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House passes American Health Care Act; all Minnesota Republicans vote ‘yes’

REUTERS/Carlos Barria
Republicans celebrated at the White House after the House passed the American Health Care Act.

Thursday, the House of Representatives successfully did what eluded it in March, and what it tried in vain to do for six years: pass a repeal and replacement of the Affordable Care Act. By a vote of 217 to 213, the House voted to advance the American Health Care Act, the GOP’s proposed alternative to Obamacare.

Twenty Republicans joined the entire Democratic House caucus in voting no on the measure. Minnesota GOP Reps. Erik Paulsen and Tom Emmer, who had been undecided on the AHCA until the eleventh hour, supported the bill.

Now, it is up to the U.S. Senate — where there had been considerable skepticism over the AHCA, even among Republicans — to take up a version of the health care bill before it can advance any further.

The political ramifications of the vote were immediately clear: as Republicans celebrated, Democrats crowed that their yes votes would come back to bite them, and taunted Republicans by singing and waving goodbye to them on the House floor after the vote.

Still, Thursday's vote marks a surprising comeback for a bill that failed miserably two months ago, when various GOP factions — particularly moderates and hard-line conservatives — fled the long-awaited repeal and replace plan, forcing Speaker Paul Ryan to pull the bill shortly before a scheduled vote.

In the aftermath, the AHCA got new life thanks to two amendments to make it more appealing to conservatives and moderates: one to give states options to bypass key elements of Obamacare, and another to shore up so-called high risk pools for insuring those with pre-existing conditions.

The latter amendment, worked out by Michigan Rep. Fred Upton, who was formerly a no on the AHCA, seeks to mitigate fears over losing protections for those with pre-existing conditions by setting aside $8 billion over five years in support for high-risk pools.

Broadly, the AHCA would maintain some planks of Obamacare but gives states a way to get around them, such as the essential health benefits and community rating provisions, which prevent those with pre-existing conditions from being charged more by insurers.

Beyond that, the bill repeals the individual mandate for health coverage, the employer mandate to provide insurance to employees, and eliminates a host of taxes, such as the one on medical devices.

The Upton amendment may have been the gust that finally pushed undecided members off the fence and into the yes camp.

Count Third District Rep. Erik Paulsen among those blown off the fence on the latest version of the AHCA. Hours before a scheduled vote, Paulsen’s office confirmed that the congressman supported the bill. He supported the initial version of the AHCA and voted for it out of the Ways and Means Committee, but as new amendments were introduced, Paulsen avoided taking a position, and provided confusing answers to press questions.

Minnesota’s three Republicans, in interviews and statements after the vote, preferred to focus on the flaws of Obamacare instead of the concerns raised from both the right and the left over this bill.

In a statement, Paulsen said “the status quo under Obamacare is no longer acceptable… This is just the latest step in reforming our health care system to be more patient-centered.”

Rep. Tom Emmer — who said in a statement that the AHCA is “not perfect” — struck a similar tone in speaking with MinnPost after the vote.

“We’ve got people that are losing coverage options every day,” he said. “It’s important that we do something… The time for pointing fingers is long past.”

Emmer said his office received a lot of feedback from constituents — at one point on Thursday, callers could not get through to his D.C. office because it was so overloaded — but the message he took is that they wanted something done.

“For me, it’s not acceptable where we’re at. It’s not working. It’s collapsing.”

Second District Rep. Jason Lewis, who stood and cheered on the House floor once the AHCA passed the threshold for passage, said in a statement he “promised the people of the 2nd District that I would promote real health care reform that works for their families. I’m keeping that promise.”

Now what?

After the vote on Thursday afternoon, President Donald Trump, Speaker Ryan, and a host of GOP congressmen — including Lewis —stood in the White House's Rose Garden and proclaimed a huge victory.

But the AHCA’s passage in the House is only the first milestone in what will be a long, difficult road if the AHCA is to become law. The U.S. Senate will need to take up health care, and it’s clear that it is a far less hospitable chamber for the ideas outlined in the House plan.

Even though the health care plan is set up to pass along the guidelines of budget reconciliation — meaning only 51, not 60, votes are required for passage — enough Senate Republicans voiced their concern about the first version of the AHCA to cast real doubt on the health of the bill in the upper chamber.

Senators from red states that opted to expand Medicaid under the ACA — such as Arkansas Sen. Tom Cotton and West Virginia Sen. Shelley Moore Capito — will be lawmakers to watch in the upper chamber as they mull a projected $800 billion in Medicaid cuts over time in the House’s plan.

This time around, senators have been a bit more quiet, but observers are predicting they will come up with bill that could look much different from the one that came out of the House. Utah Sen. Orrin Hatch, a key player, told the Washington Examiner that “there are undoubtedly going to be some changes.”

Though several senators have broadly outlined changes they might want to make, they face a limited window to fashion a compromise. The budget reconciliation tactic has a shelf life that expires at the end of the fiscal year — Sept. 30, 2017 — so the House and Senate must approve a compromise bill and send it to the White House before then.

Democrats defiant

If they lost the battle today, Democrats are optimistic they can win the war. In statements and interviews, they excoriated the AHCA: Rep. Keith Ellison, in a statement, said the bill was a “$1,000,000,000,000 tax cut for the top 2% of households. Everyday Americans will be forced to pick up this tab, and they’ll pay for it with their health, their security, and in some cases, with their lives.”

First District Rep. Tim Walz, who is running for governor, called the bill “downright cruel,” and slammed Ryan for “rushing to a vote without holding any hearings and without an updated [Congressional Budget Office] score to show millions of Americans just how much their pocketbooks and well-being will suffer.”

(Indeed, the House voted to pass the AHCA without knowing its impact on the budget or on the number of insured people, though the CBO assessed the first version of the AHCA would save $337 billion from the deficit while 24 million people would lose their insurance.)

