The GOP Tax Cut is here

The Senate GOP has finally released its plan for massive tax cuts for the rich, what they call their healthcare bill. Other places will look at all the details, so I’ll just look at the important bits:

The 400 highest-income taxpayers alone would receive tax cuts worth about $33 billion from 2019 through 2028, which is more than the federal spending cuts from ending the Medicaid expansion in any one of 20 expansion states and the District of Columbia.  In fact, the tax cuts for the top 400 roughly equal the federal cost of maintaining the expansion in Nevada, West Virginia, Arkansas, and Alaska combined.  (See Figure 1.)  Policymakers face a stark choice: maintain the Medicaid expansion coverage for 726,000 people in these four states, or advance the pending legislation and cut taxes by millions of dollars a year for 400 households whose annual incomes average more than $300 million apiece.

I left that last bit in just for laughs–the choice for Republicans is clear: tax cuts for the ultra rich.

Households with incomes above $1 million a year would get annual tax cuts averaging more than $50,000 apiece

Meanwhile, the House-passed bill would spend about $700 billion from 2019 through 2028 on tax cuts mainly for high-income people and wealthy corporations from repealing the ACA taxes that fall on them, we estimate based on Joint Committee on Taxation data.

Now if you cut taxes by $700 billion you’re going to have to cut benefits by about the same amount. Since Republicans are back in power they no longer care about the deficit but Reconciliation rules (this bill is going through the Senate using this) means it can’t increase the deficit by much.

So, remember that this is what Republicans are for: cutting benefits to millions of who are poor or middle-class to pay for massive tax cuts for the rich and especially the ultra-rich.

Trump administration out to cut contraception

It seems that Trump officials in Health and Human Services lie as much as he does (via here):

Secretary Tom Price, who has claimed that “there’s not one” woman who can’t afford birth control on her own (despite the high up-front cost of the most reliable contraceptives).

She (Teresa Manning) insists that contraception is ineffective, despite evidence that hormonal methods are 91% effective and long-acting reversible contraceptives such as intrauterine devices (IUDs) are 99% effective at preventing pregnancy.

She (Charmaine Yoest) asserts that condoms (whose use reduces the risk of HIV transmission by at least 70%) do not protect against HIV or other sexually transmitted infections. Yoest also claims contraception does not reduce the number of abortions and says that to accept this argument “would be, frankly, carrying water for the other side to allow them to redefine the issue in that way.”

Yoest and Manning are joined by Katy Talento, who has been named to the Domestic Policy Council, in claiming that the most effective types of contraceptives cause infertility and miscarriages. Talento has published some particularly outlandish articles on this topic, mis-citing a 2012 study whose author disavowed her description of his work in asserting that contraceptives are “breaking your uterus.”

Even worse, Yoest continues to cite long-discredited studies that used retrospective reporting to support her assertion that abortion causes breast cancer, despite the overwhelming evidence to the contrary from properly constructed prospective studies. … Nor, as she has claimed, does abortion cause mental illness; in fact, a long-term study that compared women who were denied abortions with those who were able to obtain them revealed that it is being forced to carry an unwanted pregnancy to term that is associated with near-term adverse psychological outcomes.

Perhaps the most insidious and politically potent assertion by these appointees is that common forms of contraception are actually abortifacients.

Hormonal contraceptives work primarily by preventing ovulation and thereby preventing fertilization. Even in cases in which they affect the endometrium, studies more recent than those used for the initial Food and Drug Administration–approved labeling have shown they do not interrupt an established pregnancy.

These people are against contraception but they know that a large majority of Americans support the use of contraception:

More than nine-in-ten adults think using birth control is either morally acceptable (36%) or not a moral issue at all (57%); just 4% say using contraception is morally wrong.

so they try to bend the definition of contraception to claim it’s abortion. It’s not and they’re lying to try to get rid of contraception.

Republican tax-cut bill has no transparency

It seems Republicans don’t want anyone to know about their healthcare proposal:

This has become more evident each day, as the Senate plots out a secretive path toward Obamacare repeal — and top White House officials (including the president) consistently lie about what the House bill actually does.

There was even a brief moment Tuesday where Senate Republicans flirted with the idea of banning on-camera interviews in congressional hallways, a plan quickly reversed after outcry from the press.

Republicans decried the secrecy of the ACA but:

“There were hundreds of hearings and markups that lasted days — or in the case of the Senate Health, Education, Labor and Pensions Committee, months,” Rovner recalls in her piece.

