The American Health Care Act (AHCA), released by Congress this week, is intended to repeal and replace the Affordable Care Act (ACA). But as introduced, it does not align with the health reform objectives that the AMA set forth in January to protect patients. While the ACA is imperfect, the current version of the AHCA is not legislation we can support.
The replacement bill, as written, would reverse the coverage gains achieved under the ACA, causing many Americans to lose the health care coverage they have come to depend upon.
In a letter sent today to leaders of the House committees that will mark up the AHCA, AMA CEO and Executive Vice President James L. Madara, MD, wrote that the proposed changes to Medicaid would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes. Dr. Madara also noted that the proposed changes in tax credits and subsidies to help patients purchase private health insurance coverage are expected to result in fewer Americans with insurance coverage.
It is unclear the exact impact this bill will have on the number of insured Americans, and review by the nonpartisan Congressional Budget Office is still pending. The ratings and analytics firm S&P Global Ratingshas already estimatedthat as many as 10 million Americans could lose coverage if this bill becomes law, saying that between 2 million and 4 million people could lose the insurance they purchased in the individual health exchanges under the ACA, and between 4 million and 6 million could lose their coverage under Medicaid.
That just won’t do.
We all know that our health system is highly complex, but our core commitment to the patients most in need should be straightforward. As the AMA has previously stated, members of Congress must keep top of mind the potentially life-altering impact their policy decisions will have.
We physicians often see patients at their most vulnerable, from the first time they set eyes on a newborn child to the last time they squeeze a dying loved one’s hand. We don’t want to see any of our patients, now insured, exposed to the financial and medical uncertainties that would come with losing that coverage.
That is, above all, why physicians must be involved in this debate.
Rep. Joe Kennedy III speaking at 4:15AM this morning on the impact of the Republican’s #TrumpedUpCare bill on those who receive Medicaid benefits for #LongTermCare ….so much for Republicans NOT picking “winners and losers” … about 6.9 MILLION seniors across America who could find themselves turfed out of care when there’s no way to pay the bill for their care.
Clinton vs. Sanders vs. O’Malley On Fixing Banking
How do we fix Wall Street, a.k.a. “the banks”? How do the candidates compare? … The first place to look, of course, is CAF’s Candidate Scorecard … Clinton’s 63 percent rating is primarily based on not having a position on a financial transaction tax … as well as opposing reinstating some form of a Glass-Steagall Act and a lack of specific proposals related to the categories “Break Up Big Banks” and “Affordable Banking.” Meanwhile, Sanders rates 100 percent … O’Malley is stressing his positions on and independence from Wall Street [and] also has a 100 percent…
Blue States Make Voting Easier as Red States Add Restrictions
“In Illinois, a new provision allows voters to register electronically when they visit various state agencies. And in Delaware, some residents with criminal records will regain the right to vote … In Republican-controlled states, the story is different. North Carolina has instituted a new voter ID requirement. North Dakota has narrowed the forms of identification voters can present … Ohio’s GOP-controlled legislature has instituted … shorter early voting hours.” Meanwhile, here at home in Nevada, folks who wish to participate in the Democratic County Caucuses will enjoy the ability to “same-day” register to participate, while Republican caucus goers will need to have registered at least 10 days prior to the caucus date AND will be required to present a government issued photo ID card … no indication as to which will be allowed and which will not (e.g., will VA photo IDs be accepted?).
Ex-Gov turned Democrat Charlie Crist announced a run for U.S. House
On Tuesday, ex-Gov. Charlie Crist announced that he would run for the St. Petersburg FL-13 seat. Crist said all the way back in July that he’d run for this seat if he lived in it after redistricting, so this announcement was no surprise. However, Republican Rep. David Jolly, who is leaving this district behind to run for the Senate, unexpectedly crashed what would have otherwise been a routine campaign kickoff. Jolly told reporters that he cares too much about the seat “to lay down and let this huckster walk into office.” Republicans utterly hate Crist, who left the party in 2010, so this kind of stunt certainly won’t hurt Jolly’s chances in the GOP primary. If Crist wins, he’ll be one of only a few ex-governors to be elected to the House. The University of Minnesota’s Smart Politics blog finds that in the last half-century, only four other ex-governors have done this, and none of them had run a state anywhere near as large as Florida.
Meanwhile in the House of Representatives, the Freedom Caucus is vowing not to play nice —all this at a crucial time when some pretty critical votes will need to be taken:
A vote will be needed to pass a fiscal budget, not yet another let’s kick the can down the road continuing resolution to extend the current (previous) budget that was passed, and
A vote will be needed regarding the Iran Deal, which the US and other foreign nations have already begun to implement regardless of any approval/disapproval from our disfunctional Congress.
November should prove quite interesting. But, if all of that that is not enough agitprop for your tastes, Speaker Boehner is proposing that it’s possible that they could actually “repeal Obamacare” by the end of the year. What is he smoking, drinking or otherwise ingesting? Apparently he thinks President Obama is just gonna roll over and sign onto their repeal efforts taking away any and all opportunities for millions of Americans to be able to purchase health care insurance. Somebody needs to throw some ice water in his face and yell “Wake Up Bozo!”
