Tag Archives: repeal

WalletHub: Milwaukee in top 10 cities most affected by ‘Trumpcare’

Source: WalletHub

With the average health-insurance premium estimated to rise 15-20 percent in the next two years and federal tax credits expected to decrease under the recently proposed American Health Care Act, the personal-finance website WalletHub conducted an in-depth analysis of cities most affected by the GOP health plan, which it referred to as “TrumpCare.”

To gauge the impact of the Republican-proposed health plan on people who buy their own insurance, WalletHub’s analysts compared 457 U.S. cities based on the differences in premium subsidies that the average household would receive under “Obamacare” and “Trumpcare.”

The impact on Milwaukee:
 

  • Average Obamacare Premium Subsidy: $5,707
  • Average Trumpcare Premium Subsidy: $5,000
  • Subsidy Difference: -$707
  • Milwaukee ranks 78th most affected overall and 10th most affected among large cities.

On the web

https://wallethub.com/edu/cities-most-affected-by-trumpcare/33588/

Deciphering CBO’s estimates on the Republicans’ health bill

The Congressional Budget Office is out with its estimate of what effects the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government.

The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

Here are some of the CBO highlights:

• $337 billion reduction in the deficit. That’s CBO’s estimate over the next decade, taking into account both decreased government spending in the form of less help to individuals to purchase insurance and lower payments to states for the Medicaid program. It also includes decreased revenue from the repeal of the taxes imposed by the ACA to pay for the new benefits.

• 24 million more people without insurance in a decade. The federal budget experts estimate that people will lose insurance and that the drop will kick in quickly. In 2018, they say 14 million more people would join the ranks of the uninsured. It would reach the 24 million by 2026, when “an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

• 15 percent of Planned Parenthood clinic patients would “lose access to care.” These patients generally live in areas without other sources of medical care for low-income people. The Republican bill would cut out Medicaid funding for Planned Parenthood for a year.

• 15 to 20 percent increase in 2018 premiums, but relief would follow. Monthly costs for insurance would go up at first, due to the elimination of the requirement for most people to have insurance or else pay a tax penalty. After 2018, CBO estimates that average premiums would actually drop by 10 percent by 2026 compared to current law. That is because the lower prices for younger people would encourage more to sign up. By contrast, the law would “substantially [raise] premiums for older people.”

• 95 percent of people who are getting Medicaid through the health law’s expansion would lose that enhanced federal funding. The CBO estimates that only 5 percent of enrollees in the expansion program would remain eligible for the higher federal payments by 2024, since the bill would phase out those payments to states as patients cycle in and out of eligibility.

• 14 million fewer Medicaid enrollees by 2026. That’s 17 percent fewer than projected under current law. The projection includes people who are currently eligible and would lose coverage, as well as people who might have become eligible if more states, as expected, expanded coverage under the ACA. CBO projects that is unlikely to happen now.

• $880 billion drop in federal Medicaid spending over the decade. That comes primarily by imposing, for the first time, a cap on federal contributions to the program for those with low incomes.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

 

House GOP health bill jettisons insurance mandate, much of Medicaid expansion

House Republicans unveiled their much anticipated health law replacement plan Monday, slashing the law’s Medicaid expansion and scrapping the mandate that individuals purchase coverage or pay a fine. But they opted to continue providing tax credits to encourage consumers to purchase coverage, although they would configure the program much differently than the current law.

The legislation would keep the health law’s provisions allowing adult children to stay on their parents’ health insurance plan until age 26 and prohibiting insurers from charging people with preexisting medical conditions more for coverage as long as they don’t let their insurance lapse.  If they do, insurers can charge a flat 30 percent late-enrollment surcharge on top of the base premium, under the Republican bill.

In a statement, House Speaker Paul Ryan (R-Wis.) said the proposal would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance. It protects young adults, patients with preexisting conditions, and provides a stable transition so that no one has the rug pulled out from under them.”

The GOP plan, as predicted, kills most of the law’s taxes and fees and would not enforce the so-called employer mandate, which requires certain employers to provide a set level of health coverage to workers or pay a penalty.

Democrats quickly condemned the bill. “Tonight, Republicans revealed a Make America Sick Again bill that hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across American,” House Minority Leader Nancy Pelosi tweeted. “Republican will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely.”

