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Coffee CAHC policy round-up: March 15, 2017

Coffee CAHC is a twice-weekly newsletter where we round up and comment on the latest health coverage policy developments both nationally and here in Maine. We hope you find these updates helpful!

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Coffee CAHC

115th Congress, 1st session

128th Maine Legislature, 1st session


March 15, 2017


I’m so over winter. I know, I know, “but you live in Maine”, “but you’re from Maine”, etc etc. Sorry, not sorry. A few weeks of pseudo-spring left me unwilling and unable to cope with this whomp of snow. Alright, I’m being selfish here: how are YOU doing? Y’alright? Things going ok? I hope so, dear readers, I really do. But in the spirit of today being the Ides of March, let’s move on to the doom and gloom, shall we?


National level

Well, as predicted, the Congressional Budget Office (CBO) “score” for the GOP replacement plan landed on Monday afternoon. And, uh, holy macaroni – it’s brutal.

CBO estimates that, under the “American Health Care Act” (AHCA), 14 million fewer people would have health coverage in 2018 alone. To put that in perspective, that’s like taking coverage away from the entire combined populations of Pennsylvania and Maine. And then things get really bad (they weren’t already?). By 2026, CBO estimates that 24 million fewer people will have coverage than do currently. That’s roughly the population of Australia, all going without health care over the next decade. To put it lightly: yikes.

Meanwhile, if the AHCA passes, premiums will shoot up over the next few years before settling down from 2020 and beyond. The one thing that Republican leadership has been able to point to in this report is that the AHCA saves the deficit a couple hundred billion dollars over the decade, mostly from getting rid of Medicaid expansion. (Which reminds me of that thought experiment: there’s a button that, if you push it, will kill a random person somewhere on the planet but you’ll get a million dollars. Would you do it? This bill is like pushing that button a couple thousand times.)

The reaction from DC has been pretty much what you’d expect from a bunch of elected officials being offered the chance to kill off health coverage for 24 million voters. …mostly. Leadership is still clinging to their view that the bill offers the best chance to deliver on something they’ve been promising to do for four election cycles now.

And, honestly, you sort of see the dilemma: for years they’ve been pledging to repeal the ACA, in a political climate where they knew President Obama would veto any such effort, so they didn’t have to actually offer a credible replacement or live with the consequences of what their proposals would actually accomplish if enacted. Those chickens are coming home to roost, now. They’re trapped between a rock (blowing up the health coverage system for tens of millions of people) and a hard place (facing hordes of their base voters who have been feverishly clamoring for repeal for seven years now). I’m not saying I have any sympathy for them, but this is why they can’t just pull the plug.

Still, the CBO score is a significant setback. Where do things go from here?

As far as I know, the House is still on track to move the two separate bills to the Budget Committee this week, where they’ll get merged into a unified package.

From there it makes a detour through the Committee on Rules. Here’s where things could get interesting. The Committee on Rules in the House decides on things like how much time will be allowed for debate, how many amendments will be allowed (if any) and on which sections of the bill, and generally sets the tone for whether a package gets any kind of real “debate” on the floor or is set on autopilot for a straight up-or-down vote as-is.

It will be very, very important to watch what kind of rule gets adopted for this bill. If leadership decides that the bill will need amendments in order to pass the House – if, for example, the Freedom Caucus really digs in their heels on Medicaid expansion – then the Rules Committee is where we’ll see them tip their hand. On the other hand, if leadership decides to stick to their guns and run the package as-is (largely because they think it can pass through the Senate reconciliation process), the rule they adopt will reflect that.

My assumption is that whatever happens will happen because they’ve counted votes very carefully and come up with something that they are confident will get the 218 votes needed to pass. It would be a colossal black eye for the Speaker and a huge monkeywrench thrown in the works if this bill lost on a floor vote in the House – not necessarily a death knell, but it would certainly put the thing on life support.

Even if or when (I assume “when”) it does pass the House, it then faces what seems to be an increasingly unhappy Senate, where the bill is getting knocked from the left, right, and center. It’s still pretty hard to see how you cobble together a package that pulls in even a majority of senators at this point.

That’s where things stand procedurally. In the week since the bill was released, though, we’ve learned a little more about some of what’s in it. One thing I want to flag is that if the bill passes as written, Medicaid will no longer be required to cover mental health services.

Right now, the feds have a list of services and treatments that Medicaid must cover. Under the AHCA, a lot of the decisionmaking on what to cover or not cover under Medicaid will be left up to the individual states. But don’t forget that the bill also moves Medicaid to a “per capita cap” system, where the state gets “X” amount of money for every enrollee from the feds and has to make up any difference from the state budget. That means that if a state like Maine wanted its Medicaid program to cover mental health services, but adding mental health services meant Medicaid cost more than “X” dollars per member, we’d be on the hook to make up the difference.


State level

The snow storm knocked out most legislative business yesterday, so once again, things are fairly quiet here. But here’s a teaser: I hope to have something very, very interesting to share with all of you in this section of Friday’s Coffee CAHC (I thought I might be able to get it out today, but haven’t gotten the all-clear yet). Exciting!

I do want to point out that our friends over at MECEP continue to do fantastic work looking at the impact of the AHCA on consumers in Maine. Their work is good, but the numbers are pretty grim. Anybody want a 1500 percent increase in their premiums? …no?


Would you like to know more?

You can peek at the entire 37 page CBO report here. It’s actually pretty readable. (note: that hyperlink has changed a few times over the past couple of days, so if it’s broken…again…just go to and look for the “AHCA cost estimate” from their homepage).

Vox has done a huge deep-dive into their reporting on the ACA and the repeal/replace movement since the election. I’ll admit that I haven’t read the entire thing yet, but you all know how much I love Sarah Kliff’s reporting, and what I’ve read of it so far has been fascinating.


Finally, a couple of interesting calls to action that I want to let you all know about.

First, our partners at SEIU are coordinating a national call-in day tomorrow to let Republicans in Congress know that we’re opposed to radically overhauling the Medicaid program as we know it. To any of our readers in Congressman Poliquin’s district, tomorrow would be an excellent day to contact his offices and let them know that you support a robust, well-funded Medicaid program that protects Mainers who rely on it for themselves and their families. Here’s the link to the Congressman’s contact info for his various offices. It’s always a good idea to call the in-district office closest to you, rather than his D.C. office. (Congresswoman Pingree has already come out strongly opposed to the replacement proposal, but I’m sure her offices wouldn’t mind some calls to thank her for that support).

Second, the White House currently has a page set up for people to share their “Obamacare stories.” I’m gonna go out on a limb here and guess that they’re looking for bad experiences, but we think it’s important for them to hear how vitally important and successful the ACA has been for so many people. If you’re willing, head over to the link and submit your experiences with the ACA. Make sure you know that if you do, though, you’ll be opting in to receive communications from the White House by e-mail.


Until next time, friends, I remain,


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