Senators wanted to talk about the Affordable Care Act and why they believed they needed to pass it. They gave floor speech and after floor speech defending its provisions. Patients had months to lobby their legislators on particular issues that they thought were important. A few months ago I interviewed one woman, for example, who successfully lobbied former Sen. Kent Conrad (D-ND) to add a ban on lifetime limits in health insurance.

I remember Christmas Eve 2009 in particular, when I lived in New York and my roommate’s family came to visit for the holiday. They opened presents in our living room. I was holed up in my bedroom watching the Senate vote on the ACA, the culmination of a 25-day floor debate.

They really don’t want any time for the public to complain:

There are some factors that could slow down the Senate. In comparison to the House, the Senate is barred from voting on a bill before a cost and impact estimate is released from the nonpartisan CBO.

But if the Senate is to really vote before they leave town for a week on June 30th, a goal that many Republicans hope is still achievable, that leaves little time for the public to see legislation. A CBO score takes 10 to 14 days to produce. There are only 17 days left before the end of the month.

The approach is broadly similar to the process that produced the American Health Care Act in the House last month. At the time, leaders released a finished bill and voted on it within 24 hours — so fast that the Congressional Budget Office couldn’t estimate its cost and effects for another three weeks. The move was a jarring shift after years of promises from House GOP leaders to slow down major legislation and post all bills online several days before a vote.

That last bit is obviously ironic as Republicans never seem to have a problem breaking promises or norms.

Some Republicans are complaining about the secrecy:

“I’ve said from Day 1, and I’ll say it again,” said Senator Bob Corker, Republican of Tennessee. “The process is better if you do it in public, and that people get buy-in along the way and understand what’s going on. Obviously, that’s not the route that is being taken.”

Senator Ron Johnson, Republican of Wisconsin, offered a hint of the same frustration felt by Democrats seeking more information about the bill.

“I come from a manufacturing background,” Mr. Johnson said. “I’ve solved a lot of problems. It starts with information. Seems like around here, the last step is getting information, which doesn’t seem to be necessarily the most effective process.”

Mr. Paul said he had no plans to bring out the copy machine again, but he suggested that the Senate’s current course left something to be desired. “My preference would be a more open process in committees,” he said, “with hearings and people on both sides.”

but they obviously don’t really mean it. After all there are at least three Senate Republicans saying they would like the bill to be more open and yet it’s not open. Since there are 52 Republicans in the Senate and all Democrats are opposed to the bill, three Republicans could kill the bill. This gives them a lot of power and yet, somehow, they’re not using it to make the process more open. That tells you they don’t really care. Just like Republicans don’t care if millions of Americans lose their health insurance.

Trump/Republican Tax Cut as bad as predicted

The CBO has released their analysis of the tax cut disguised as a healthcare bill that passed the House:

CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under H.R. 1628 than under current law. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 23 million in 2026. In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law. Under the legislation, a few million of those people would use tax credits to purchase policies that would not cover major medical risks.

They also compare how non-group insurance would fare under current law (Obamacare) to the new law:

Under Current Law. Although premiums have been rising under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference between that percentage and the premiums for a reference plan. The subsidies to purchase coverage, combined with the effects of the individual mandate, which requires most individuals to obtain insurance or pay a penalty, are anticipated to cause sufficient demand for insurance by enough people, including people with low health care expenditures, for the market to be stable in most areas.

Nevertheless, some areas of the country have limited participation by insurers in the nongroup market under current law. Several factors could lead insurers to withdraw from the market—including lack of profitability and substantial uncertainty about enforcement of the individual mandate and about future payments of the cost-sharing subsidies to reduce out-of-pocket payments for people who enroll in nongroup coverage through the marketplaces established by the ACA.

Under the Legislation. CBO and JCT anticipate that, under H.R. 1628, nongroup insurance markets would continue to be stable in many parts of the country. Although substantial uncertainty about how the new law would be implemented could lead insurers to withdraw from or not enter the nongroup market, several factors would bring about market stability in most states before 2020. In the agencies’ view, those key factors include subsidies to purchase insurance, which would maintain sufficient demand for insurance by people with low health care expenditures, and grants to states from the Patient and State Stability Fund, which would lower premiums by reducing the costs to insurers of people with high health care expenditures.

The agencies expect that the nongroup market in many areas of the country would continue to be stable in 2020 and later years as well, including in some states that obtain waivers from market regulations. Even though the new tax credits, which would take effect in 2020, would be structured differently from the current subsidies and would generally be less generous for those receiving subsidies under current law, other changes (including the money available through the Patient and State Stability Fund) would, in the agencies’ view, lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market.

