some health care bill that is an amendment of the AHCA passed by the House, the next step will be a House-Senate Conference Committee, which would write a final bill that attempts to thread the very narrow needle between more moderate and more conservative Republicans in both the House and Senate. The bulk of the work of the committee would, likely, be carried out in private among Republicans only. The bill it produces would go back to the House and Senate where it would receive an up and down vote with no opportunity for amendments.

Senate to Choose Between Health Catastrophe or Something Worse

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Mitch McConnell and his Republican allies have one more trick up their sleeves to try to get some health care bill through the Senate. This week they will seek a vote to proceed to debate on the bill passed in the House on the understanding that there will be a process, colloquially known as voterama, in which a series of votes on one or more substitutes to the bill, or amendments, will be introduced. That is, Senators are being asked to proceed to debate without any clear idea what final bill they will eventually vote on.

I will say more about the process in a moment. But first I want to urge you to join the Insure PA / Protect Our Care phone bank to ask people in those states with Senators who are unsure about their position to call those Senators and ask them to vote no. (You can call Senator Toomey, too, but he pretty clearly has decided he cares far more about tax cuts for the rich than health care for Pennsylvanians.)

Statement on CBO Score of BCRA

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Earlier this week we released a blog post and a long paper called, “It Can’t Be Fixed” that explained why the basic structure of all of the Republican “repeal and replace” necessarily leads to a health care system in which large numbers of Americans and Pennsylvanians lose insurance.

The Congressional Budget Office (CBO) evaluation of the last version of the Senates’ Better Care Reconciliation Act (without the Cruz Amendment) released on Thursday confirms our argument once again. The CBO predicts that 22 million people will lose health insurance in the first decade. Our quick analysis of the impact on Pennsylvania shows that over one million will lose insurance in our commonwealth.

It Couldn't Be Fixed: Policy and Politics in the Republican Health Care Bill

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Now that the Senate Republican effort to repeal and replace the Affordable Care Act has failed, let’s take a step back and understand why no bill based on the Republican approach to health care could have been fixed enough to reduce the pain to levels acceptable to a majority of Republicans in Congress, let alone to the American people. 

The basic design of the bill was deeply flawed from the perspective of anyone who thinks that America has a responsibility to guarantee quality, affordable health care to all. The design only made sense if one, instead, seeks a politically palatable way to reject that responsibility and reduce federal health care spending in order to cut taxes on large corporations and the rich.

What started as a bill to repeal the Affordable Care Act (ACA) became a bill to partly repeal the health insurance regulations and subsidies for insurance purchased in the individual marketplaces, fully repeal the Medicaid Expansion, and radically restructure – and drastically reduce – funding for traditional Medicaid.

PA House GOP Stealth Attack on Medicaid

**UPDATE 7/11/17 - 4:45 PM** The House passed the bill through to the Senate 102-91. The Senate must again vote on the bill as amended

PA House Republican leaders are trying to force Pennsylvania to seek federal waivers for our Medicaid program that would establish requirements that Medicaid recipients either be working or searching for a job and that that ask them to pay premiums or higher co-pays for their insurance. 

These ideas were part of Governor Corbett’s plan to expand Medicaid, which Governor Wolf rightly rejected.

New Estimates of the Loss of Federal Funding to Pennsylvania from the Senate Health Care Bill

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The Manatt Health Group and the Robert Wood Johnson Foundation have released a new study of the impact of the Senate health care bill, the Better Care Reconciliation Act of 2017, on the states. Their estimates of the impact of the bill confirms our recent study showing that Pennsylvania will suffer devastating reductions in federal funding for Medicaid.

The new study provides two sets of estimates of how much federal funding each state loses – one if the state keeps the Medicaid Expansion and a second if it does not. According to the study, if Pennsylvania eliminates the Medicaid Expansion in 2021, the state stands to lose $30.1 billion in federal funding between 2020 and 2026 – $25 billion as a result of the elimination of federal funding for the Medicaid Expansion, and $5.1 billion as a result of the impact of per capita caps on traditional Medicaid.

Senate Bill Raises Marketplace and Employer-based Premiums for Most Pennsylvanians

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We have been focused recently on the impact of the Senate health care bill on Medicaid, mainly because the dangers of both the House and Senate bills to Medicaid have not been well known, and because the Senate bill is far worse than the House bill. 

So, in this and next post I want to remind you that if you purchase health insurance on the exchanges / marketplaces or receive it from your employer, the Senate bill is bad for you as well.

How Dumb Does Senator Toomey Think We Are?

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I’m not just a practitioner of political rhetoric, but also a connoisseur of it. I can appreciate a good argument and a well-turned phrase put forward by our ideological opponents. And, rather than get disturbed by what the other side says, I take their best work as a challenge. But what truly does get me angry is when our opponents not only lie, but do so with arguments that are insulting to the intelligence of the people we are trying to influence – the citizens of Pennsylvania and America.

State As Well As Federal Republicans Go After Medicaid

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At both the state and federal level, Republican Party leaders seem to be on the warpath against Medicaid. Thankfully, rank and file Republicans in both legislatures and the public seem to be pushing back against them, as long, bi-partisan support for Medicaid continues.

MEMO: Effects of U.S. Senate Health Care Bill on Pennsylvania

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MEMO

To: Interested Parties

From: Marc Stier, Director, Pennsylvania Budget and Policy Center

Date: June 28, 2017

Re: Effects of U.S. Senate Health Care Bill on Pennsylvania


The Pennsylvania Budget and Policy Center will be releasing a number of briefs on the effects of the U.S. Senate health care bill in the next few days. You can see our initial statement in response to the CBO scoring of the bill here. Below is our first brief on the effects of the bill on Pennsylvania.

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