Democrats also promised to keep the heat on Republicans as the law goes forward, and to make sure voters remember all this in November.

Ellison — tasked with helping Democrats recoup their electoral losses next year as the deputy chair of the Democratic National Committee — told MinnPost “it’s a sad day for the American people, but we’re committed to making sure the American people know what they did and are held accountable for it.”

Eighth District Rep. Rick Nolan said Republicans could face a reversal of what happened to the Democrats in the 2010 midterms, in which anti-Obamacare sentiment fueled the defeat of 63 Democratic representatives, like Nolan’s predecessor, Jim Oberstar.

Nolan said he’s encountered “unbelievable awareness and deep concern” over the GOP health reform effort in his recent town halls in his District.

“It has people in my district really in a way I haven’t seen before,” he said. “The battle’s not over yet… It’s not going to go away quickly or easily.”

Voters should expect to hear a lot about today’s vote for the next 18 months: the parties’ various campaign arms moved quickly after the vote to advance their messages.

The Democratic Congressional Campaign Committee released digital ads Thursday afternoon attacking Paulsen and Lewis for their votes; while the National Republican Campaign Committee moved to defend Paulsen and Lewis with an email blast saying they had kept their promise to voters.

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Comments (116)

The photo that accompanies this article says it all!

A group of white men chuckling away as they once again successfully line the pockets of their wealthy benefactors. Really, the only thing to say about this bill is to state that those who voted for it are [bleep!]

Yes - only one token white woman

In the picture - so republican

Pictures

24 million Americans will lose their health insurance, but Congressman Erik Paulsen did get his photo opportunity with Donald Trump. I wonder how long it will take Rep. Paulsen to get the picture up on his website?

Getting his picture taken

Is the extent of his ability!

Not Much to Say

except that under Disaster Donald,...

the Republicans now have the power to kill us all,...

and that's what they'll do.

Their richest constituents will probably be the last ones to die,...

but they'll be just as dead as the rest of us in the end,...

all the while joining Dysfunctional Donald in blaming the rest of us,...

for what they, themselves, have wrought.

Sadly, Ray Bradbury was wrong,...

I don't see any way we'll manage to colonize Mars soon enough,...

to preserve the human species before we're all dead on earth.

Pendulums

Our system goes Left, Right, Left, Right, etc...

I personally am indifferent regarding ACA and ACHA, for most of us Americans they have little impact. ACA cost US citizens a lot and seemingly limited competition in many locales. ACHA keeps some of the benefits and loosens a lot of the strait jacket rules.

I am always puzzled why some people distrust the local and state politicians / citizens so much. I mean even if the Feds totally exited Healthcare, do you have so little faith in your neighbors that they will do right by the truly needy people in your State.

Not a matter of trusting the local and state politicians

It is a matter of the changes to the ACA are in my estimation going to do nothing to improve access to reasonable health care at a price that will not bankrupt the average American.

Unfortunately

Unfortunately ACA did little to reduce the cost of healthcare in America. It just charged a bunch of taxes, made a bunch of rules, and subsidized the cost for some.

Here is a list of what I think needs to be attacked if one really wants to reduce healthcare costs. in America... Not sure how to get there.
http://give2attain.blogspot.com/2012/02/american-healthcare-cost-dirvers...

Agreed that a discussion is needed

I agree that a broader discussion is needed. I don't agree with several of the factors identified as drivers of the cost of healthcare that are listed at the link you posted, but that is fine, we need a discussion.

Which Ones

Which do you not see as factors?

I Glanced at Your List

How much of a cost-driver is litigation? Put another way, how much does so-called "defensive medicine," or the procedures done to war off claims of medical negligence, add to the cost of medical care?

Note that tort litigation is traditionally a matter of state law, not federal law, so there's that whole "states' rights" thing to deal with/ignore.

Apparently

This source says $46 Billion annually.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231873/

The challenge with my list is that they all add up... And everyone points at someone else's waste / waist as the unacceptable one.

•Unhealthy Americans abound
•Americans want to save everyone
•Saving everyone weakens Americans
•Americans insist everyone MUST stay alive Link2
•Americans love lawsuits
•Americans and Doctors love expensive tests
•American Government bureaucracy
•Private insurance bureaucracy, profits & wages
•Pharmaceutical personnel, profits & wages
•Medical device personnel, profits & wages
•Healthcare bureaucracy, profits & wages
•Excessive medical licensing requirements

Interesting

I have seen other figures as estimating that so-called tort reform saves about 3% in the overall cost of health care in the United States.

The interesting thing about "defensive" medicine is that automatically labeling it as a bad thing misunderstands tort liability in America. A doctor is not liable for medical negligence (the politically correct term of art these days) unless her conduct did not meet the standards of care for the profession, and unless that lapse in standards caused the patient some harm. Defensive medicine, which I interpret as performing tests later deemed unnecessary, would seem to set a standard of care.

"•Americans want to save everyone
•Saving everyone weakens Americans
•Americans insist everyone MUST stay alive" So you're okay with death panels?

2 Percent

Apparently $46 Billion is ~2%.

If malpractice was determined by a trial of their technical peers and they focused on the science, you would be correct. Unfortunately we have non-experts on the jury, the spouse /kids get to express how terrible the loss is, and the jury often feels that the deep pockets folks can afford to help them out.

I am not quite for death panels, but I certainly am for physician assisted suicide once certain criteria are met. My Grandmother had a severe stroke and was pretty much "not there" for the last 5 years of her life. It seems like such a waste.

Please remember that the factors are just factors... Choices and actions that increase the cost of American healthcare significantly.

Malpractice

I practiced plaintiff's medical malpractice law for a short time. It is not easy to win those cases. Juries are actually biased towards doctors. They are also expensive, as well as difficult--expert witness fees run to the thousands of dollars in all but the simplest, most obvious cases (which tend to settle).

I'm with you on assisted suicide.

