Republicans are redefining what it means to “fix” Obamacare, now that they’re in the driver’s seat. And they're doing it because a lot of the other things they had promised to "repair" did not get tackled, at least in the House-passed bill.
Congressional Republicans have lobbed a broad range of criticisms at the Affordable Care Act in the six-and-a-half years before their chance of repealing the law materialized last November. They yelled from the House and Senate floor, on the campaign trail and around their districts that Obamacare would destroy jobs, cost people their health coverage and diminish the quality of care.
But now many Republicans, especially conservatives, are judging their own success at replacing the health-care law by just one benchmark: whether it lowers insurance premiums. Not how many people it covers. Not how much it lowers federal spending. Not whether it reduces red tape.
Sen. Ted Cruz (R-Texas), who has beaten the anti-Obamacare drum perhaps harder than any other member of Congress, has fully embraced this much narrower goal. The ultimate test of success or failure, he told a group of us yesterday, is whether a final GOP plan lowers premiums.
“If we drive down the cost of premiums so that people who are struggling can more easily afford health insurance for their family, we will have succeeded,” Cruz said.
And if that doesn’t happen? “If the cost of premiums continues to skyrocket, as they have under the last seven years under Obamacare, than we will have failed,” Cruz said.
It’s true that premium hikes are among the problems Cruz and other Republicans have with Obamacare. But that’s far from the only metric they’ve used to measure it. Just revisit Cruz’s epic floor speech in September 2013 railing against the ills of Obamacare -- a hard volley in his pretty singular crusade to orchestrate a government shutdown over refusing to fund it.
In that 21-hour-and-19-minute speech, Cruz mentioned premiums 37 times. But he talked far more about the law’s perceived effect on jobs, the economy and access to health coverage. He used the word “jobs” 128 times and the word “losing” 56 times. At times, the future presidential candidate didn't even mention premiums while listing his top problems with Obamacare.
“How many more Americans will have to lose their jobs because of Obamacare before Congress acts?” Cruz asked rhetorically at one point. “How many more Americans will have to see their wages or their hours cut as a result of this ill-conceived law before we do something about this? How many more people will have to lose access to health coverage before Congress does something?”
If you’re not convinced that's there been a rhetorical bait-and-switch, take a look at this letter Rep. Mark Meadows (now the House Freedom Caucus chairman) wrote to House leadership around the same time, asking them to refuse to pass an appropriations bill funding Obamacare.
Meadows -- and 79 other House Republicans who signed the letter -- cited job losses, insurance policy changes, violations of religious freedom and strains on state budgets from Medicaid expansion as reasons for defunding the law. They didn’t mention premium costs at all.
Things are different now. An amendment allowing states to opt out of some insurance regulations -- which could potentially drive down premiums in some places -- is what ultimately got Meadows and other HFC members on board the GOP health-care bill. Meadows told reporters in March that his support for the bill came down to whether it would lower health-care premiums “in a significant way.”
It’s not entirely strange that Republicans are suddenly fixated on lowering insurance premiums. Most Americans can’t afford health insurance without assistance (either from their employer or the government) and the issue plays well politically. It is also perhaps the best talking point that Republicans got out of the seemingly endless negotiations in the House bill, which many conservatives feel does not go nearly far enough to repeal Obamacare. Lowering premiums is something everyone can understand.
Republican also know they’re not winning on the number of people covered, as their bill would reverse recent improvements in that department. And if they want the government to spend less money helping people buy plans, the only way to make insurance affordable is to lower its costs directly.
But there remains the thorny question of whether premiums will actually go down.
The Congressional Budget Office has said the House health-care bill would ramp up premiums initially, compared to under current law, but then lower them somewhat. Once the CBO finishes scoring the legislation with the last-minute amendments, it could determine that premiums would decrease even more, now that states could opt out of some insurer regs. But here's the verdict, for now:
--Premiums for individual market plans (in other words, non-employer plans) in 2018 and 2019 would increase 15 to 20 percent more than they would otherwise. That’s because the measure would remove the fine for being uninsured, thereby prompting fewer healthy people to enroll.