The legislation has been the focus of intense negotiations among different factions of the Republican Party and the Trump administration since January. The Affordable Care Act passed in 2010 without a single Republican vote, and the party has strongly denounced it ever since, with the House voting more than 60 times to repeal Obamacare. But more than 20 million people have gained coverage under the law, and President Donald Trump and some congressional Republicans have said they don’t want anyone to lose their insurance.

When Republicans took control of both Congress and the White House this year, they did not have an agreement on the path for replacement, with some lawmakers from states that have expanded Medicaid concerned about the effect of repeal and the party’s conservative wing pushing hard to jettison the entire law.

Sen. Rand Paul (R-Ky.), one of those favoring a full repeal, tweeted: “Still have not seen an official version of the House Obamacare replacement bill, but from media reports this sure looks like Obamacare Lite!”

Complicating the effort is the fact that Republicans have only 52 seats in the Senate so they cannot muster the 60 necessary to overcome a Democratic filibuster. That means they must use a complicated legislative strategy called budget reconciliation that allows them to repeal only part of the ACA that affect federal spending.

Beginning in 2020, the GOP plan would provide tax credits to help people pay for health insurance based on household income and age, with a limit of $14,000 per family. Each member of the family would accumulate credits, ranging from $2,000 for an individual under 30 to $4,000 for people ages 60 and higher. The credits would begin to diminish after individuals reached an income of $75,000 — or $150,000 for joint filers.

Consumers also would be allowed to put more money into tax-free health savings accounts and would lift the $2,500 cap on flexible savings accounts beginning in 2018.

The legislation would allow insurers to charge older consumers as much as five times more for coverage than younger people. The health law currently permits a three-to-one ratio.

Community health centers would receive $422 million in additional funding in 2017 under the legislation, which also places a one-year freeze on funding for Planned Parenthood and prohibits the use of tax credits to purchase health insurance that covers abortion.

Both the Energy and Commerce and Ways and Means Committees are scheduled to mark up the legislation Wednesday. The committees do not yet have any Congressional Budget Office analysis of how much the legislation would cost or how many people it would cover.

Party leaders have said they want to have the bill to President Trump next month.

In a statement, senior Democrats on both panels said the measure would charge consumers “more money for less care. It would dramatically drive up health care costs for seniors. And repeal would ration care for more than 70 million Americans, including seniors in nursing homes, pregnant women and children living with disabilities by arbitrarily cutting and capping Medicaid,” said Rep. Frank Pallone of New Jersey and Rep. Richard Neal of Massachusetts.

The House GOP plan makes dramatic changes to Medicaid, the state-federal health insurance program that covers 70 million low-income Americans. The program began in 1965 as an entitlement — which means federal and state funding is ensured regardless of cost and enrollment. But the Republican bill would cap federal funding for Medicaid for the first time.

The federal government picks up between half and 70 percent of Medicaid costs. The percentage varies based on the relative wealth of the state.

Under the GOP plan, federal funding would be based on what the government spent in the fiscal year that ended Sept. 30. Those amounts would be adjusted annually based on a state’s enrollment and medical inflation.

Currently, federal payments to states also take into account how generous the state’s benefits are and what rate it uses to pay providers. That means states like New York and Vermont get higher funding than states like Nevada and New Hampshire and those differences would be locked in for future years.

Republicans have pushed to cap federal funding to states in return for giving them more control in running the program.

The legislation also affects the health law’s expansion of Medicaid, in which the federal government provided enhanced funding to states to widen eligibility. The bill would also end that extra funding for anyone enrolling under the expansion guidelines starting in 2020. But the legislation would let states keep the extra funding Obamacare provided for individuals already in the expansion program who stay enrolled.

About 11 million Americans have gained Medicaid coverage since 2014.

Changing the expansion program is a delicate balance for the Republicans. Four GOP senators from states that took that option said Monday they would oppose any legislation that repealed the expansion.

“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska wrote in a letter to Majority Leader Mitch McConnell.

Provided under a creative commons license by Kaiser Health News. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation

Baldwin: ACA repeal would pull $5.5 billion from addiction services

Sen. Tammy Baldwin, D-Wis., joined  U.S. Sen. Sherrod Brown, D-Ohio, and Jeanne Shaheen, D-New Hampshire,  in warning President Donald Trump that repealing the Affordable Care Act with no replacement would pull the rug out from under communities working to combat the opioid epidemic.