Malpractice

The unfortunate reality is that we all are helping to pay those malpractice premiums, there are a lot of lawyers/plaintiffs willing to try for that settlement and the Doctors / hospitals err on the side of paranoid to avoid that smear on their record.

For a European benchmark
https://www.loc.gov/law/help/medical-malpractice-liability/germany.php

"The main reasons for the low awards for pain and suffering in Germany are procedural. In German civil proceedings there are no juries or other forms of lay participation. The cases are decided by professional judges and, even though Germany has no stare decisis doctrine, damages for pain and suffering are often awarded according to precedent, even though each case is supposed to be adjudged according to its merits. Commercial publishers compile tables of damage awards for pain and suffering for various injuries, and the judges use these as guideposts."

Brief Rebuttal Your Honor?

"[T]here are a lot of lawyers/plaintiffs willing to try for that settlement . . ." More plaintiffs than lawyers. We turned away more cases than we accepted. The dicey ones are just not worth it.

"In German civil proceedings there are no juries or other forms of lay participation. The cases are decided by professional judges . . ." How do you reconcile that with the Seventh Amendment?

Not Sure

Since I am not a lawyer, I am not sure. But I think modern technology justifies moving away from a trial by common citizens if we truly want to ensure justice is done.

The problem is that the trial lawyers and the "somebody needs to pay" folks will fight this logical step tooth and nail. So I guess this will help our healthcare costs to stay high relative to the rest of the world.

Logical Steps

What seems logical often comes into conflict with very clear constitutional dictates:

Amendment VII

In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise reexamined in any court of the United States, than according to the rules of the common law.

SCOTUS

Seems like this should be tested and let's have SCOTUS decide.

Let's just cut through some of the Bull

Once again (because your memory seems so short), here is the yearly per person cost of providing health care in some of the countries in the civilized or industrialized world:

Italy: $3,207

Japan $3,713

United Kingdom: $3,971

Australia: $4,177

France: $4,367

Canada: $4,506

Sweden: $5,003

Germany: $5,119

Switzerland: $6,787

www.pgpf.org/chart-archive/0006_health-care-oecd

United States: $10,345

www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-...

"The U.S. spends more on health care than other high-income countries but has worse outcomes, including shorter life expectancy and greater prevalence of chronic conditions."

www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-ca...

As tracked since 1980 -- 30 years before Obamacare -- the UK spends 8.8% of its gross domestic product on health care. Canada spends 10.7%. We spend just under 18%.

www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-ca...

It's not that complicated (or in need of further obfuscation):

America's private sector, for-profit owners and material participants in our health care system are conscienceless greed-soaked rationalizers who are charging Americans an average of $5,000 per year more than necessary to provide them with an inferior product on a "Your money or your life" basis and being allowed to continue to do so by our elected officials.

I recommend (again) that you start your contemplation and research on this issue there and do what you can to quit twirling around on things like the random and mostly fatuous ideas on the list at the end of your link.

If we, as a society, simply adopted a hybrid system drawn from the best of the long-tested and proven models of the other countries on that list (and several not on it) we, as individuals, would find ourselves with an additional $4,500 to $5,500 per year in our bank accounts each and every year.

In terms of Minnesota as a whole, our health care costs would drop by approximately $20 to $25 BILLION PER YEAR (more than half our state's budget) if we, as a state, could get OUR per capita/GDP health care spending down to somewhere near Canada's.

(Please point me to the "tax relief" plan that comes anywhere NEAR generating that level of across-the-board -- rich, poor, in between Democrats and Republicans -- taxpayer saving.)

"Saving everyone weakens Americans"??

"Americans insist everyone MUST stay alive"??

You think those are valid and important questions to be asking?

Valid and important areas of consideration for "health care savings"; as in, if only Americans could be convinced to forget those foolish, naive, selfish notions and do their patriotic duty by signing up for (free, government-funded?) treatment at the Kevorkian Center?

You'd be one of the first in line, right?

Or are you someone who doesn't believe in the "everyone MUST be saved" idea but, at the same time, doesn't see themselves on the Expendable Americans list either?

Aware

I am very aware of the numbers, and I am aware that many of the other countries in the world are the beneficiaries of America's expensive system... Kind of like how they benefit from our expensive military. Just think of the huge number of medical devices, implantable devices, and other technologies that we develop in the USA. In this case greed is great for the 7 Billion humans on Earth.

As I have said before, I see pros / cons to both arguments. And factors are just factors whether you want to adjust them or not is another question.

No. It's the prices

Speaking of research, if you'd do a little on your own point you'd see the idea, while sounding good, logical, etc., doesn't come close to adding up.

Here's a snapshot from 2012:

Total research spending by private industry: $70.4 billion

Total research spending by US gov (NIH): $48.9 billion

Total US research spending: $119 billion

Total 2012 US health care spending: $2.8 trillion

As I'm sure you're aware -- and for a little "size clarity's sake" -- $2.5 trillion equals $2,500 billion which means . . .

Private sector research only accounts for 2.5% of US health care cost; public sector research accounts for 1.75%; and, together, all US health care research accounts for just 4.25% of the price Americans are paying.

Again: Do a little research and you'll see it's the prices private sector health care industry "players" are charging (without question or any interference whatsoever) that are the cause of the "cost problem."

As always, you can come up with whatever you can think of to make your case for preservation of the status quo but you can't change the numbers.

Those numbers show that our system is in terrible shape and it's the prices the private sector is charging that have made it that way.

Until that is changed nothing will change.

It's not research and development that's causing the problem.

It's not Obamacare or "the government" causing the problem.

And (in the spirit of non-partisanship) it wouldn't be the AHCA that would be causing (the much worse) problem if it became law.

Those prices are causing the problem.

Contributing Factors

Rarely in life do I find one cause for a complex problem. In this case I have given you quite a few contributing factors.

Here is some more data on another... And folks wonder why healthcare is expensive in the USA...
http://www.who.int/gho/ncd/risk_factors/overweight/en/

Not so fast . . . . .

