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Coffee CAHC policy round-up: November 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, adjourned


Wednesday, November 15, 2017


Good grief. Is anybody else as gobsmacked as I am by the revelation that Thanksgiving is next week?! I only realized this on Monday. I thought we had a couple weeks to go. Yeesh. I have several skills, but “keeping track of holidays” apparently is not one of them.


National level

You have got to be kidding me.

Yes, folks, I’m sorry to say, but…it’s back. “It” being ACA repeal. And I am worried. In fact, I’m more worried about this one than I was about many of the repeal plans we saw earlier this year.

This time, the “plan” is to stick repeal of the individual mandate into the ginormous tax reform bill winding its way through Congress right now. So far, the Senate is the one pulling the trigger on this maneuver, but I’m confident that the House would love nothing more than to join in.

There are all sorts of reasons they’re throwing the two together. For one thing, the tax reform proposal is using our old friend “reconciliation”, meaning the final complete package only needs 51 votes to clear the Senate.

On a related note, because they’re using reconciliation – which comes with very specific rules on how the bill saves money, and how much money, and over what timeline – throwing individual mandate repeal into the bill buys them about $350 billion in savings to the federal government, which is crucial to help them get their tax package to the finish line the way they want it.

But probably the biggest and most important reason – and the reason I am so, so worried about this one – is that it makes it extraordinarily difficult for any Republican member of Congress to vote against it. Let me explain.

Tax reform is a core priority for Congressional Republicans and the Trump Administration. In fact, it’s their #1 priority, despite the fact that they put health care first. That’s not me guessing: that’s straight from the mouth of Treasury Secretary Mnuchin, on President Trump’s behalf. Just as importantly, it’s a core priority for GOP donors: in a surprisingly candid moment recently, one member of Congress said point blank that his donors told him not to call them anymore if tax reform didn’t pass.

It’s also important to remember that, with the collapse of ACA repeal earlier this year, the GOP majorities in the House and Senate have failed to deliver a single major legislative victory for President Trump’s agenda.

Add all of this up to together, and throw in a dash of “the righteousness of tax cuts for the hyperwealthy is a longstanding article of faith for the GOP”, and you’ve got a perfect storm where, despite a few ongoing quibbles over specifics, it becomes difficult to imagine any Republican voting against tax reform, even if the individual mandate repeal is in there.

Of course, we know the stakes. CBO has made those clear: 13 million people lose coverage, premiums go through the roof, and the markets for individual insurance collapse across the country.

We didn’t think a tax break for America’s billionaires was a good idea when that was the proposal in earlier versions of repeal-and-replace: we certainly don’t think it’s any better as an idea now. And when you combine skinny repeal with a tax bill that, among other direct harm to the middle class (such as ending the student loan interest deduction), also gets rid of the medical deduction, it’s hard to escape the conclusion that the tax reform bill is one big attempt to take health care away from hardworking Americans to give a handful of billionaires some extra cash to stash away.

If Congress can look past their dollars-and-cents obedience to their donor class for a few minutes, our hope is that they will realize the massive damage they are doing in human terms to their voters and constituents.

You know the drill. We stopped these things before, and hopefully we can stop them again. It’s time to call, write, and e-mail. Make sure your members of Congress know how you feel about this latest effort at “sneaky repeal”.



State level

Here in Maine, the damage from this Senate bill would be about 50,000 Mainers losing coverage: 15,000 next year alone. That’s according to this expert analysis from our friends at the Maine Center for Economic Policy.

Not much new on expansion since it passed, other than that the posturing continues. In case anybody was unclear from my message last week: the clock on implementation starts ticking once the Legislature reconvenes in January. Once they come back into official session, the ballot expansion law will take effect 45 days later (mid-February).


Would you like to know more?

Tim Jost takes a look at what’s going on with risk corridor payments. (Spoiler alert: short answer is “not much and none of it great.”)


Until next time, friends, I remain,


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