The senators said repeal could endanger millions of Americans just as they are getting treatment.

Repeal threatens to cut $5.5 billion from states battling opioid addiction. A recent report from Harvard Medical School and New York University details the impact repeal would have on people struggling with addiction. Nationwide, nearly 1.3 million Americans receiving treatment for substance abuse or mental health disorders would be kicked off of their coverage under repeal.

Also, states would lose $5.5 billion in federal dollars each year that go toward treating people through the Medicaid expansion or the marketplaces.

“The consequences of repealing the Affordable Care Act are dire for all Americans, but they are especially calamitous for Americans living with a mental illness, a substance use disorder, or both,” the senators wrote Trump in a letter sent earlier this week. “Repealing this law will cut billions of dollars in funding, kick tens of millions of Americans off of their health insurance and saddle providers with hundreds of millions of dollars more in uncompensated care.”

In December 2016, then-President Barack Obama signed into law the bipartisan 21st Century Cures Act, legislation to provide $1 billion in federal grant funding over the next two years to states like Wisconsin, Ohio and New Hampshire that have been hard-hit by the opioid epidemic.

The letter was also signed by Democratic Sens. Dianne Feinstein, Patty Murray, Jack Reed, Thomas R. Carper, Debbie Stabenow, Benjamin L. Cardin (D-MD), Amy Klobuchar (D-MN), Sheldon Whitehouse, Kirsten Gillibrand, Al Franken, Richard Blumenthal, Brian Schatz, Christopher Murphy, Tim Kaine, Elizabeth Warren, Edward J. Markey, Cory Booker, Gary C. Peters, Chris Van Hollen and Margaret Wood Hassan.

New Congress sees mandate to undo Obama’s agenda

Republicans’ grip on all levers of power stands as a mandate to the GOP-led Congress, which will move swiftly to try to undo eight years of outgoing President Barack Obama’s agenda.

With Republican President-elect Donald Trump weeks away from assuming office, GOP lawmakers plan to open the 115th Congress on Tuesday and immediately take steps to repeal Obama’s health care law. Beyond that, they’ll look at a tax overhaul, reversing Obama-era environmental regulations and other conservative priorities.

Republicans will face some obstacles. House Minority Leader Nancy Pelosi says Democrats “stand ready to fight vigorously” to protect health care and other priorities, and Republicans will have to compromise with Senate Democrats to move major legislation through that chamber.

A look at what the 115th Congress will be up to in 2017:

NEW MEMBERS

New members of the House and Senate will be sworn in on Tuesday, the first day of the new Congress.

In the Senate, five Democrats and two Republicans will be sworn in for the first time, joined by returning members who won re-election in 2016. After those members are sworn in, there will be 52 Republicans, 46 Democrats and two independents who caucus with the Democrats.

The House will have 52 new members — 27 Republicans and 25 Democrats. There will be 241 Republicans in the House and 194 Democrats.

CONFIRMING A NEW CABINET

Trump is sworn in on Jan. 20, and Republicans in the Senate will spend the first days and weeks of his presidency pushing to confirm his Cabinet picks. Democrats changed the rules and curbed the filibuster in 2013, making it easier for Republicans to move nominations. But even though they won’t be able to block Trump’s nominees, Democrats have pledged to fight many of them anyway, highlighting what they say is the hypocrisy of Trump’s populist message and his wealthy, corporate-favoring nominees for several posts.

REPEALING OBAMA’S HEALTH CARE LAW

The Senate plans to begin repealing Obama’s health care law on Tuesday, Congress’ very first day, with consideration of a procedural measure that will shield from Democratic filibusters legislation annulling much of that statute.

Lawmakers will then spend the next few months working on legislation canceling broad swaths of the law. Likely to go are its mandate that people buy health insurance or face IRS fines, and its expansion of Medicaid coverage to more lower-earning Americans. Some elements of the repeal likely wouldn’t go into effect for two to four years.

Republicans will then begin the more complicated task of building a new system. The GOP will have to craft new programs for the nation’s $3 trillion health care system and make sure insurance markets don’t collapse while the transition is under way.

