Yes, the “Skinny Repeal” is Just a Play to Get to Conference. But It’s Also Terrible Policy.

Jared Bernstein

Jared Bernstein Senior Fellow, Center on Budget and Policy Priorities

Readers know I’ve been deeply engaged in the healthcare debate, and highly critical of the efforts thus far to repeal and replace, demean and deface, disgust and disgrace, etc.

But I haven’t weighed in on up to the minute changes in part because they’re changing fast and because the journalists who follow this are doing a good job of tracking developments in the Senate.

In sum, Senate R’s have failed to pass any of the repeal and/or replace bills they’ve come up with so far. At this point, McConnell looks to be counting on getting to 50 votes with “skinny repeal,” which gets rid of the individual and employer mandates, along with a tax on medical devices.

At one level, this is high strategery. His play is to get to conference, i.e., once both chambers have passed bills, the R’s convene a committee that tries to agree on a plan that R majorities in both houses will support. There’s no requirement that what comes out of conference looks like what went in, and that means they’re most likely to go right back to the full, draconian repeal-and-replace cuts that would lead to tens of millions losing coverage.

Would Senate “moderates” who’ve blocked these bills thus far backtrack and vote for stuff they’ve heretofore opposed, like huge cuts to Medicaid or ending coverage of pre-existing conditions, maternal care, mental health, substance abuse treatment, etc.? They might, but it’s worth remembering that the debate on the conference bill is constrained, no amendments are allowed, and leadership will be in full arm-twisting mode.

People are calling the skinny repeal a Trojan Horse but it’s really more of a stalking horse. The Trojan Horse was supposed to be something good on the outside with something bad on the inside. But this damn thing is just all bad.

In fact, the skinny repeal should make even less sense to Republican voters (and yes, I know that trying to make sense out of any of this is a waste of time). While the Medicaid expansion has proven to be extremely important in expanding affordable coverage, the part of Obamacare that conservatives have consistently screamed the most about is the alleged collapsing of the non-group market.

That’s phony too, of course, as I’ve written in many places, and, in fact, that part of the market was beginning to stabilize. From one of my earlier pieces on this:

After a few years of the experience with the ACA, private insurers are figuring out how to profitably price coverage. But many moving parts make this process an ongoing challenge for them. Some of that was expected, like the phaseout of reinsurance subsidies. But others, like the Trump administration’s flirting with the loss of cost-sharing subsidies that private insurers depend on to hold down premium charges, are pure sabotage.

These payments reduce deductibles and copays for low- and moderate-income people, and their loss could lead the average premium for a benchmark plan to go up almost 20 percent. Just as they’re getting the pricing calibrated, the uncertainty around whether the government will continue to make these payments has surfaced as one of the main reasons that private insurers are asking themselves whether it makes sense to continue to offer coverage in the exchanges.

Let’s pause on the irony here for a moment. Conservatives’ flawed ideology (explained below) that the private sector is the most efficient delivery mechanism for health coverage kept a public option out of the ACA. But the private insurers themselves said at the time, and maintain to this day, that they can’t serve the exchanges without government subsidies. Now, Republicans want to block those subsidies, because … you guessed it … the private market blah, blah, yada, yada.

To pile irony on top of irony, the skinny repeal doesn’t go after Medicaid, but it’s a great tool to further destabilize the non-group market. Once you end the mandates, you invite the adverse selection that undermines risk pooling. Healthy people opt out, leaving more expensive people behind. Premium rise–2o%, according to CBO–leading the next healthiest tier to leave, and so on (the budget office also predicts this plan will leave 16 million fewer people with health coverage).

Which is why, according to the Times, Blue Cross Blue Shield warned senators “against repealing the mandate that almost everyone have insurance without something to take its place.”

BTW, depending on how much of the rest of the ACA remains intact, higher premium subsidies will help many consumers offset these higher coverage costs, meaning not only will skinny repeal cover fewer people at higher costs, but the government will have to make up some of the difference. Great work, R’s!

Given the just plain mean and ill-founded hostility of Republicans towards the poor and Medicaid, I at least understood their motive for the deep cuts they proposed (supported by Trump, who lied about this in the campaign, promising not to cut the program). Yet now, they’re tactically stripping down their repeal plans down to parts that exclusively make purchasing health care in the private marketplace a lot more expensive, the very thing they’ve whined about for years.

I know I should be totally used to it by now, but I’m still taken aback by the hypocrisy of these politicians, and by their willful failure to try to meet the needs of anyone who isn’t one of their rich donors.

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Reposted from On the Economy

Jared Bernstein joined the Center on Budget and Policy Priorities in May 2011 as a Senior Fellow.  From 2009 to 2011, Bernstein was the Chief Economist and Economic Adviser to Vice President Joe Biden, executive director of the White House Task Force on the Middle Class, and a member of President Obama’s economic team. Prior to joining the Obama administration, Bernstein was a senior economist and the director of the Living Standards Program at the Economic Policy Institute in Washington, D.C. Between 1995 and 1996, he held the post of deputy chief economist at the U.S. Department of Labor. He is the author and co-author of numerous books, including “Crunch: Why Do I Feel So Squeezed?” and nine editions of “The State of Working America.”

Posted In: Allied Approaches

Union Matters

Get to Know AFL-CIO's Affiliates: National Association of Letter Carriers

From the AFL-CIO

Next up in our series that takes a deeper look at each of our affiliates is the National Association of Letter Carriers.

Name of Union: National Association of Letter Carriers (NALC)

Mission: To unite fraternally all city letter carriers employed by the U.S. Postal Service for their mutual benefit; to obtain and secure rights as employees of the USPS and to strive at all times to promote the safety and the welfare of every member; to strive for the constant improvement of the Postal Service; and for other purposes. NALC is a single-craft union and is the sole collective-bargaining agent for city letter carriers.

Current Leadership of Union: Fredric V. Rolando serves as president of NALC, after being sworn in as the union's 18th president in 2009. Rolando began his career as a letter carrier in 1978 in South Miami before moving to Sarasota in 1984. He was elected president of Branch 2148 in 1988 and served in that role until 1999. In the ensuing years, he worked in various roles for NALC before winning his election as a national officer in 2002, when he was elected director of city delivery. In 2006, he won election as executive vice president. Rolando was re-elected as NALC president in 2010, 2014 and 2018.

Brian Renfroe serves as executive vice president, Lew Drass as vice president, Nicole Rhine as secretary-treasurer, Paul Barner as assistant secretary-treasurer, Christopher Jackson as director of city delivery, Manuel L. Peralta Jr. as director of safety and health, Dan Toth as director of retired members, Stephanie Stewart as director of the Health Benefit Plan and James W. “Jim” Yates as director of life insurance.

Number of Members: 291,000 active and retired letter carriers.

Members Work As: City letter carriers.

Industries Represented: The United States Postal Service.

History: In 1794, the first letter carriers were appointed by Congress as the implementation of the new U.S. Constitution was being put into effect. By the time of the Civil War, free delivery of city mail was established and letter carriers successfully concluded a campaign for the eight-hour workday in 1888. The next year, letter carriers came together in Milwaukee and the National Association of Letter Carriers was formed.

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There is Dignity in All Work

There is Dignity in All Work