Rep. Paul Ryan announces speaker bid, with conditions. NYT: “…Ryan called for … an end to the antics of ‘bomb throwers and hand wringers,’ according to members in the room … He suggested that he wanted an answer by Friday. Mr. Ryan made it clear that he would not accede to preconditions set by ‘one group,’ a clear reference to the members of the hard-line Freedom Caucus…”
Freedom Caucus resists. Politico: “They were dismissive of his Ryan’s request that they relinquish a procedural tactic they used to threaten to strip outgoing Speaker John Boehner of his title – one of the most potent weapons in the group’s arsenal.”
The House of Representative is in chaos. John Boehner announced his intention to step down as Speaker at the end of the month. There doesn’t appear to be anyone to take his place. The leading candidate, Majority Leader Kevin McCarthy, abruptly withdrew from the race yesterday. Another popular choice, Paul Ryan, says he’s not interested.What happened? How did we get to this point? One document, produced by the House Freedom Caucus, holds all the answers. Framed as a “questionnaire” the document effectively makes it impossible for any candidate to both: (1) Get elected speaker, and (2) Not send the entire country (and maybe the world) over a cliff.
Why the Freedom Caucus has so much power
The House Freedom Caucus, a relatively new group of about 40 Republicans loosely associated with the Tea Party, has an extraordinary amount of power in this process. Any potential speaker needs the support of 218 Republicans on the floor of the House. There are currently 247 Republicans in the House. That’s a large majority but without the Freedom Caucus, no candidate can get to 218.
What the Freedom Caucus says they want
The Freedom Caucus says they are just fighting for arcane rule changes that will enhance “democracy” in the House. On CNN yesterday, David Brat, a prominent member of the Freedom Caucus outlined his criteria for a new speaker. (You may remember Brat for his surprise victory over Eric Cantor, the man many assumed would replace Boehner as speaker.)
Anyone that ensures a fair process for all sides. That’s what we are all looking for, right… We’ve shown principle. We are waiting for leadership candidates to put in writing moves that ensure you have a democratic process within our own conference. That is what everyone is waiting to see. And it’s got to be in writing, ahead of time for that to be credible.
Sounds perfectly reasonable, right?
What the Freedom Caucus actually wants
Yesterday, Politico published the House Freedom Caucus “questionnaire” which it described as pushing for “House rule changes.” The document does do that. But it also does a lot more. It seeks substantive commitments from the next speaker that would effectively send the entire country into a tailspin.
For example, the document seeks a commitment from the next speaker to tie any increase in the debt ceiling to cuts to Social Security, Medicare and Medicaid.
Cutting Social Security, Medicare and Medicaid is extremely unpopular, even among Republicans. These programs are sacrosanct to most Democratic members of Congress. There is effectively no chance that President Obama or Senate Democrats — both of whom would need to support such legislation — would agree to “structural entitlement reforms” in the next month under these kind of conditions.
The House Freedom Caucus essentially wants to make it impossible for the next speaker to raise the debt ceiling. But that is just the beginning.
The House Freedom Caucus also wants the next speaker to commit to numerous conditions on any agreement to avoid a government shutdown:
The House Freedom Caucus wants the next speaker to commit to not funding the government at all unless President Obama (and Senate Democrats) agree to defund Obamacare, Planned Parenthood and a host of other priorities. This is essentially the Ted Cruz strategy which prompted at 16-day shutdown in 2013. They’re demanding to have this now be enshrined as the official policy of the Speaker of The House.
The House Freedom Caucus wants the next speaker to commit to oppose any “omnibus” bill that would keep the government running. Rather, funding for each aspect of government could only be approved by separate bills. This would allow the Republicans to attempt to finance certain favored aspects of government (the military), while shuttering ones they view as largely unnecessary (education, health).
Why McCarthy thinks the House might be ungovernable
For McCarthy, the document helps explain why he dropped out of the race. If he doesn’t agree to the demands of the House Freedom Caucus, he cannot secure enough votes to become speaker. But if he does agree to their demands, he will unable to pass legislation that is necessary to avoid disastrous consequences for the country.
Top Republicans are calling Paul Ryan and begging him to be speaker. But thus far, he hasn’t agreed to run. None of the candidates currently running appear to have substantial support.
The agenda of the House Freedom Caucus makes a difficult job effectively impossible. Agreeing to their demands means presiding over a period of unprecedented dysfunction in the United States.
Even if a candidate was able to become speaker without formally agreeing to the Freedom Caucus’ most extreme requirements, one would still have to deal with the group — and a larger group of House Republicans sympathetic to them — in order to get anything done.
This is why Boehner wanted out and why no one really wants to take his place.
I’m very pleased that many presidential candidates will be here today to address you. It is a signal that the work you’ve been doing – laboring in the vineyards for decades – is getting the political attention it deserves. But the real test of a candidate’s commitment is not whether we come to speak at your national conference, as important as that is. It’s whether we’re still around after the cameras are gone and the votes are counted. It’s whether our positions live up to our rhetoric.
And too often we see a mismatch between what some candidates say in venues like this, and what they actually do when they’re elected. I don’t think you can credibly say that everyone has a “right to rise” and then say you’re for phasing out Medicare or for repealing Obamacare. People can’t rise if they can’t afford health care. They can’t rise if the minimum wage is too low to live on. They can’t rise if their governor makes it harder for them to get a college education. And you cannot seriously talk about the right to rise and support laws that deny the right to vote.