TAX OVERHAUL

Senate Majority Leader Mitch McConnell, R-Ky., and Speaker Paul Ryan, R-Wis., want a massive overhaul of the tax system with the goal of simplifying a complicated tax code that rewards wealthy people with smart accountants as well as corporations that can easily shift profits and jobs overseas.

It would be the first major tax overhaul in 30 years. Trump has also advocated a tax overhaul, but with fewer details. He promises a tax cut for every income level, with more low-income families paying no income tax at all.

SUPREME COURT

Supreme Court Justice Antonin Scalia died 11 months ago, but the Senate still hasn’t considered a replacement. That’s because McConnell blocked consideration of Obama’s nominee, Judge Merrick Garland, saying the next president should make the pick. The strategy paid off, and the Republican Senate will consider whomever Trump nominates.

MEDICARE CHANGES

Ryan is the most powerful advocate in Washington for an overhaul of Medicare and a premium-support approach that would, over time, remake it into a voucher-like program that could force some seniors entering the program to buy health insurance on the open market instead of getting coverage through the traditional open-ended program.

But his ideas likely will run into a political reality. Trump said on the campaign trail that he wouldn’t cut the program, and Senate Republicans haven’t been as enthusiastic either.

Candidate Trump also initially promised not to cut Medicaid — the federal-state health insurance program for low-income and severely disabled people. During the campaign, Trump seemed to shift, backing “block grants” that limit federal funding.

SOCIAL SECURITY

Like Medicare, some House conservatives have said they want to overhaul Social Security and slow the program’s growth to curb spending. But Trump has said he doesn’t want to touch those programs, and Ryan told CBS’ “60 Minutes” in December that he has no plans to change Social Security.

REVERSING REGULATIONS

Republican leaders have complained throughout Obama’s presidency about burdensome regulations, a theme Trump used frequently during the campaign as well. GOP lawmakers now want to undo some of Obama’s regulations and executive orders using the Congressional Review Act, a rarely invoked procedure.

Many of the regulations they are targeting are environmental rules put in place by the Environmental Protection Agency, including the Clean Power Plan to cut carbon pollution from coal-fired power plants, a clean water rule that has drawn the ire of farmers and another rule imposed in December to protect nearby streams from coal-mining debris.

INFRASTRUCTURE

Trump made rebuilding the nation’s aging roads, bridges and airports a major part of his job-creation strategy in the presidential race. But those plans appear to have fizzled, somewhat, as GOP leaders have questioned the spending.

 

If Republicans repeal health law, how will they pay for replacement?

Leading Republicans have vowed that even if they repeal most of the Affordable Care Act early in 2017, a replacement will not hurt those currently receiving benefits.

Republicans will seek to ensure that “no one is worse off,” said House Speaker Paul Ryan, R-Wis., in an interview with a Wisconsin newspaper earlier this month. “The purpose here is to bring relief to people who are suffering from Obamacare so that they can get something better.”

But that may be difficult for one big reason — Republicans have also pledged to repeal the taxes that Democrats used to pay for their health law. Without that funding, Republicans will have far less money to spend on whatever they opt for as a replacement.

“It will be hard to have comparable coverage if they start with less money,” Gail Wilensky, a health economist who ran the Medicare and Medicaid programs under President George H.W. Bush, said in an interview.

“Repealing all the ACA’s taxes as part of repeal and delay only makes a true replacement harder,” wrote Loren Adler and Paul Ginsburg of the Brookings Institution in a white paper out this week. It “would make it much more difficult to achieve a sustainable replacement plan that provides meaningful coverage without increasing deficits.”

The health law’s subsidies to individuals buying insurance and the Medicaid expansion are funded by two big pots of money.

The first is a series of taxes, including levies on individuals with incomes greater than $200,000, health insurers, makers of medical devices, brand-name drugmakers, people who use tanning salons, and employer plans that are so generous they trigger the much-maligned “Cadillac Tax.” Some of those measures have not yet taken effect.

However, the Congressional Budget Office estimated in early 2016 that repealing those provisions would reduce taxes by an estimated $1 trillion over the decade from 2016-2025.

The other big pot of money that funds the benefits in the health law comes from reductions in federal spending for Medicare (and to a lesser extent, Medicaid). Those include trims in the scheduled payments to hospitals, insurance companies and other health care providers, as well as increased premiums for higher-income Medicare beneficiaries.