--But starting in 2020, other factors are expected to put downward pressure on premiums, including a younger mix of enrollees, the availability of money states could use to cover expensive patients and the lifting of some insurer regulations. By 2026, average premiums would be 10 percent lower than under Obamacare.
House Republicans are at least temporarily okay with how their bill would affect premiums. But at least one Senate Republican, Sen. Bill Cassidy (La.), doesn’t appear to be fine with it. He told me yesterday he’s worried about passing legislation that would prompt any premium increases, even temporarily.
“My sister-in-law calls me from San Francisco -- they’re paying $20,000 a year and a $6,000 deductible per family,” Cassidy said. “Now we should all be concerned about this. This is pricing middle-class families out of the ability to afford insurance.”
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AAH: The dean of our Capitol Hill team, Paul Kane, explains that the path to a health-care compromise is through states that have expanded Medicaid under Obamacare and the senators who represent them. Paul breaks it down for us: "All told, there are 20 Senate Republicans who hail from states where their governors accepted federal Medicaid funding to provide increased coverage ... These 20 senators represent more than 4 million constituents whose health-care coverage comes from the ACA’s Medicaid expansion." Four top senators to watch are: Shelley Moore Capito (West Va.), Rob Portman (Ohio), Cory Gardner (Colo.) and Lisa Murkowski (Alaska). "Those four senators, representing more than 1.3 million constituents benefiting from the expansion, are enough to torpedo anything that does not comport to their wishes on that single issue," Paul writes.
OOF: Health-care negotiations in the Senate are currently centered in this 13-member working group, which includes moderates like Portman and Gardner and conservatives like Cruz and Mike Lee (Utah). My colleagues Robert Costa and Sean Sullivan delve deeper, reporting that the group is "at the center of a fragile connection between hard-liners and leadership that may be the Senate’s best chance to pass its own version. The strategy, according to interviews with two dozen Republican senators and aides, is to bring together lawmakers with starkly different views, let them talk — and keep them talking until consensus is reached, in a process that could drag on for months.
... There’s one big problem: Many of the key Republican senators who could stand in the way of a successful health-care vote are not in the group. And some of them are forming their own coalitions ... the three biggest issues yet to be reconciled are the scope of coverage for people with a preexisting injury or illness, health-care tax credits and Medicaid. Many differences remain among members of the working group itself."
OUCH: There's a serious communications clamp-down going on at HHS -- so much so, that two congressional Republicans are rebuking Secretary Tom Price for his new policy requiring senior HHS staffers to get official permission before any communications with members of Congress or their staff. Sen. Chuck Grassley (R-Iowa) and Rep. Jason Chaffetz (R-Utah) said the policy that Price’s chief of staff outlined in a memo last week “is potentially illegal and unconstitutional, and will likely chill protected disclosures of waste, fraud, and abuse."
Here's what we know so far about how Republicans are approaching health care in the Senate: A measure will be crafted behind closed doors among 13 Republicans (and likely a few more), it won't go through committee hearings and it could look significantly different than the House's American Health Care Act.
--Senators emerging today from the group's third meeting wouldn't give a specific timeline for having a measure ready. "No, no," Sen. Ron Johnson responded when asked whether a timeframe was discussed. "We want to get this right." But Johnson added that there will be a vote eventually. "We were told we're going to be voting on this one way or the other," he said.
-- Sen. Orrin Hatch of Utah said efforts to replace Obamacare are complicated because once the public "is on the dole," they'll "take every dime they can." The comments, coming from a top committee chairman likely to pull heavy influence in the working group, reflect the fear Republicans (and Democrats, too) have at taking away government benefits people are already getting. Democratic Sen. Patty Murray blasted Hatch's use of the words "on the dole," saying that people benefiting from the ACA are "working families" in circumstances "most of us hope we don't get into."
--House Speaker Paul Ryan is suggesting his own timeline, now that the health-care bill is off his plate. "Hopefully, it takes a month or two to get it through the Senate," Ryan told Fox and Friends yesterday.