"I personally am indifferent regarding ACA and ACHA, for most of us Americans they have little impact."

If it goes through as is, it may impact you more than you've realized:

From VOX (https://www.vox.com/policy-and-politics/2017/5/4/15539010/ahca-lifetime-...): "A little-noticed provision in the Republican health care bill could allow insurers to reinstate lifetime limits in health insurance. This change would affect Americans in the individual market as well as the 159 million Americans who get health insurance at work, and it would be particularly dangerous to people or families with chronic conditions that require millions of dollars in medical treatment."

and

"A single state’s decision to weaken or eliminate its essential health benefit standards could weaken or effectively eliminate the ACA’s guarantee of protection against catastrophic costs for people with coverage through large employer plans in every state,”

Yes

I am perfectly aware that the Liberal view is to try to protect almost everyone from most everything via more regulations no matter the cost.... Especially if that cost can be passed on to other tax payers who they think have too much money...

But I will stick with my original position... "for most of us Americans they have little impact"... Now I do understand that a very small group of Americans may run into problems... However I am not willing to burden the whole system and all of the members for that possibility.

The idea of unlimited benefits for a very defined and limited payment amazes me... Are you willing to increase everyone's cost accordingly? Not just the unfortunate few wealthy people who have been paying it since ACA passed?

John, do you know anyone in a

John, do you know anyone in a nursing home, covered solely by Medicaid ? Have you ever ran into an impoverished pregnant woman who needs health care ? Have you ever run into anyone who is permanently disabled by physical or mental causes ?

That's about 1 million people in Minnesota that are covered by Medicaid--about a fifth or sixth of the population.

Surely you know at least a couple of them. Perhaps you've even had a relative or two that is in a nursing home having "spent down" their resources to qualify for Medicaid ?

Do they have such unlimited Medicaid benefits that doctors and hospitals and nursing homes are tripping over themselves to serve them ?

No, they get the minimal grudging services from a limited number of providers because Medicare reimbursement is so low.

The biggest part of the AHCA cost savings is related to cutting/limiting Medicaid, whereby less money will go to fund services for those million Minnesotans.

Perhaps another gold-plated bathroom for the Trump family.

Do you think the million Minnesotans will get even better services with even less reimbursement ?

Death panels, indeed.

My Old Question

Why do Liberals not trust State and Local governments, and the people in the States, to care for their neighbors?

This endless insistence that the Feds need to collect the money, create a sea of regulations, pay for oversight, then choose who gets what, the state needs to hire people to oversee the transfer, keep the records and deal with the audits seems awfully expensive and full of waste.

I vote for getting the Feds role reduced, I think Minnesotans can care for our own.

As for the benefit limit, Pat seems concerned about that. I believe that benefits should be related to premiums paid. If we want unlimited benefits, we should all get out our checkbook and not just the 1%...

I guess I would say, it's the

I guess I would say, it's the GOP that isn't trusted to look out for their neighbors--national or local.

ST. PAUL, Minn. (AP) — Senate Republicans said Monday that they want big cuts for many of Minnesota's social services programs, while state officials and Democrats believe that could harm families with unexpected pregnancies and those who receive medical assistance and social security.

The GOP's $15.4 billion bill showed a $671 million gap between Democratic Gov. Mark Dayton's and the Senate Republican budget proposals for all health and human services programs over the next two years — with the Department of Human Services seeing the biggest cuts. Monday's Committee on Health and Human Services meeting dealt mostly with the budgetary aspects of the 400-plus page bill because Senate staffers had yet to compile the lengthy legislation's policy effects, angering Democrats on the committee.

Ah

What they want and what they will get will likely be very different. And if the people of MN don't think things are headed the right direction. We in the state can adjust relatively quickly. And please remember that there are 2 very valid sides to this topic.

I just asked one of my hard core Conservative readers the following... He had a bad experience with Medicare which adds to his distrust of gov't managed healthcare.

"Just curious... How do you keep these 2 very different things in your head without it exploding?

- Based on your personal experience, dooming people to rely on ER rooms, the charity of Doctors / Hospitals and gov't healthcare to save their parent / child is terrible. (ie some people will die)

- Providing significant health insurance subsidies so that people can afford good private health insurance is terrible. (ie takes money from hard working citizens, lazy people may benefit, promote continued generation poverty)

Now personally I can see that there is a trade off to be made here, and that neither extreme is GREAT and neither is TERRIBLE. Where as both the far right and the far left certainly seem polarized.

Trust our legislators?

I'd trust our legislators more on the issue of health care if they were committed to having the same insurance they're trying to foist off on the rest of us. Unfortunately, the Republicans have already sneaked in an amendment excusing them from this, so they can keep their gold-plated taxpayer-paid health insurance while telling others with cancer to "suck it up." How STRANGE that anyone should mistrust them!!!

Seems

Excellent point!!! But it seem both parties did that since ACA never applied to the Congress after the Obama and crew passed it. Though maybe it did since the government offers insurance. (ie like a big company)

Pat's point

I was responding to your statement "I personally am indifferent regarding ACA and ACHA, for most of us Americans they have little impact."

So it appears that if you are required to "get out your checkbook" and write a big one in the event that new healthcare legislation resulted in your company deciding to go with the lowest common denominator when it comes to the cost and coverage of health benefits available to you, you would define that as having "little impact" on your life?

Actually

Actually I had to start watching my diet much closer... And should start exercising more...

They implemented a healthy lifestyles credit that has some real teeth... My family plan premium increases by ~$250 a month if my wife and I do not keep our weight, cholesterol, sugars, blood pressure and triglycerides in a good place... Makes sense to me and I am eating a salad right now because of it.

Please remember that I think in terms of total compensation... I have faith that companies will offer what is necessary to keep good employees working for them.

There but for the grace of God . . . . . .