CBO estimated in 2015 that cancelling the cuts would boost federal spending by $879 billion from 2016 to 2025.

The GOP, in the partial repeal bill that passed in January and was vetoed by President Barack Obama, proposed to cancel the tax increases in the health law, as well as the health premium subsidies and Medicaid expansion. But it would have kept the Medicare and Medicaid payment reductions. Because the benefits that would be repealed cost more than the revenue being lost through the repeal of the taxes, the result would have been net savings to the federal government — to the tune of about $317.5 billion over 10 years, said CBO.

But those savings — even if Republicans could find a way to apply them to a new bill — would not be enough to fund the broad expansion of coverage offered under the ACA.

If Republicans follow that playbook again, their plans for replacement could be hampered because they will still lose access to tax revenues. That means they cannot fund equivalent benefits unless they find some other source of revenue.

Some analysts fear those dollars may come from still more cuts to Medicare and Medicaid.

“Medicare and Medicaid face fundamental threats, perhaps the most since they were established in the 1960s,” said Edwin Park of the liberal Center on Budget and Policy Priorities, in a webinar last week.

Republicans in the House, however, have identified one other potential source of funding. “Our plan caps the open-ended tax break on employer-based premiums,” said their proposal, called “A Better Way.”

House Republicans say that would be preferable to the Cadillac Tax in the ACA, which is scheduled to go into effect in 2020 and taxes only the most generous plans.

But health policy analysts say ending the employer tax break could be even more controversial.

Capping the amount of health benefits that workers can accept tax-free “would reduce incentives for employers to continue to offer coverage,” said Georgetown University’s Sabrina Corlette.

James Klein, president of the American Benefits Council, which represents large employers, said they would look on such a proposal as potentially more damaging to the future of employer-provided insurance than the Cadillac Tax, which his group has lobbied hard against.

“This is not a time one wants to disrupt the employer marketplace,” said Klein in an interview. “It seems perplexing to think that if the ACA is going to be repealed, either in large part or altogether, it would be succeeded by a proposal imposing a tax on people who get health coverage from their employer.”

Wilensky said that as an economist, getting rid of the tax exclusion for employer-provided health insurance would put her “and all the other economists in seventh heaven.” Economists have argued for years that having the tax code favor benefits over cash wages encourages overly generous insurance and overuse of health services.

But at the same time, she added, “I am painfully aware of how unpopular my most favored change would be.”

Republicans will have one other option if and when they try to replace the ACA’s benefits — not paying for them at all, thus adding to the federal deficit.

While that sounds unlikely for a party dedicated to fiscal responsibility, it wouldn’t be unprecedented. In 2003 the huge Medicare prescription drug law was passed by a Republican Congress — with no specified funding to pay for the benefits.

Republished under a creative commons license via Kaiser Health News.

Trump action on health care could cost Planned Parenthood

One of President-elect Donald Trump’s first, and defining, acts next year could come on Republican legislation to cut off taxpayer money from Planned Parenthood.

Trump sent mixed signals during the campaign about the 100-year-old organization, which provides birth control, abortions and various women’s health services. Trump said “millions of women are helped by Planned Parenthood,” but he also endorsed efforts to defund it. Trump once described himself as “very pro-choice.” Now he’s in the anti-abortion camp.

The Republican also has been steadfast in calling for repeal of President Barack Obama’s health care law and the GOP-led Congress is eager to comply.

One of the first pieces of legislation will be a repeal measure that’s paired with cutting off money for Planned Parenthood.

While the GOP may delay the impact of scuttling the law for almost four years, denying Planned Parenthood roughly $400 million in Medicaid funds would take effect immediately.

“We’ve already shown what we believe with respect to funding of Planned Parenthood,” House Speaker Paul Ryan, R-Wis., told reporters last month. “Our position has not changed.”

Legislation to both repeal the law and cut Planned Parenthood funds for services to low-income women moved through Congress along party lines last year. Obama vetoed it; Trump’s win removes any obstacle.

Cutting off Planned Parenthood from taxpayer money is a long-sought dream of social conservatives, but it’s a loser in the minds of some GOP strategists.

Planned Parenthood is loathed by anti-abortion activists who are the backbone of the GOP coalition. Polls, however, show that the group is favorably viewed by a sizable majority of Americans — 59 percent in a Gallup survey last year, including more than one-third of Republicans.

