The Speech

Where were you when he delivered The Speech? Yes, it was just days after his inauguration when President Donald Trump addressed a joint session of Congress. The topic, of course, was healthcare. His victory could be traced, in part, to his rally cry to Repeal and Replace Obamacare. This has been a Republican mantra since 2010, but it sounded new from Donald Trump. His opponents, both Democrats and Republicans, had been taken aback by the aggressiveness of his assertions. He had promised a great new health plan. This blog was underwhelmed by the plan information he released during the campaign. But there he was, delivering a prime-time address, unveiling his proposal. Trumpcare was a comprehensive proposal that worked hard to provide protection for every American family. Leadership.

There was no speech. There was no plan. And, there is no leadership.

2017 has been a terrible year for serious people and a difficult time for those of us who once revered “The world’s Greatest Deliberative Body”. Washington’s most cynical politician, Majority Leader Mitch McConnell, decided that he would push a bill through the Senate with as little scrutiny as possible. Utilizing the Reconciliation rules, McConnell worked hard to keep the legislation under wraps. No hearings! No input from any of the stakeholders. And absolutely, positively, no Democrats. McConnell’s strategy was to get 50 of the 52 Senate Republicans to vote Yes and then have Vice-president Mike Pence break the tie. The details were irrelevant.

It may seem crazy to you or me to upend nearly 20% of the economy, not to mention the method that we access and pay for healthcare, with a legislative sleight-of-hand. But it almost happened this past July. And they are about to try again this week.

The current proposal is called Graham-Cassidy. The authors are Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), Ron Johnson (R-WI). Their television interviews have revealed the plan to be a last ditch effort to erase Barack Obama’s legacy, repeal parts of the Patient Protection and Affordable Care Act (Obamacare), and to transfer billions of dollars to states that have shown little interest in health insurance protection for their citizens, Healthcare? That hardly enters into their thinking.

Here are the basics of Graham-Cassidy

Eliminate:

• The federal exchange – healthcare.gov
• The tax credit subsidies
• The Cost Sharing Reduction
• The Individual Mandate
• The Essential Health Benefits
• The Medicaid Expansion
• All funding for one year for Planned Parenthood (Surprise!)

Changes:

• With greater flexibility, the current protections for people with preexisting conditions would be at risk.
• The majority of taxes used to pay for the PPACA would still be collected. The money would be dispensed to the states in the form of block grants. (Think the tobacco settlement)
• Money that went to states that had expanded Medicaid will be redistributed to states that didn’t. Ohio would lose between $4 billion to $9 billion!

Who is strongly supporting this legislation?

• Donald Trump

Who is opposed?

• All of the stakeholders
• Cleveland Clinic CEO Toby Cosgrove
• Senator John McCain
• The Medicaid Directors (Republican and Democrats) of all 50 states

And where is our guy, Senator Rob Portman? He has been a solid Yes for every other lame-brained proposal. He has maintained his usual silence on this one. Perhaps he is waiting for Senators Lisa Murkowski (R-AK) and Susan Collins (R-ME) to save us again.

What we know for sure is that there will never be a comprehensive health care proposal from this White House. There will never be “The Speech”.

DAVE

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