Well then, I guess you had just better hope that - if the AHCA goes through - that neither you nor any of your family members ever develop any kind of catastrophic or chronic health problem whose cost to manage could quickly exceed that $250/month you're so proud of avoiding. Not everything is controllable simply through "healthy lifestyles" choices, and insurance companies reinstating lifetime and/or annual caps on coverage could leave you financially ruined just as readily as it could those whose "lifestyle choices" you're so quick to condemn.

There but for the grace of God . . . . .

Sorry

Please remember that I live in Minnesota and trust my neighbors to make the correct call for our citizens. I have no need nor desire to have the Feds collecting extra taxes, mandating coverage, spending on an extra bureaucratic organization, etc.

Same question... What is it with this reliance on the "Grace of the Feds"? You do realize that we MN's are paying for those Fed programs... Correct?

And you are correct that not everything is related to healthy living... But it sure is important if you want to reduce the amount of time and money you spend on Healthcare.

To me ACA and AHCA are different, but not HUGELY different...

See the republicans' actions in mn so far

For a response to your third paragraph - major tax breaks for the rich just like major breaks for the rich and insurance companies in acha. Poor and lower middle class people who voted for trump and mn legislators should just get ready for no medical insurance or actual tax relief. They will wake up!

Remember

This activity is not some change to a long term tax policy. The tax increases were just implemented 7 years ago to take from those "Peters" to pay the insurance bills of the "Pauls".

Many of the Trump voters believe in being more self reliant. To them the idea of government mandated wealth transfer is immoral. I think they will be fine. And my self employed farmer friends have seen nothing but huge premium increases and no subsidies from ACA. I think they are cheering.

While you may not care about

While you may not care about the alphabet, you might have known a geezer or two in a nursing home dependent on Medicaid. You may occasionally drive by a child who has no means to pay for their health care or dental care. You might know a mother who just gave birth to a precious life (heartbeat at 6 weeks, doncha know!!) who has no money and their child is not breathing well. You perhaps just might know one of the 74 million people who are dependent on Medicaid.

Medicaid reduction (and harm to those 74 million people) is a significant and distinct part of this tax-reduction effort.

Do you really think that reduced services and compensation for services will improve the lives of any of those 74 million ?

It's certainly not an effort to improve health or health-care, nor is it an effort to bring the overall cost of health-care under control. Its true aim is to reduce the amount of that cost paid by a certain class of tax-payer (could it be the 1 % !?!). 'cause the total cost of medical care will not go down because of the new bill.

It's the new death panel.

By the way, each of your working neighbors share of Minnesota Medicaid ($ 10 billion total) would be about $4000--they may let you borrow their lawn mower--but would they cough out $4000 for the geezer in the nursing home or the unwed mother, or the kid that needed surgery ?

Competition?

We've always had competition in our Health Care System, yet per capita spending on Health Care in the US had more that doubled since 1990. Are you going to tell me it would have tripled if we didn't have competition? If that were to be true, that shows a failing system, not a good system.

I wonder what your last comment means? My local paper is advertising for a fund raiser for a local cancer victim, others use gofundme campaigns to pay for catastrophic health care related bills. Is that what you're suggesting? That we rely on fund raisers and public requests for money so we can pay for life saving medical treatment? Shall we line Chicago Ave with children begging for money to pay their bills at Minnesota Children's? Is that what the wealthiest nation, a "Christian" nation has come to?

Quality Cost Availability

The USA system arguably has the best Quality and Availability in the world for those who cam afford to pay for it. I assume that is why the wealthy and famous of the world come here when they have serious problems.

We also pay more to fund a ton of R&D and product development that help people around the world. And we are happy to spend a ton of money on end of life care. These and other factors on my list are what increase our costs.

And yes I am a huge supporter of charity and go fund me pages are great. This allows people to give and receive. These actions allow the recipient to feel gratitude and the giver to feel happiness. Things that do not happen with taxes and entitlements.

Sad!

As a cancer survivor who works full time for an employer who does not provide health insurance, it's sad to see so may, like you, who don't care about their fellow Americans. If they are not personally thrown under the bus, they care nothing for those who are.

I guess the "life" in "life, liberty and the pursuit of happiness" is meaningless.

Time to repeal and replace the GOP.

Silly Idea

Maybe it would be a good idea to find a better employer...

What is your rationale that others should be forced to pay for your healthcare bills?

Have you paid your healthcare premiums and helped fill the insurance pool your whole adult life?

Or did you save some money and take a chance? Just curious.

And this is why we don't

And this is why we don't trust our neighbors--your neo-calvinist "if you don't have what you need its because you don't deserve it" says it all.

Your Results May Vary

The joy of free will is that people are free to believe, choose, do, etc what they want to. The upside / downside is that there are natural consequences of each choice.

Are you arguing that the resulting consequence should be the same whether one studies, learns, works, exercises self control, etc or if one does not?

If our society does change so that everyone gets "free" food, healthcare, housing, income, etc no matter the choices they make in life... I wonder how many will choose to make good vs bad choices?

The war on poverty results are not encouraging. Single parent households are at an all time high and many children are still failing in school...

Please explain....

"What is your rationale that others should be forced to pay for your healthcare bills?"

I had the "opportunity" to spend several hours in two different ERs earlier this year. I would suggest to John that he invest a few hours of simple observation at the ER of his choice. And if he could answer one simple question we will be well on our way to compromise and agreement:

Position yourself near the admitting desk, listen to the cases coming in. Move to the waiting area and chat up a few of the sometimes not patiently waiting clients. It won't take long to witness first hand the number of uninsured, often irresponsible, sometimes belligerent, and sometimes gravely ill and injured folks coming in. Now tell us how you would manage the incoming crowd with your first words from your seat at the admitting desk being:

"What is your rationale that others should be forced to pay for your healthcare bills?"

Who get to pass GO?