“Defunding Planned Parenthood as one of their first acts in the New Year would be devastating for millions of families and a huge mistake by Republicans,” said incoming Senate Minority Leader Charles Schumer, D-N.Y.

Democrats pledge to defend the group and they point to the issue of birth control and women’s health as helping them win Senate races in New Hampshire and Nevada this year. They argue that Trump would be leading off with a political loser.

But if he were to have second thoughts and if the Planned Parenthood provision were to be dropped from the health law repeal, then social conservatives probably would erupt.

“They may well be able to succeed, but the women of America are going to know what that means,” said Rep. Diana DeGette, D-Colo., citing reduced access to services Planned Parenthood clinics provide. “And we’re going to call Republicans on the carpet for that.”

At least one Republican senator, Susan Collins of Maine, may oppose the effort.

Collins has defended Planned Parenthood, saying it “provides important family planning, cancer screening, and basic preventive health care services to millions of women across the country.” She voted against the health overhaul repeal last year as a result.

Continued opposition from Collins, which appears likely, would put the repeal measure on a knife’s edge in the Senate, where Republicans will have a 52-48 majority next year.

Senate GOP leaders could afford to lose just one other Republican.

Anti-abortion conservatives have long tried to cut Planned Parenthood funds, arguing that reimbursements for nonabortion services such as gynecological exams help subsidize abortions. Though Planned Parenthood says it performed 324,000 abortions in 2014, the most recent year tallied, the vast majority of women seek out contraception, testing and treatment of sexually transmitted diseases, and other services including cancer screenings.

The defunding measure would take away roughly $400 million in Medicaid money from the group in the year after enactment, according to the nonpartisan Congressional Budget Office, and would result in roughly 400,000 women losing access to care.

One factor is that being enrolled in Medicaid doesn’t guarantee access to a doctor, so women denied Medicaid services from Planned Parenthood may not be able to find replacement care.

Planned Parenthood says private contributions are way up since the election, but that they are not a permanent replacement for federal reimbursements. “We’re going to fight like hell to make sure our doors stay open,” said Planned Parenthood spokeswoman Erica Sackin.

For Trump and GOP, ‘Obamacare’ repeal is complex and risky

Here’s the idea: Swiftly pass a repeal of President Barack Obama’s health care law, perhaps soon enough for Donald Trump to sign it the day he takes the presidential oath.

Then approve legislation restructuring the nation’s huge and convoluted health care system — despite Republican divisions, Democratic opposition and millions of jittery constituents.

What could go wrong?

With Republicans controlling the White House and Congress in January, they’re faced with delivering on their long-time promise to repeal and replace “Obamacare.”

Here are hurdles they’ll face:

SPEED VS DELIBERATION

Trump and congressional Republicans will be under intense pressure from their core conservative supporters to repeal Obama’s 2010 health care law — and fast. After all, Congress already sent Obama a repeal bill last January, which he vetoed, and many GOP voters will see no reason for delays this time.

But there probably won’t be anything fast about Congress’ effort to replace Obama’s law, which is likely to take many months.

While the replacement effort is underway, Republicans will risk aggravating up to 30 million people who are covered by the law or buy policies with prices affected by its insurance marketplace. Democrats will be sure to accuse the GOP of threatening the health care of millions.

A SOLUTION

Nothing’s been decided, but here’s one likely scenario:

The new Congress, which convenes Jan. 3, tries to quickly approve legislation repealing Obama’s health care law, maybe completing it by Trump’s Jan. 20 inauguration or soon after. But the repeal would not take effect until the future, perhaps a year later, to give lawmakers time to fashion a replacement. The version Obama vetoed had a two-year delay.

Seemingly acknowledging that two-step process, Vice President-elect Mike Pence said Sunday on “Fox News Sunday” that Trump “wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare.”

Because Republicans will control the Senate by just 52-48, Congress will first have to approve special budget procedures to prevent Democrats from stopping repeal legislation by filibuster. Bill-killing filibusters require 60 votes to end.

But those special rules would apply only to items that affect the federal budget. Republicans, for example, would need a simple Senate majority to end IRS penalties against people who don’t buy insurance but would still need 60 votes — requiring Democratic support — for other changes such as raising limits on older people’s premiums.