However, the agencies estimate that about one-sixth of the population resides in areas in which the nongroup market would start to become unstable beginning in 2020. That instability would result from market responses to decisions by some states to waive two provisions of federal law, as would be permitted under H.R. 1628. One type of waiver would allow states to modify the requirements governing essential health benefits (EHBs), which set minimum standards for the benefits that insurance in the nongroup and small-group markets must cover. A second type of waiver would allow insurers to set premiums on the basis of an individual’s health status if the person had not demonstrated continuous coverage; that is, the waiver would eliminate the requirement for what is termed community rating for premiums charged to such people. CBO and JCT anticipate that most healthy people applying for insurance in the nongroup market in those states would be able to choose between premiums based on their own expected health care costs (medically underwritten premiums) and premiums based on the average health care costs for people who share the same age and smoking status and who reside in the same geographic area (community-rated premiums). By choosing the former, people who are healthier than average would be able to purchase nongroup insurance with relatively low premiums.

Why it almost sounds like things will be worse under this legislation. But let’s get to the important part:

• Repealing the surtax on certain high-income taxpayers’ net investment income;
• Repealing the annual fee on health insurance providers;
• Reducing the income threshold for determining the medical care deduction;
• Delaying when the excise tax imposed on some health insurance plans with high premiums would go into effect; and
• Repealing the increase in the Hospital Insurance payroll tax rate for certain high-income taxpayers.

And here’s what that gets:

The chart below shows the tax changes (the first two major components mentioned) go almost entirely to the highest earning households, while providing little or no benefit to the bottom 80 percent of the income distribution.  In fact, TPC estimates that a $37,000 average annual tax cut will go to the 1 percent of the population with the highest earnings (annual income of over $772,000).  The top 0.1 percent of the income distribution would receive an annual tax cut of over $200,000 (annual income over $3.9 million).

In short, the bill drops 23 million people off insurance to give very large tax cuts to the rich. Now that’s the type of bill a Republican loves.

Trump administration continues to do awful things

It’s easy to miss much of what’s going on in the Trump administration because of its stupidity, such as (Ross is the Commerce Secretary):

ROSS: There’s no question that they’re liberalizing their society. And I think the other thing that was fascinating to me: There was not a single hint of a protester anywhere there during the whole time we were there. Not one guy with a bad placard, instead there was …

CNBC HOST: But Secretary Ross, that may be not necessarily because they don’t have those feelings there, but because they control people and don’t allow to them to come and express their feelings quite the same as we do here.

ROSS: In theory, that could be true. But, boy, there was certainly no sign of it, there wasn’t a single effort of any incursion. There wasn’t anything. The mood was a genuinely good mood.

ummm:

Six years ago, in the midst of the popular uprisings in the Middle East known as the Arab Spring, the Saudi Council of Senior Religious Scholars issued a decree essentially banning public protest in the country. The following February, a 17-year-old named Ali al-Nimr was arrested for participating in an anti-government protest. Two years later, he was sentenced to death by beheading and crucifixion and remains on death row.

So it isn’t “in theory” that protests aren’t allowed, it’s in actual fact. I also wonder why he knows this, he does seem to sleep a lot:

Ross, 79, was seen catching a nap during the president’s speech Sunday in Riyadh to Saudi officials on the need to come together to battle terrorism.

This type of stuff overshadows things that will do real damage to the US, such as:

With Medicaid, the state-federal program that provides health care to low-income Americans, Trump’s budget plan would follow through on a bill passed by House Republicans to cut more than $800 billion over 10 years.

The Congressional Budget Office has estimated this could cut off Medicaid benefits for 10 million people over a decade

….

A key element of the budget plan will be the assumption that huge tax cuts will result in an unprecedented level of economic growth.

Trump recently unveiled the broad principles of what he has said will be the biggest in US history, and Treasury Secretary Steven Mnuchin told a Senate panel last week that these tax cuts would end up creating trillions of dollars in new revenue, something budget experts from both parties have disputed.

The tax cuts would particularly benefit the wealthiest Americans, as Trump has proposing cutting the estate tax, capital gains and business tax rates.

It’s always a good look to cut aid to the poor and elderly to pay for tax cuts to the rich that will increase the deficit.

They also want to kill Obamacare while pretending it died of its own accord:

The campaign to destroy Obamacare continues apace:

The Trump administration on Monday plans to ask a federal court for another 90-day delay in a lawsuit over Obamacare insurance subsidies, according to two administration sources, leaving the future of the health care marketplaces in limbo through late August. The suit, House v. Tom Price, centers on Obamacare’s cost-sharing program, which reimburses health insurers to help low-income people make co-payments at the doctor or hospital.