Been There Done That

Unfortunately I have gotten to spend some time in the ER waiting room... (ie wife and 3 kids...) I guess I think of it as balancing between 2 extremes, as I posed to a conservative reader earlier...

- Based on your personal experience, dooming people to rely on ER rooms, the charity of Doctors / Hospitals and gov't healthcare to save their parent / child is terrible. (ie some people will die)

- Providing significant health insurance subsidies so that people can afford good private health insurance is terrible. (ie takes money from hard working citizens, lazy people may benefit, promote continued generation poverty)

Now personally I can see that there is a trade off to be made here, and that neither extreme is GREAT and neither is TERRIBLE. Where as both the far right and the far left certainly seem polarized.

So do you think there should be no negative consequences in the healthcare arena for making poor choices in life? Should everyone get a free high level of expensive care no matter what they do or how many kids they have? How will that help encourage them to make better choices?

Well, not exactly...

Unless we are to sign onto the crowd chants at one of the GOP presidential debates:

"LET THEM DIE"

We are in agreement that something must be done. Here is the list of the "basic" Medicaid benefits required by the US Government to participating states:

Outpatient hospital services
EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
Nursing Facility Services
Home health services
Physician services
Rural health clinic services
Federally qualified health center services
Laboratory and X-ray services
Family planning services
Nurse Midwife services
Certified Pediatric and Family Nurse Practitioner services
Freestanding Birth Center services (when licensed or otherwise recognized by the state)
Transportation to medical care
Tobacco cessation counseling for pregnant women

Not exactly a "Cadillac Plan". Seems reasonable to me. What would you see as needing/deserving elimination?

You better find a few,as the House plan knocks 900 billion from Medicaid.

Believing that we can take 1 trillion of government support from healthcare and it will only get better is drinking far right kooky kool aid: It simply ain't going to work.

The Answer Is

So from your response I assume you believe that everyone standing on American soil does deserve the same level of healthcare no matter how they have chosen to live their life. (ie no responsibilities)

And that it is the responsibility of the people who choose to learn, work, save and invest is to pay enough in extra taxes to ensure it happens.

That is one option... By the way, if the feds cut funding... States can choose to raise taxes if the people support that.

Question for Your Answer

"So from your response I assume you believe that everyone standing on American soil does deserve the same level of healthcare no matter how they have chosen to live their life. (ie no responsibilities) . . ."

How much in medical resources did J. Paul Getty III require? He was the heir to a large fortune who overdosed on drugs and alcohol in 1981, but who received daily therapy and personal care for the next 30 years of his life.

Getty, along with other family members, became citizens of Ireland to avoid taxes.

Do Not Know

It is an interesting story though. And it looks like the family ended up paying for his care.

http://www.washingtonpost.com/wp-dyn/content/article/2011/02/07/AR201102...

What was your point?

My Point

Mr. Getty was able to get very expensive health care for a condition brought about entirely by his own self-indulgence. His money came from inheritance.

Does he deserve that level of care more than anyone else?

Sorry

I come from a long line of conservative saving investing giving workaholics and have been trained to think very long term. I just see it as the Grand Parents and Parents paid for the care of their worthless son. It seems that they were willing to cut him off and let him suffer but a judge forced them to care for him.

So let's see how consistent you are... If the Parents had cut this worthless human off... How much should the tax payers pay to care for him? And for how long?

What level of care was owed to him for standing on US soil?

Missing My Point

You have been the one to emphasize personal responsibility, and a certain "worthiness" to receive society's largess. So I ask you: does a person who puts himself in a chronic condition through his own indulgence deserve better or more extensive care just because he made the very clever choice to be born into a wealthy family?

"What level of care was owed to him for standing on US soil?" Since he renounced his US citizenship for tax reasons, I would say that is a matter for the Republic of Ireland to decide.

Avoidance

Yes there is luck in who you are born to and where you are born. And yes life is not fair... And of course people can use their personal property to care for their adult children. I think most of us Parents see that as a earned benefit of learning, working, saving, investing... So I guess he does deserve that level of care, maybe his Parents even owed it to him if they helped screw him up. The judge certainly thought so.

Back to my questions:
How much should the tax payers pay to care for someone?
And for how long?
What level of care was owed to them for standing on US soil?

What Level?

I would say an obese smoker who does not work is entitled to no lesser degree of care than the decadent grandson of a billionaire who drinks and snorts himself nearly unto death.

Call it what you will, but I like to think of it as human dignity.

Well, not exactly...

We both seem to agree that we cannot ethically, morally and practically take the:

"LET THEM DIE"

path of GOP Trumpian stalwarts. So that means we can hopefully find compromise somewhere between:

"OK, show up in the ER and we'll help you out" (Which you seemed to agree with)

AND

"A basic level of guaranteed care aimed at keeping folks out of the ER" (Which I find reasonable)

Do you disagree with that? I think the Medicaid basic reqs. provided a starting place to find a compromise. What did you find troublesome in the Medicaid basics?

Again, the house bill does not solve a healthcare problem as much as it solves a how to pay for a tax cut problem.

Unsure

I am not sure the benefits matter as much as the goal... I was fine with ACA except the funding mechanism was too progressive... If we all agree that we want to provide free healthcare to some of citizens, then we should all pay.

The question comes back to Neal's quote...

"Therefore, everybody should just take it easy, and the government must provide for them? No. Another moral principle is that everyone is responsible for his or her sustenance, but if something beyond his or her control gets in the way, either by personal misfortune or more general problems, such as emanating from in society, public authority cannot simply ignore anyone in need. "

How do we set up a social support system that holds our lower performing citizens to the requirement of striving to provide for their own sustenance?

I simply believe that all citizens have basic responsibilities that they must fulfill in order to earn all the benefits this society offers. We make successful people pay taxes, what do we make unsuccessful people do to support the continued success of our country?

The idea of continuing to give them more and more benefits, at the expense of others, with NO accountability for improvement, learning, work, etc seems to lead to a bad place for our country.