House Budget Committee Chairman Tom Price, R-Ga., says that will restrain Republicans’ ability to ram a “lock, stock and barrel” repeal through Congress.

GOP RISKS

One GOP danger: Congress and Trump might repeal Obama’s law, but while they’re laboring on a replacement, nervous insurance companies begin pulling out of markets and raising premiums. Insurers have been doing that under Obama, but now it would occur under a Republican government.

Another hazard: Congress’ work could spill into the 2018 campaign season, when the entire House and a third of the Senate face re-election. Republicans will grow increasingly timid about anything that might anger voters.

“We want to be the rescue party instead of the party that pushes millions of Americans who are hanging by the edge of their fingernails over the cliff,” says Sen. Lamar Alexander, R-Tenn., who chairs the Senate Health committee.

GOP PATHWAYS

Virtually all Republicans want to get rid of the health law’s mandates that individuals buy coverage or risk IRS fines, and that large employers insure workers.

They also want to erase taxes on higher-earning people and the health care sector. And they’d like to retain parts of the law guaranteeing coverage for people with pre-existing medical problems and keeping children under age 26 on family plans.

Unifying Republicans much beyond that is a work in progress.

Trump’s health care views have varied and lack detail. His campaign website touts tax deductions for health insurance premiums and permitting policies to be sold across state lines. He’d also revamp Medicaid, which subsidizes health coverage for low-income people, directing fixed amounts of money to states and letting them structure benefits.

House Speaker Paul Ryan, R-Wis., last summer unveiled an outline of the House GOP’s solution, though it lacked cost estimates and details. It would provide tax credits, impose taxes on the most generous employer-provided health care plans, revamp Medicaid and let Medicare beneficiaries pick private plans instead of today’s fee-for-service coverage.

Senate Finance Committee Chairman Orrin Hatch, R-Utah, has also advanced a framework relying heavily on tax credits.

REMAINING QUESTIONS

Thirty-one states — including Pence’s Indiana, where he is governor — plus the District of Columbia have expanded Medicaid coverage to 9 million additional people under Obama’s law. Curtailing that program will divide Republicans.

Taxing the value of some employer-provided health plans, aimed at curbing the growth of costs, is “a political land mine,” says GOP economist Douglas Holtz-Eakin. Republicans have long resisted tax increases.

Obama’s law mandates coverage for individuals because without that requirement many healthy people would forgo policies, driving up costs for everyone else and destabilizing insurance markets. Ryan has proposed shielding people from higher premiums if they’ve had “continuous coverage,” allowing higher rates for people who have not had policies, but Republicans have yet to decide how to keep insurance markets viable.

Newtown families’ lawsuit against gun maker dismissed

A judge has dismissed a wrongful-death lawsuit by Newtown, Connecticut, families against the maker of the rifle used in the Sandy Hook Elementary School shooting massacre.

The judge cited an embattled federal law that shields gun manufacturers from most lawsuits over criminal use of their products.

State Superior Court Judge Barbara Bellis granted a motion by Remington Arms to strike the lawsuit by the families of nine children and adults killed and a teacher who survived the Dec. 14, 2012, school attack, in which a gunman killed 20 first-graders and six educators with a Bushmaster AR-15-style rifle made by Remington.

The families were seeking to hold Remington accountable for selling what their lawyers called a semi-automatic rifle that is too dangerous for the public because it was designed as a military killing machine. Their lawyer vowed an immediate appeal of the ruling.

The judge agreed with attorneys for Madison, North Carolina-based Remington that the lawsuit should be dismissed under the federal Protection of Lawful Commerce in Arms Act, which was passed by Congress in 2005 and shields gun makers from liability when their firearms are used in crimes.

Advocates for gun control and against gun violence have criticized the law as special protection for gun makers.

It became an issue in the presidential campaign this year when Hillary Clinton, now the Democratic nominee, criticized then-challenger Bernie Sanders for his support of the law in 2005.

Sanders, a Vermont U.S. senator, is now backing a bill to repeal the law.

Lawyers for Remington said Congress passed the act after determining such lawsuits were an abuse of the legal system.

But the families’ attorneys argued the lawsuit was allowed under an exception in the federal law that allows litigation against companies that know, or should know, that their weapons are likely to be used in a way that risks injury to others, and the judge disagreed.

