Changes made to RINOCare are Simply not Enough

House Republicans made changes to the American Health Care Act, aka RINOCare, on Monday evening, but I believe it is simply not enough to fulfill their promise to repeal Obamacare.

First, representatives put forth the manager’s amendment.  While the amendment does escalate the relief from repeals of several sections of Obamacare to 2017, it also “adds an additional year of relief from Obamacare’s Cadillac tax, moving the implementation date from 2025 to 2026.”

It also establishes more bureaucracy.

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Pages 18-20. This section of the amendment establishes Section 141 of the Social Security Act creating an American Health Care Implementation Fund within the U.S. Department of Health and Human Services (HHS) to carry out: o Sec. 121. Per capita allotment for medical assistance; o Sec. 132. Patient and State Stability Fund; o Sec. 202. Additional modifications to premium tax credit; and, o Sec. 214. Refundable tax credit for health insurance coverage. A $1,000,000,000 appropriation is made to the fund.

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What is wrong with a simple repeal bill?  Why do we have to do this song and dance?  Republicans are in charge.  In the same manner that Democrats forced Obamacare down the throats of the American people, why are Republicans not simply standing up for the people and shoving a full repeal of Obamacare back down the throats of the Democrats?  It’s because they want to control it.  There really is no other answer.

As usual, the Democrats were playing the hypocrites.  Just like Rep. Nancy Pelosi (D-CA) did a 180 on reading the bill before passing it, Rep. Kathy Castor (D-FL) blasted Republicans for introducing the bill less than 48 hours ago without a score from the Congressional Budget Office on effects on the deficit and insurance coverage.  While these things are right to point out, they are hypocritical from Democrats.

The Republican bill continues to push the socialistic mentality of Medicaid.  In fact, the sections on Medicaid are where the largest changes occur.  Among those  changes are:

  • allowing states to choose between Medicaid per capita caps or block grants;
  • providing states an optional Medicaid work requirement;
  • allowing for inflation-adjusted Medicaid costs of the elderly and disabled; instituting a full repeal of Obamacare taxes a year earlier.

Again, I ask, if the Medicaid money belongs to the states, why do we even allow the central government to get it in the first place?  It isn’t constitutional spending that falls under the enumerated powers of Congress.  In fact, why do states adopt such things?  It’s all about the money, and not really about the law.

And just to demonstrate that the money and central government usurping control over the states illegally, this section of the amendment should prove the point.

Pages 8-10. For any state that in 2016 had a DSH allotment that was more than six times the national average and requires political subdivisions within the State to contribute funds toward Medicaid, the amount of allowable medical assistance expenditures under the per capita allotment reform is reduced by the amount required to be raised from the political subdivisions. The amendment provides an exception of the State requires such funds from political subdivisions with a population that exceeds 5,000,000.

  • Pages 10-18. Consistent with the vision outlined in the House Republican health care proposal, A Better Way, the amendment creates a new option for States to opt to receive, starting Fiscal Year2020, a flexible block grant of funds for providing health care for their traditional adult and children populations served in the per capita allotment. Funding for the block grant would be determined using the same a base year calculation for the per capita allotment reforms.
  • Pages 10-11. States may choose to provide care for certain populations by receiving a block of funds for a period of 10 years, rather than providing care through the per capita allotment
  • Pages 12-13. States choosing the block grant are required to submit a report that identifies the conditions for eligibility under the block grant which are in lieu of eligibility in current law, except in the case of certain low-income pregnant women and children in poverty
  • Pages 13-14. States choosing the block grant are also required to, in the submitted report, outline the types of items and services; the amount, duration, and scope of such services; the cost-sharing with respect to such services; and the method for delivering care. These items and services are in lieu of those requirements in current law, except that the block grant must provide medical assistance for hospital care; surgical care and treatment; medical care and treatment; obstetrical and prenatal care and treatment; prescribed drugs, medicines and prosthetics; other medical supplies and services; and health care for children under 18 years of age
  • Pages 14. A plan shall be deemed approved by the Secretary of HHS unless the Secretary finds within 30 days that the plan is incomplete or actuarially unsound.
  • Pages 15-16. The amount of block grant funding shall be calculated by computing the per capita cost for the eligible population, multiplied by the number of enrollees in the year prior to adopting a block grant. The funding will increase by the growth in the consumer price index but will not adjust for changes in population. Unused funds rollover and remain available for expenditure so long as a State has a block grant
  • Page 17. A State may choose to provide health care to either non-expansion adults and children, or just non-expansion adults
  • Page 18. States adopting the block grant are required to contract with an independent entity to ensure the State is in compliance with the requirements for a block grant. Such audit reports are required to be made available to HHS upon request.

More control for more money for unconstitutional spending, that’s what this is.

Thought these concessions may draw a few votes from Republicans, it fails to actually do what was promised during the campaign, a full repeal of Obamacare.

By making the concessions of Medicaid, part of the problem is that Republicans failed to end the Obamacare Medicaid expansion program early enough.

The Washington Examiner reports on  Rep. Joe Barton (R-TX) pointing this out.

A conservative lawmaker wants to dramatically shorten the transition period for rolling back Obamacare’s Medicaid expansion in the Republican repeal plan.

Rep. Joe Barton, R-Texas, said the Medicaid expansion should end after this year, instead of in 2020 as outlined in the American Health Care Act, a plan issued late Monday by GOP leadership that repeals a majority of Obamacare.

Barton on Tuesday attended a meeting of the conservative Freedom Caucus, which has balked at the 2020 transition deadline.

“House Republicans have promised to replace the [Affordable Care Act] with something better and cheaper,” he said.  “This bill does not do that.”

Several amendments are expected to be introduced on Wednesday ahead of a vote on the bill on Thursday.  Rep. Barton is expected to present an amendment on the Medicaid expansion transition during the House Energy and Commerce Committee.

House Freedom Caucus Chairman Mark Meadows is not happy about the changes that have been made so far and told Axios on Monday, “Our leadership is going to put forth a bill that does not address any of the concerns in a meaningful way and will dare us to vote against it.”

President Donald Trump is scheduled to meet with House Republicans on Tuesday to talk about the bill.

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