Replies

"Maybe it would be a good idea to find a better employer" -- Sure, because it's just so easy to find one that provides affordable health care. Tried it lately? Didn't think so. That's typical blame-the-victim thinking. Sad!

"What is your rationale that others should be forced to pay for your healthcare bills?" -- You're putting words in my mouth. I never said that, no one is, nor do I expect it. I just want affordable health care. Something every other "first world" country has.

"Have you paid your healthcare premiums and helped fill the insurance pool your whole adult life? Or did you save some money and take a chance?" -- I'm 55 and I've been paying for insurance since I was 18. No lapse in coverage Thank you for asking.

Choices

I am sorry but we choose our employer, we choose our education, we choose our job, etc. I am not blaming a victim, I am explaining the reality that choices have consequences.

The simple reality is that ACA expanded Medicaid, provided subsidies, coverage until 26, pre-existing condition coverage and capped premiums for older people to 3 times... by transferring those costs to other citizens. (ie tax the wealthy, cutting FSA yearly amount, medical device tax, higher premiums for all, etc) It made some citizens pay for the care of others. It did little to attack the factors I listed above, that is why I asked about your rationale for supporting it.

Then I am happy that you have the pre-existing condition mandate in force. My frustration is that apparently a large number of people are signing up, paying a few months of premium to get major surgery and then dropping out again... I like to call it pre-existing conditions fraud and it is part of why the ACA premiums keep skyrocketing.

Claims

You claim that "apparently a large number of people are signing up, paying a few months of premium to get major surgery and then dropping out again".

Please provide a source for your claim.

Even if said claims are true

Even if said claims are true (and I don't think they are to any great extent), that's a problem that could be easily fixed by making some changes to the ACA. You don't have to toss the whole thing out and kill the health insurance of 20+ million Americans.

A fact that applies . . . . .

A fact that applies to this whole sorry situation. The ACA could have and SHOULD HAVE had the inevitable kinks worked out of it in the months and years following its passage. A process that has been routinely followed to repair inadvertent gaps, problems and omissions in any large and complex piece of new legislation. Then the problems could have been addressed, and what was a good start could have become a really successful way to address the needs of Americans all across the country.

Instead, one party was so hellbent on making sure Obama would fail that instead of coming together to fix the bill, all they could do was run sham vote after sham vote to repeal it, file lawsuits over its problems instead of working on ways to repair them, and just generally keep putting party over country, costing Americans dearly in the process.

Really

Do you really think the Democratic politicians would have met the GOP half way?

The ACA was a HUGE TAX and GIVE AWAY exercise. Where in the world would the two sides even start? I mean the Democratic Party passed it with no GOP support.
https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

I am not disagreeing with you that it would be nice if both sides would play nice, but it seems that both sides are incredibly dug in on this one. I haven't seen any Democratic politicians coming over to work with the GOP on AHCA.

They didn't even try

They (Republicans) just immediately set out to do everything they could to kill the bill rather than even try to repair it.

I Think

I think the folks on the far right would disagree with your opinion. They just see AHCA as ACA lite...

Hardly

The time to start working to help repair the bill would have been right after it was passed in 2010, not now, seven years later.

The Present

The Present is one of my favorite books.

Learn from the Past
Help Create the Future
but spend most of your time

Living in the Present

What can the Democrats do to help a more reasonable version of AHCA get passed?

Thereby taking the power away from the Far Right?

And will they do that?

No efforts by GOP

President Obama told Nancy Pelosi and House Democrats to cool their heels for months while the bipartisan Gang of Six on the Senate Finance Committee tried to reach a compromise. It was only after Chuck Grassley said that Republicans couldn't support *any* bill that Democrats moved forward and passed the best bill they could get the votes for.

Can you show me any similar efforts made by President Trump and Republican Congressional leadership to reach out to Democrats on the AHCA?

Agreed

The GOP is slightly more difficult than the DEMs... But not by any huge amount...

Um...

Obama stopping the process for months in search of bipartisan agreement and Trump/Republicans doing their process with zero efforts at outreach are not remotely similar.

Why

Silly question but why would the GOP reach out at this time? From what I have read and seen, the DEMs have adopted the role of government obstructionist hook line and sinker. Look at the Gorsuch vote if you disagree... Apparently this is our new reality for the foreseeable future.

And as we have discussed before, with Liberals watching their news sources and Conservatives watching their news sources... I do not see how this changes... I like to play in the middle of the road and most people just get frustrated with my comments. I have Conservatives calling me Liberal and Liberals swearing I am Conservative...

It is a messy situation... I hope we figure out how to become one country again. :-)

Relative

A relative who works at a major health insurance firm... I don't know how large the number was but it definitely had their attention. Imagine collecting just $1,500 and paying out $40,000 for a new hip, knee, etc...

Apparently their data indicated which people would do this... But ACA makes no exceptions so they just had to raise the premiums on everyone to pay for it... Bummer...

Anecdotal

So the support for your claim is anecdotal. Okay, then . . . .

Anecdotal

"Anecdotal: not necessarily true or reliable, because based on personal accounts rather than facts or research."

I prefer to think of it as inside information from a credible source. I am pretty sure this very large insurance company who operates in every State has ground the numbers before increasing the premiums each year. Why do you think the ACA premiums keep sky rocketing?

And do you really see all consumers being so ethical that they would not do this?

If everyone is that ethical... Who are all these folks stealing identities, credit card numbers, shop lifting, or worse? Do you really think those folks would think twice before taking advantage of that big insurance company?

Of course they forget that all of us customers need to pay more to cover their choice...

The anecdote . . . .

comes from you.

Avoidance

I leave all those great questions and that is your reply? Please expand on this.

Why?

Why should I spend any time replying to something supported only by your anecdotal retelling? You have presented nothing verifiable that actually supports your claim.