“While the families are obviously disappointed with the judge’s decision, this is not the end of the fight,” said Joshua Koskoff, a lawyer for the families. “We will appeal this decision immediately and continue our work to help prevent the next Sandy Hook from happening.”

Jonathan Whitcomb, an attorney for Remington Arms, declined to comment.

The company recently had been fighting to keep internal documents requested by the families from public view. The judge issued an order in August allowing certain documents containing trade secrets and other information to be kept from public view, but she said the order did not apply to all other documents in the case.

Besides Remington, other defendants in the lawsuit include firearms distributor Camfour and Riverview Gun Sales, the now-closed East Windsor store where the Newtown gunman’s mother legally bought the Bushmaster XM15-E2S rifle used in the shooting.

Gunman Adam Lanza, who was 20 years old, shot his mother to death at their Newtown home before driving to the school, where he killed 26 other people. He killed himself as police arrived.

GOP bill to repeal health care law pointless political theater, say Dems

The GOP-led Congress sent legislation to President Barack Obama on Jan. 6 repealing his signature health law, fulfilling a promise to Republican voters in a presidential election year but inviting a certain veto.

The nearly party-line vote in the House was 240-181. The legislation had already passed the Senate last year under special rules protecting it from Democratic obstruction, so it goes straight to the White House.

Republicans boasted of a signal achievement, saying they were forcing Obama to face up to the failures of his law while illustrating the stark political choices voters face.

“We are confronting the president with the hard, honest truth,” said Speaker Paul Ryan of Wisconsin. “Obamacare doesn’t work.”

Democrats called it pointless political theater that will have the same ultimate outcome as the 61 previous repeal votes that were blocked in the Senate, since Obama will veto the legislation.

“A bill that is going to the White House, that will get the fastest veto we’ve ever seen happen in this country, is a monumental vote?” said Rep. Jim McGovern, D-Mass. “This is just a waste of everyone’s time.”

Democratic presidential front-runner Hillary Clinton has decried the repeal legislation while leading GOP candidates applauded it. Ryan and other GOP leaders acknowledged it will take a Republican president to get rid of the law. But they said that is the point.

“It is our opportunity as Republicans to lay out the choice for the American people,” said Rep. Cathy McMorris Rodgers of Washington.

Majority Leader Kevin McCarthy of California predicted that a Republican president will be in the White House next year and Congress will pass the repeal legislation again, “but we won’t have to worry about a veto from the White House.”

For maximum visibility Republican leaders made the legislation, which also cuts federal funding for Planned Parenthood, their first major vote of 2016. Although they don’t command sufficient votes to override a presidential veto, they hope to schedule the override vote to coincide with the Jan. 22 March for Life in Washington commemorating the anniversary of the Supreme Court decision legalizing abortion.

Yet Ryan hedged when asked whether the House will ever vote on a GOP replacement to Obamacare. Ryan has pledged that the House will come up with its own plan this year, something the GOP has repeatedly promised but failed to do in the nearly six years since the law’s enactment. But he said details such as whether this plan will actually come to a vote have not been determined.

“Nothing’s been decided yet,” Ryan said. “Just wait.”

Three Republicans joined Democrats in voting against the repeal bill: Reps. Robert Dold of Illinois, and Richard Hanna and John Katko of New York. One Democrat voted for it: Rep. Collin Peterson of Minnesota.

The bill would dismantle the health law’s key pillars, including requirements that most people obtain coverage and larger employers offer it to workers.

It would eliminate the expansion of Medicaid coverage to additional lower-income people and the government’s subsidies for many who buy policies on newly created insurance marketplaces. And it would end taxes the law imposed to cover its costs.

More than 16 million Americans have gained health coverage since the law was enacted, according to government figures. They could risk losing it under the GOP approach. Republicans argue the health law has driven up costs and hurt consumers, and they promise “patient-centered” solutions in its place.

The bill would also terminate the roughly $450 million yearly in federal dollars that go to Planned Parenthood, about a third of its budget. A perennial target of conservatives, the group came under intensified GOP pressure last year over providing fetal tissue for research.

Planned Parenthood officials and Democratic lawmakers accused Republicans in floor debate of attacking women’s health. Republicans, in turn, took to the floor to critique Planned Parenthood in graphic terms, accusing the group of killing babies.