GOP sticks two-pronged fork in #ACA: defund Medicare, cut taxes leaving no $$ for replacement

[CousinIT]

Repealing the Affordable Care Act (ACA) before a replacement plan can be enacted – even if the repeal is delayed – poses many extraordinary dangers. The Center for Health Policy published a detailed examination of these dangers last week, emphasizing that repealing the ACA before replacing it would cause significant disruption in the individual health insurance market and risk imploding the market altogether if no replacement emerges – all but ensuring that millions of Americans who purchase their own insurance (many of whom had insurance pre-ACA) will become uninsured.

But the effect on the individual marketplace isn’t the only consequence of repealing before replacing. Less discussed are the additional challenges created by the tax cuts that would be enacted if Congress models its ACA repeal on the legislation that was passed (but vetoed) early last year through the budget reconciliation process—a process that seems increasingly likely. These tax cuts would make it much more difficult to achieve a sustainable replacement plan that provides meaningful coverage without increasing deficits.

TAX CUTS WILL ACCELERATE THE EXHAUSTION OF MEDICARE’S TRUST FUND

Specifically, the reconciliation repeal bill from earlier this year eliminated $680 billion (over ten years) of taxes on high-income households and the health care industry (e.g., insurers, device manufactures, and drug companies). In addition to increasing deficits, by rescinding the 0.9% Hospital Insurance Trust Fund payroll tax on wages above $200,000, these tax cuts would also accelerate the exhaustion of Medicare’s Part A Trust Fund by four years, from 2028 to 2024.[1]

NOT ENOUGH MONEY LEFT FOR REPLACEMENT AFTER REPEALING THE ACA’S TAXES

Supposing the same repeal and delay bill is put forward, but with the repeal now set to take effect on January 1, 2019, it would net roughly $500 billion in deficit reduction over the ten-year budget window. Lawmakers would likely create an “ACA replacement fund” with the bill’s deficit reduction – a sort of piggybank that they could subsequently tap into to pay for a replacement plan. It’s unclear how well this approach adheres to Congressional rules, but it is similar to how the “Medicare Improvement Fund” or “SGR Transition Fund” banked savings from one bill to help pay for increased Medicare spending in the form of “doc fixes” down the line.

https://www.brookings.edu/blog/up-front/2016/12/19/paying-for-an-aca-replacement-becomes-near-impossible-if-the-laws-tax-increases-are-repealed/

[CousinIT]

1. GOP Readies Swift Obamacare Repeal With No Replacement Ready

The first major act of the unified Republican government in 2017 will be a vote in Congress to begin tearing down Obamacare.

But the euphoria of finally acting on a long-sought goal will quickly give way to the reality that Republicans -- and President-elect Donald Trump -- have no agreement thus far on how to replace coverage for about 20 million people who gained insurance under the health-care law.

“They haven’t come to a consensus in the House and the Senate about the possible replacement plans,” said Douglas Holtz-Eakin, a conservative economist and former adviser to Senator John McCain’s 2008 presidential campaign. “They don’t know Point B.”

Republicans are debating how long to delay implementing the repeal. Aides involved in the deliberations said some parts of the law may be ended quickly, such as its regulations affecting insurer health plans and businesses. Other pieces may be maintained for up to three or four years, such as insurance subsidies and the Medicaid expansion. Some parts of the law may never be repealed, such as the provision letting people under age 26 remain on a parent’s plan.

https://www.bloomberg.com/politics/articles/2016-12-29/gop-readies-swift-obamacare-repeal-with-no-replacement-in-place

[WhiteTara]

4. They don't give a damn about

replacement. They are animals on 2 legs.

[Bettie]

5. They're the animals who are more equal than others

and they will tear it all down.

And we have no way to stop it from happening. It's like watching a plane go down. Except it is our collective future.

[Wellstone ruled]

2. This smoldering pile of manure

has been lurking and no one wants to talk about it. These assholes want their White America Mayberry 1950's back and be damn to you others.

[Rollo]

3. Let's hope...

Let's hope that at least some of the R's who voted for last winter's reconciliation budget bill that would have defunded the ACA and Medicare did so in full realization that Obama would veto it, and are unlikely to risk voting the same this time around.

Defunding the ACA is bad enough, but stiffing millions of seniors on Medicare would be quite another. Despite the rise of the alt-right and Trumpism, Medicare and Social Security are still the twin third rails of American politics. Mess with either at your own risk.

And it's difficult to imagine a replacement for the ACA that would renounce what essentially was a conservative Republican plan all along, as proposed by the Heritage Foundation in the 1990's and signed into state law by Romney in the aughts. Even the much maligned mandatory insurance provision was a conservative idea, and without which any proposal short of single payer would surely fail.

The ACA does need tweaking, but the R's do not seem inclined to do anything that constructive. If they add ruining Medicare for millions, they will sealing their own defeats in the subsequent congressional election cycle, never mind who wins the White House.

[wiggs]

6. They've been saying it for years. Cut government until it's small enough to drown in a bathtub. nt