Choices

Please remember that I am Switzerland regarding this topic... I spend as much time on one side as the other. My biggest problem is how ACA was paid for.

If you choose to deny that there are people in our society who are fine with undertaking fraudulent, criminal and/or free loading activities, please feel free.

It would be nice if you were correct, then we would not need nearly as many police, judges and prisons.

Interested in your thoughts

"Maybe it would be a good idea to find a better employer..."

Could you provide your rational as to why my employment status should have anything to do with health care? Why is it that if I lose my job, through no fault of my own, I lose my health care?

It seems non-nonsensical. Every other "first world" country has figured that out. I'm curious as to why conservatives continue to cling to this notion. How do you equate health care with employment?

Mandate

I am fine with separating employment from insurance, however it seems pretty entrenched.

I would like a strong free market and an insurance mandate, just like car liability insurance. Though it is nice to have the company handle the paperwork.

Now why are Conservatives against government managed healthcare... My guess is that they look at how expensive our military is and how expensive / challenged our public education system, and they say NO WAY do I want to subject myself to that...

Reactions:Isn't this the

Reactions:

Isn't this the 60th time they've done this ? Does it mean anything other than the same dead-headed thing than it did before ? The only reason why it passed was with the reassurance that it really wasn't going to mean anything and the "adults" would fix it and make it better.

Second, there is confirmation of the TPM Iron Rule of "moderate Republicans"--they always cave under pressure.

Third, Lewis, Paulson and Emmer deserve all of the possible fallout of this.

Fourth, Trump and Ryan doing victory laps seems a tad premature.

Fifth, rolling out the cases of beer on the floor to celebrate will be a killer graphic in the next election.

Sixth, any future BS on the sanctity of precedent and procedure is clearly that--only a couple of hours to read, debate and pass a measure that affects a sixth of the national economy and will directly affect the lives of a tenth of Americans in an adverse manner. Yes, celebrate while you can.

Precedent and procedure

This guy, Simon Maloy, put it pretty well . . .

"As we speak, Republicans in the House of Representatives are busily rewriting the major health care reform bill they plan to vote on tomorrow. The point of all this last-second activity is not to improve the terrible law but to give it a slightly better chance of garnering enough GOP support to actually survive the upcoming vote. If House Speaker Paul Ryan and the Republican leadership were interested in crafting a workable bill that fixes problems in the health care system, they would be taking their time to carefully work out a resolution through the legislative process. Instead, they're trying to crash land the flaming piece of wreckage that is the American Health Care Act."

www.salon.com/2017/03/22/trumpcares-premium-spikes-heres-how-the-republi...

Moral and intellectual bankruptcy

is what's indicated by the House passage of this abomination that carries only the faintest whiff of health care to accompany its gigantic tax break for the upper one or two percent of the population, while effectively tossing millions who had finally managed to acquire health insurance coverage back into their previous situation. To rely on health insurance companies for mercy is to place one's neck on the block and hope that the guillotine's very simple mechanism somehow, magically, fails.

That this cruel impersonation of a health care bill was passed by the House without even a plausible attempt at the due diligence that responsible lawmakers would normally require says far more than Republicans would like about their fiscal probity and concern for their fellow citizens. Both are totally absent from this bill. Thousands in Minnesota will either lose their health coverage, or find that their deductibles have risen by more than 50%, or that the improvement promised for years by the cruel ideologue in the form of Paul Ryan is all smoke and mirrors. If there is any justice, and I'm not sure there is, Republicans who voted for this bill will be burned in effigy and voted out of office in the next election cycle. If the President signs it, we'll need no further proof that the President is the fraud and liar a good many who opposed him said he was during the campaign.

For a more articulate condemnation than my own, see Jonathan Chait: http://nymag.com/daily/intelligencer/2017/05/trumpcare-an-abdication-of-...

Really?

"I mean even if the Feds totally exited Healthcare, do you have so little faith in your neighbors that they will do right by the truly needy people in your State."

Fred, after paying attention to how my Republican representatives and senators have voted in St. Paul over the last decade I have no faith, let alone a little. And it's not just health care, transportation, education funding, housing, social programs, minimum wage, etc., the list goes on and on. When a basic strategy is to pit white outstate Minnesota against the largest urban area on practically every issue, why even ask an absurd question like that?

Difficult not to notice

…all the old white men grinning in the photo that leads the column. Perhaps I should pick up the pace of my reading of "The Handmaid's Tale."

Yesterday in MAGA (Trump to

Yesterday in MAGA (Trump to Australia PM):

"We have a failing health care — I shouldn't say this to our great gentleman and my friend from Australia," Trump said, "because you have better health care than we do."

Australia's health-care system is run by the government. It's essentially a single-payer, Medicare-for-all system that is available to everyone, with private insurance also available. (They even call it "Medicare.")

A new twist on Andersen's tale

Amazing, not only is the prez The Emperor who has no clothes, he's also the child at the end of the story who tellls everyone that the emperor has no clothes.

Moral Abomination

The so called Party of God, supposedly filled with those who would have us believe they are the guardians of the sanctity of life, just voted for a bill that will remove health insurance from a mind boggling twenty four million Americans, and likely more than that. All in slavish devotion to ideology and in service to the wealthiest among us, giving them a tax cut of $1T over ten years.

Is that tax cut worth denying Medicaid to the least among us?

This is absolute moral depravity, and to think it was even celebrated with libations and a Rose Garden press op.

Shame on those 218 representatives. And shame on Speaker Ryan, who claims his Catholic values inform his politics, politics whose only goal seems to be afflicting the afflicted and comforting the comfortable. What a shocking display of immorality from those who hold themselves out as the party of morality.

Fascinating

You must have a different interpretation of religion, charity and morality.

I must have missed the lessons regarding how the moral thing for individuals to do is to promote society forcefully taking $1 Trillion from certain citizens so that it can be given arbitrarily to other citizens.

It seems to me that the morality can be questioned on both sides.