Annnnnd the Trumpcare battle may now drag out into the dog days of August...
2019 OPEN ENROLLMENT ENDS (most states)
Time: D H M S
Senate Majority Leader Mitch McConnell (R-KY) announced Tuesday that he is canceling half of Congress’ annual month-long August recess, keeping lawmakers in town to finish their drawn-out and so far unsuccessful effort to repeal the Affordable Care Act and tackle other pressing matters.
“Once the Senate completes its work on health care reform, we will turn to other important issues including the National Defense Authorization Act and the backlog of critical nominations,” he wrote.
Tensions are rising between Senate Majority Leader Mitch McConnell’s leadership team and his party’s ideological factions, with a renewed sense of pessimism creeping into the Senate GOP’s efforts to repeal Obamacare.
An amendment written by Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah) is fracturing the conference, with the measure taking center stage at the party’s first caucus lunch in nearly two weeks on Tuesday. Though the proposal to allow the sale of cheap, deregulated insurance plans is championed by the right, disagreements over the drafting of the amendment could delay or torpedo altogether the GOP’s healthcare bill.
Of course, as I noted the other day, Cruz's amendment would be an unmitigated disaster, deliberately creating the very "death spiral" which ACA critics keep claiming (falsely, for the most part, though there are exceptions) is happening already.
Note that they may still end up holding a vote next week anyway...I'm not sure if this is from before or after McConnell's announcement of the delayed recess:
After much back and forth among McConnell, the two conservative senators and the Congressional Budget Office, the amendment was rewritten again on Monday, two sources said. While the rest of the latest draft is expected to receive a CBO score by next week, it may not include an analysis of Cruz and Lee’s amendment, which could take many days more for the CBO to analyze due to its complexity.
McConnell has told senators this week that the Senate will vote on the repeal next week and urged senators to use the bill’s open amendment process to alter the bill to suit their concerns, according to senators and aides.
There's also this head-scratching paragraph:
More moderate GOP senators are hoping the measure can be altered to win support of the conference rather than divide it. Some Republicans want to see the risk pools for healthy and sicker people linked in some way so that it prevents sick people from seeing their premiums spike.
The hope is that the amendment “still lowers premiums here but doesn’t create this kind of death spiral over there,” said Sen. Bill Cassidy (R-La.), who said he has spoken to Cruz about his idea. “It’s more actuarially sound.”
Um...guys? GUYS??? THAT'S WHAT THE ACA ALREADY DOES: It merges the on- and off-exchange individual market policies into a single risk pool within each rating area. The Cruz Amendment, at least the one we know of, would do the exact opposite, which is the entire problem with it (well, that and the fact that the tax credits for ACA-compliant policies are even stingier than the ACA's and have even fewer people eligible for them).
In fact, one of the problems with the indy market under the ACA today is that the risk pool isn't large enough, with a couple million grandfathered/transitional plan enrollees still out there in a separate pool.
Now, David Anderson just suggested that perhaps the GOP is talking about creating "a single national QHP risk pool"...which would actually be an excellent idea if it was done without splitting the market into high and low risk pools at the same time...but which would still be a disaster if the pool was split.
Frankly, if they want to get rid of all state rating areas and merge the entire individual market into a single national risk pool, that'd be a great idea...in fact, that's even listed as #17 on my "If I Ran The Zoo" list...and this would go even further, since I was only suggesting a single risk pool per state, not nationally!
Heck, they could even go one step further and merge the individual market with the small group market (#18 on my list)!
Somehow, I don't think that's what they have in mind, though.
Meanwhile, for all the fuss made over the individual market, it's still mostly about beating up on Medicaid:
GOP senators from Medicaid expansion states are expected to gather on Tuesday afternoon to discuss their own concerns with the bill, namely major future spending reductions to the Medicaid program and the winding down of Obamacare’s Medicaid expansion. A bloc of a dozen centrist Republicans are worried about the Senate bill’s initial treatment of the Medicaid program and have balked at legislation that calls for such deep cuts.