This is the suit filed by the House against Obamacare’s CSR subsidies. The delay means insurers won’t get assurance one way or the other about the fate of these subsidies, which in turn means they have to assume they’re going away. Anything else would be irresponsible.

And that means insurers have to raise premiums substantially to make up for the potential loss of CSR payments.

This will mean millions more will lose health insurance.

Republicans vote to deprive tens of millions of healthcare

House Republicans have passed their “healthcare” bill:

The measure skirted through the House by a thin 217-213 vote, as all voting Democrats and a group of mostly moderate Republican holdouts voted no. A defeat would have been politically devastating for President Trump and Speaker Paul Ryan, R-Wis.

The nonpartisan Congressional Budget Office estimated in March that the GOP bill would end coverage for 24 million people over a decade. That office also said the bill’s subsidies would be less generous for many, especially lower-earning and older people not yet 65 and qualifying for Medicare.

A CBO estimate for the cost of latest version of their bill will not be ready before the House conducts its vote.

But rich people will get a trillion dollars in tax cuts in the next ten years, so there’s that. Kevin Drum has a nice summary:

With that in mind, let’s do a quick wrap-up of the bill:

  • There have been no public hearings.
  • There’s no final text.
  • There’s no updated CBO score.
  • It is opposed by virtually every patient advocacy group and everyone in the health care industry.
  • Congress is still exempted from the new rules that allow states to waive essential benefits.
  • It raises premiums dramatically for older people.
  • It removes Obamacare’s protection against being turned down for a pre-existing condition.
  • It would steadily gut Medicaid spending for the very poorest.
  • It removes coverage from at least 24 million people, probably more.
  • It slashes taxes on the rich by about a trillion dollars over ten years.

It probably won’t pass in the Senate (one can hope at least), but this shows what Republicans are for: the rich and definitely not the working class.

Wellness programs don’t really work … except for employers

I’m a little slow on this but it seems companies really want to get genetic information on employees:

A little-noticed bill moving through Congress would allow companies to require employees to undergo genetic testing or risk paying a penalty of thousands of dollars, and would let employers see that genetic and other health information.

Employers got virtually everything they wanted for their workplace wellness programs during the Obama administration. The ACA allowed them to charge employees 30 percent, and possibly 50 percent, more for health insurance if they declined to participate in the “voluntary” programs, which typically include cholesterol and other screenings; health questionnaires that ask about personal habits, including plans to get pregnant; and sometimes weight loss and smoking cessation classes. And in rules that Obama’s Equal Employment Opportunity Commission issued last year, a workplace wellness program counts as “voluntary” even if workers have to pay thousands of dollars more in premiums and deductibles if they don’t participate.

That doesn’t sound very good but at least it helps the health of employees:

Rigorous studies by researchers not tied to the $8 billion wellness industry have shown that the programs improve employee health little if at all. An industry group recently concluded that they save so little on medical costs that, on average, the programs lose money. But employers continue to embrace them, partly as a way to shift more health care costs to workers, including by penalizing them financially.

and from here:

The so-called “Safeway Amendment” was added to the ACA. Now, if you fail, or refuse to take part in, your employer’s “voluntary” wellness test, it can increase your premium by 30 percent — or, if you’re a smoker who refuses to quit, by 50 percent.

There is no evidence that this new rule produced a significant drop in America’s health-care costs. And that isn’t terribly surprising — since Burd’s column was composed almost entirely of lies.

“[A] review of Safeway documents and interviews with company officials show that the company did not keep health-care costs flat for four years, the Washington Postreported in January 2010. “Those costs did drop in 2006 — by 12.5 percent. That was when the company overhauled its benefits … the decline did not have anything to do with tying employees’ premiums to test results. That element of Safeway’s benefits plan was not implemented until 2009.”

In other words, Safeway reduced costs for a single year by raising its employees’ deductibles. It didn’t save money by encouraging its workers to lead healthier lives — it saved money by making its workers pay a larger portion of their health-care costs.

Gee, it doesn’t help the employees but does help the employers. What a shock. And it gets better:

The privacy concerns also arise from how workplace wellness programs work. Employers, especially large ones, generally hire outside companies to run them. These companies are largely unregulated, and they are allowed to see genetic test results with employee names.

They sometimes sell the health information they collect from employees. As a result, employees get unexpected pitches for everything from weight-loss programs to running shoes, thanks to countless strangers poring over their health and genetic information.

So, to summarize, Obama and Congress were convinced to put a provision into the ACA that did basically shifted costs from the employer to the employee for little or no health benefits and now the GOP wants to expand that provision. You have to love it.

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