But Ryan's not totally on easy street. The speaker's former habit of cruising around the Capitol with ear buds in his ear might have come in handy yesterday, when he was greeted by rowdy protesters outside a school in Harlem. Several hundred people gathered outside the charter school Ryan was scheduled to visit, mostly chanting about GOP efforts to repeal the ACA, Politico New York reports.
--Rep. Dave Brat of Virginia, an outspoken Freedom Caucus member, encountered hundreds of people booing, laughing derisively and shouting at his town hall meeting last night. And about 30 demonstrators gathered outside the district office of Rep. Dana Rohrabacher of California, holding signs that read "Just say no to Trumpcare" and "Putin's favorite congressman."
--Other Republicans meeting with criticism back home have responded in varying and sometimes weird ways. Rep. Peter T. King of New York said the GOP health bill is too serious a topic to celebrate, the way President Trump and other Republicans did in the Rose Garden. Believe it or not, Rep. Jeff Denham of California called the bill "bipartisan" even though not a single Democrat voted for it. Denham is among seven Republicans being targeted by House Democrats ahead of the 2018 election.
Some who are angry about Obamacare repeal are going beyond just tame protests. My former Politico colleagues Kyle Cheney and Ken Vogel write of "macabre theatrics" some liberal groups are using. Like carting caskets to Republican districts and encouraging constituents, should they die, to ship their own ashes to lawmakers. How clever...and morbid.
On the flip side, the conservative American Action Network will launch today a $250,000 digital ad campaign urging constituents in 25 districts to thank their member of Congress for voting for the GOP health-care bill. Over the next two weeks, the group will run the ads on Google and Facebook aimed at encouraging Ryan, Majority Leader Kevin McCarthy (R-Calif.), several others in leadership and some moderates who reluctantly voted for the plan. ANN has already spent more than $12.7 million to promote the American Health Care Act and other conservative health-policy ideas.
Here's a peek at the ad:
Where was HHS Secretary Tom Price yesterday? Looks like he and White House counselor Kellyanne Conway spent time in Michigan and West Virginia yesterday to discuss those states' heavy problems with opioid abuse:
But what's interesting here is the backdrop: The Trump administration is seeking to slash the White House Office of National Drug Control Policy, proposing in a memo that circulated last week to cut its budget by nearly 95 percent and cut 33 employees, almost half the office's staff. The cuts would affect the office's intelligence, research and budget functions and several state-focused programs.
Nonetheless, Price insisted the proposed cuts hide the "big picture," saying in Michigan that Trump's devotion to the issue is "absolutely unquestionable."
“Through the Office of Management and Budget, the department and the White House, we’re working to make sure those resources are in the place where they can have the greatest amount of effect, the greatest influence brought to bear,” Price said.
During their stop in West Virginia, a reporter was arrested for trying to ask Price a question about the GOP health-care bill. Watch:
Today we turn our fact-checking attention to Sen. Ted Cruz, who told us this on Tuesday:
"The number one reason why so many millions of people are unhappy with Obamacare is it’s caused premiums to skyrocket. The average family’s premiums have increased over five thousand dollars under Obamacare.”
--The Facts: Cruz was correct on the number, at least if he was talking about coverage gained through the workplace. For employer-sponsored plans, the average annual family premium rose from $13,375 in 2010 (the year the Affordable Care Act was passed) to $18,412 last year, an increase of $5,037 (according to the Kaiser Family Foundation). If Cruz was referring to marketplace plans, it's harder to evaluate his statement because of less available data and huge variation in rate hikes between states. But many marketplaces have seen hefty, double-digit rate hikes, and there's much anecdotal evidence that families relying on marketplace coverage got burned.
--But remember: Even though an increase of $5,000 over six years seems large (and it is by most standards), costs for employer-sponsored plans actually grew more slowly right after Obamacare was passed than before. Average family premiums have risen by 20 percent since 2011, compared to 31 percent from 2006 to 2011 and 63 percent from 2001 to 2006. So Cruz was somewhat misleading by presenting this as a dramatic shift.
Meet the all-male Senate working group on health care:
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Jimmy Kimmel talks about President Trump, M.D.:
And Stephen Colbert talks to the health-care bill: