No. of Recommendations: 0
... that would prevent the likes of Traitor Joe Lieberman from making health care more expensive.

The 3 decisions that will shape Medicare-for-all
https://www.vox.com/policy-and-politics/2018/12/17/18141464/...

The central lesson of both Obamacare and the efforts to repeal it is that getting 60 votes for health care reform is almost impossible.

In Obamacare’s case, the filibuster meant Democrats needed to win every single one of their 60 members, which meant every single Senate Democrat held a veto on the bill. Absent the filibuster, the Affordable Care Act could’ve been substantially more generous, and substantially more ambitious. Sen. Joe Lieberman, for instance, vowed to kill the bill unless both the public option and a proposal to open Medicare to 55-year-olds were axed. If Democrats could’ve passed the bill with 51 votes, they could’ve told Lieberman to take a hike.

</snip>


intercst
Print the post Back To Top
No. of Recommendations: 5
If Democrats could’ve passed the bill with 51 votes, they could’ve told Lieberman to take a hike.

And if Republicans could pass a bill with 51 votes, they could have repealed the ACA entirely in 2017 and replaced it with their preferred alternative.

Sometimes the marginal vote is a centrist Democrat blocking a progressive proposal...but sometimes the marginal vote is a centrist Republican blocking a hard right proposal. The reason the GOP got in such a bind over ACA repeal is that while they had the ability to repeal (in part) the bill with 51 votes, they would have needed 60 votes to enact their preferred replacement. So they had no path to drafting their own bill, just axing parts of the existing ACA.

Albaby
Print the post Back To Top
No. of Recommendations: 0
The filibuster rules put the Senate in the catbird seat and pretty much make the House of Representatives a nullity.

Why would they change and make give the House a lot more power than it has now?



Seattle Pioneer
Print the post Back To Top
No. of Recommendations: 2
albaby1 writes,

<<If Democrats could’ve passed the bill with 51 votes, they could’ve told Lieberman to take a hike.>>

And if Republicans could pass a bill with 51 votes, they could have repealed the ACA entirely in 2017 and replaced it with their preferred alternative.

</snip>


Exactly! We need the GOP to pass their preferred alternative and strip health insurance from 20 million people. That's the only way to get people's attention, and have them punish the GOP at the voting both.

That's why I'm so proud of the job Trump is doing. Millions of "moderates and independents" now understand the dishonestly and incompetence you get with Republican governance. You need to break a few dishes to make any progress.

intercst
Print the post Back To Top
No. of Recommendations: 0
SP writes,

The filibuster rules put the Senate in the catbird seat and pretty much make the House of Representatives a nullity.

Why would they change and make give the House a lot more power than it has now?

</snip>


The problem right now is that nothing can get done with the 60 vote threshold in the Senate. Eventually the gridlock will endanger the current officeholders. They'll need to change to survive.

intercst
Print the post Back To Top
No. of Recommendations: 2
The reason the GOP got in such a bind over ACA repeal is that while they had the ability to repeal (in part) the bill with 51 votes, they would have needed 60 votes to enact their preferred replacement. So they had no path to drafting their own bill, just axing parts of the existing ACA.

Isn't actual reason is that didn't have ANY BILL to propose, debate, and compromise on? Had that happened, then maybe the votes would've been forthcoming.
Print the post Back To Top
No. of Recommendations: 2
...replaced it with their preferred alternative.

LOL. Good one. Which alternative is it that Republicans preferred? Why not explain the details of that bill to all of us that don’t remember the GOP bill they were offering?
Print the post Back To Top
No. of Recommendations: 1

And if Republicans could pass a bill with 51 votes, they could have repealed the ACA entirely in 2017 and replaced it with their preferred alternative.


No, albaby, they wouldn't have.
The reason why the ACA still stands is not the filibuster, it's that there was no alternative that was remotely acceptable to the American people.

The GOP will not let the filibuster stand in the way of something they really want to do.
See: tax cuts.
Print the post Back To Top
No. of Recommendations: 0
Exactly! We need the GOP to pass their preferred alternative and strip health insurance from 20 million people. That's the only way to get people's attention, and have them punish the GOP at the voting both.

That's rather cruel and heartless towards the 20 million people who need that health insurance...many of them children.

But the GOP would probably have been able to tailor their bill so that some of those 20 million people didn't lose their insurance. After all, that's why they didn't just pass the clean "skinny repeal" of the ACA - it was really hard to get 50 votes to simply take all those people off insurance altogether.

So if you take away the filibuster, you hand the GOP the same opportunity as the Democrats - the chance to draft a bill that accomplishes their goals without paying too high a political price.

Albaby
Print the post Back To Top
No. of Recommendations: 1
No, albaby, they wouldn't have.
The reason why the ACA still stands is not the filibuster, it's that there was no alternative that was remotely acceptable to the American people.


They came within a single vote of passing it as it is. But they couldn't get that last vote, because the reconciliation process doesn't let them come up with an alternative that can be remotely acceptable to the American people. They can't go back to the status quo ante or stick a "TrumpCare" label on a replacement bill that partially undoes the ACA.

The GOP will not let the filibuster stand in the way of something they really want to do.
See: tax cuts.


Again, tax cuts are easy to do without letting the filibuster stand in your way, because tax cuts are almost entirely budgetary - they're tailor-made for using reconciliation. You can't do that with more substantive regulation.

Albaby
Print the post Back To Top
No. of Recommendations: 1
The GOP will not let the filibuster stand in the way of something they really want to do.
See: tax cuts.


Psst. Over here.

The tax bill only had 51 votes. It could NOT pass the filibuster.

https://www.nytimes.com/interactive/2017/12/19/us/politics/t...

The bill was able to pass with a simple majority of votes because of a Senate mechanism known as budget reconciliation,
Print the post Back To Top
No. of Recommendations: 2

The tax bill only had 51 votes. It could NOT pass the filibuster.



Yes, of course. But the GOP managed to get it passed anyway, despite the fact that it clearly blows up the deficit and should not have been able to get through the reconciliation process.

The tax cuts are an excellent example that the filibuster is not preventing the GOP from doing the bulk of what it really wants.
Print the post Back To Top
No. of Recommendations: 3
But they couldn't get that last vote, because the reconciliation process doesn't let them come up with an alternative that can be remotely acceptable to the American people.

Albaby,
it's not the reconciliation process that prevents the GOP from coming up with an acceptable alternative.

I think the problem with the GOP attempts at healthcare reform can be summed up in one sentence:

There is no healthcare system to the right of Obamacare that would be acceptable to the American people.

In terms of its basic concept, Obamacare is as right-wing and as market-oriented as you can get while making reasonably affordable insurance coverage available to close to everyone.


https://boards.fool.com/the-problem-with-gop-healthcare-refo...

NOTHING the GOP can come up with would be able to offer affordable coverage to people with pre-existing conditions. That's ultimately what killed the ACHA, and it has nothing to do with the filibuster.
Print the post Back To Top
No. of Recommendations: 0
NOTHING the GOP can come up with would be able to offer affordable coverage to people with pre-existing conditions. That's ultimately what killed the ACHA, and it has nothing to do with the filibuster.

Except again, they came within a single vote of doing that. It passed the House, and very nearly passed the Senate.

I disagree that the GOP was unwilling to inflict some hit to people with pre-existing conditions. The main obstacle to "skinny repeal" was that they had no flexibility to soften the blow a bit (although even then, McCain's objections were largely relating to the lack of regular order in considering the bill, not substantive). Had they not been constrained with filibuster rules, and had some measure of flexibility in crafting a bill that wasn't so indiscriminate in its effects, they could have easily passed repeal.

Albaby
Print the post Back To Top
No. of Recommendations: 4
Had they not been constrained with filibuster rules, and had some measure of flexibility in crafting a bill that wasn't so indiscriminate in its effects, they could have easily passed repeal.


No, they couldn't have. Well, they might have passed the "skinny repeal", but that wasn't really a repeal, was it. They ended up getting rid of the individual mandate later anyway.

I was watching the healthcare debate back then VERY closely. As in, I read/listened to hundreds of pages of analysis every day for several weeks.
Pathological, really.
There was no squaring the circle. The GOP wanted their massive tax cut (repeal of the Obamacare taxes), and that meant that there was much less money to subsidize health insurance.
Starting from that fixed point, there was no acceptable solution that could be arrived at.

To make up for the revenue shortfall, they had to get rid of pre-existing condition protection (or hugely cut coverage). There wasn't any way to get around that. There's no way of making up for the massive revenue losses unless you impose massive cuts somewhere. The lack of flexibility was not due to the filibuster, it was because if you don't have money to spend because you allocate it all to tax cuts, then you don't have flexibility.

Well, I suppose they could have just kept the subsidies and run a deficit. But then they could have done that through reconciliation as well and just added a sunset provision like they did in the tax reform.
Print the post Back To Top
No. of Recommendations: 0
To make up for the revenue shortfall, they had to get rid of pre-existing condition protection (or hugely cut coverage). There wasn't any way to get around that.

I agree. And since they couldn't get rid of pre-existing protection - since that's a regulatory provision- using reconciliation, that wasn't really an option for them. Had they had that option, they could have fashioned a bill that trimmed protections for pre-existing conditions (perhaps even significantly), which would have allowed them to attack other parts of the ACA without blowing up the individual market.

Again, the GOP was convinced that repealing the ACA (at least in part) was a political winner for them, or at least a political necessity for appeasing their base. Were they given the flexibility to attack the bill without being constrained by reconciliation, I think it's overwhelmingly likely that they would have done so. The ACA was saved by the filibuster, which makes it much harder to repeal existing programs even as it makes it harder to adopt new ones.

Albaby
Print the post Back To Top
No. of Recommendations: 0
Had they had that option, they could have fashioned a bill that trimmed protections for pre-existing conditions (perhaps even significantly), which would have allowed them to attack other parts of the ACA without blowing up the individual market.

Albaby, "trimming" those protections was precisely what the various iterations of the ACHA and the skinny repeal were doing.
In the case of the skinny repeal, for example:

Provide greater flexibility to the states through waivers: Obamacare changed the way insurers do business, banning them from discriminating against people with pre-existing conditions and requiring them to cover 10 essential health benefits, including maternity and mental health. These regulations pushed up the cost of coverage.

The "skinny repeal" bill would give states more flexibility in implementing some of these regulations, including the essential health benefits and the out-of-pocket spending limit.


https://money.cnn.com/2017/07/27/news/economy/senate-skinny-...

There was no "all or nothing" requirement. Or at least the GOP was acting (and drafting) as if there wasn't.
Print the post Back To Top
No. of Recommendations: 0
Albaby, "trimming" those protections was precisely what the various iterations of the ACHA and the skinny repeal were doing.

Only to a point. That's why they couldn't change the list of 10 essential health benefits (for example). All they could do was make fiddles around the edges of interpretation and implementation. They couldn't repeal the statutory provisions outright, or replace them with new ones.

Albaby
Print the post Back To Top
No. of Recommendations: 1
They couldn't repeal the statutory provisions outright, or replace them with new ones.

But they could give the states "waivers to innovate". That was certainly flexible. And that's what they tried to do.
Really, what would they have done different without the filibuster?
They had to cut. A great deal.
There would have been no way around that. What magical and not extremely unpopular thing do you believe they could have done to fill that hundreds-of-billions budget hole?

If the GOP had had a healthcare plan it really liked, the filibuster would have been abolished in an eye blink.
But the truth is that the GOP is not interested in healthcare, other than insofar as cutting it enables them to cut taxes for rich people.
The ACHA achieved that goal just fine.
Print the post Back To Top
No. of Recommendations: 0
What magical and not extremely unpopular thing do you believe they could have done to fill that hundreds-of-billions budget hole?

If the GOP had had a healthcare plan it really liked, the filibuster would have been abolished in an eye blink.


They could have gone back to letting insurance companies offer whatever plans they wanted to. They could have re-written the statutory requirements for the marketplaces, or eliminated portions of the required health benefits. Etc.

None of these things are "magic" - like most legislation, there would be people that would be unhappy with the changes. But their base would be supremely happy, and that would have been enough to get it through (just like the Democratic majority had to swallow to accept the ACA in the first place, even though there were a lot of things that were less-than-ideal about it, because their base wanted health care reform of some measure). What handicapped them is that they couldn't alter the basic structure of the ACA - the exchanges, the minimum coverage requirements, the community rating mechanisms, etc.

The GOP isn't going to abolish the filibuster in an eye blink, because the Republican Senators know that it gives each of them an outsized role in legislation - just like Democratic senators never seriously considered abolishing the filibuster for legislation to get the ACA (or climate change bills or card check) passed.

Albaby
Print the post Back To Top
No. of Recommendations: 3
The GOP isn't going to abolish the filibuster in an eye blink

Congratulations. You have stated something no one disagrees with as rationalization for your meandering argument against health care reform.

Increasingly your argument sounds like this: "I work for wealthy firms that purchase excellent health insurance for me so I do not support any health care reform for others. They can all be kicked to the curb and die as far as I'm concerned. I will make arguments that changing what we have will be politically difficult so therefore should not be attempted, because that argument favors me."

Only Donald Trump did not realize that health care reform was complicated or that changing it would face political resistance. Some of us just tend to be motivated to try to improve it anyway.
Print the post Back To Top
No. of Recommendations: 0
AD: Well, I suppose they could have just kept the subsidies and run a deficit. But then they could have done that through reconciliation as well and just added a sunset provision like they did in the tax reform.

<ahem> I thought we have been running a deficit for at least 30 years (Only the Clinton second term ran a surplus.

CNC
Print the post Back To Top
No. of Recommendations: 0
<<If the GOP had had a healthcare plan it really liked, the filibuster would have been abolished in an eye blink.>>


Oh, Democrats have had numerous opportunities to abolish the Senatorial filibuster. The filibuster is used by both political parties.


In my opinion, the most important effect of the filibuster is that it generally requires political consensus to pass most laws, and a side effect of that is to pretty much nullify the influence of the House of Representatives.

95% of the time, the issue in passing a law is what the Senate does, not what the House does. And that is largely because action on a proposed law is blocked in the Senate until substantial consensus is present.

Neither Democratic Senators nor Republican Senators are anxious to give up that power, generally speaking.

Seattle Pioneer
Print the post Back To Top
No. of Recommendations: 9
But their base would be supremely happy,

I find it hard to imagine that the typical elderly rural voter, who would have had to spend maybe 3 times as much money for the same coverage, would have been very happy.

and that would have been enough to get it through (just like the Democratic majority had to swallow to accept the ACA in the first place, even though there were a lot of things that were less-than-ideal about it, because their base wanted health care reform of some measure).
What handicapped them is that they couldn't alter the basic structure of the ACA - the exchanges, the minimum coverage requirements, the community rating mechanisms, etc.



You are mistaken, albaby.
The various ACHA proposals would have substantially altered ALL of those.

The community rating:
Raised from a multiplier of 3 to a multiplier of 5:

Insurers could charge older adults five times what younger consumers pay for health insurance — up from three times what younger people pay, under the current law.

https://www.aarp.org/politics-society/advocacy/info-2017/eff...


The essential health benefits (minimum coverage):

States would have the option to get waivers from two of Obamacare’s requirements: that insurers cover “essential health benefits,” and that they charge the same price to everyone regardless of their health history. That would get rid of a key protection for people with preexisting conditions. An amendment added to the AHCA in late April allows states to opt out of Obamacare’s “community rating” requirement — which says that all people, healthy and sick, should be charged the same prices — for people who do not maintain continuous health insurance coverage.

https://www.vox.com/policy-and-politics/2017/5/3/15531494/am...

This would have done exactly what you think the GOP would have liked to do, but you claim couldn't have: introduce flexibility on minimum coverage.
Give waivers to the states which can then flexibly decide which coverage to require and which not.

This is what the GOP proposed, without any regard to the filibuster.
The reason why they didn't go through with it, I assume, is because this would have been extremely terrible for the older, rural population. Which, as I understand, is a big component of Trump's base. If you were between 50 and 65 and living in a rural area (i.e. a Trump voter), you would have either seen your coverage shrink tremendously or seen your effective premiums go up by something like 200% to 600%. Neither of which, I imagine, would have been very popular.

I was watching all this very, very closely in realtime, and couldn't really understand how this comprehensive re-write was supposed to be compatible with filibuster rules. But the GOP legislators were apparently not concerned about that, and the only time I have heard any concerns was about the ludicrous replacement for the individual mandate.

Otherwise, there was absolutely no talk of any constraints.


Here is a tool you can use to simulate the impact of one of the AHCA variants on premiums and tax subsidies. As you will see, I'm not kidding about the massive costs that would have hit Trump voters.

https://www.kff.org/interactive/tax-credits-under-the-afford...
Print the post Back To Top
No. of Recommendations: 0
The various ACHA proposals would have substantially altered ALL of those.

* * *

Otherwise, there was absolutely no talk of any constraints.


That's just not true. Sure, AHCA had all those things when it passed the House - because the House can pass whatever it wants on a straight majority. But even the Republicans were fairly candid that those provisions would not pass muster under the rules governing reconciliation:

The problem is that Senate Democrats are expected to argue that various parts of the House bill will not meet Senate rules governing what can be included in reconciliation.

Democrats will argue that those provisions, such as a rule allowing states to seek a waiver for a regulation that requires insurers to offer certain minimum benefits, do not have a straightforward connection to spending, taxes or the deficit — something required under reconciliation.

[GOP Senator John] Cornyn said the House bill — if it passes — will have to be revised.

“I suspect the bill the House passes will be modified if for no other reason that the reconciliation rules would require it,” he said. “My goal would be if they pass a bill, which I hope they will, it will come over here and we’ll do our best work to cobble together 51 votes.”


https://thehill.com/homenews/senate/331842-in-senate-pessimi...

And even then, the House recognized that they had to keep the overall framework of the existing legislation. While the GOP could change the dials and tweak the specifics of the ACA through the reconciliation process, the overall framework of the ACA could not be altered. They had to work within that framework, not change it (or eliminate it). That also meant that several of their favorite health care ideas (like buying insurance across state lines) couldn't be added to the bill. Only items that have a direct budgetary impact can be adopted through reconciliation.

So the GOP had no ability to return to the status quo ante, and few options within the parts of the ACA that they had to keep without blowing up the individual insurance markets.

Albaby
Print the post Back To Top
No. of Recommendations: 0
Otherwise, there was absolutely no talk of any constraints.

Replying again - the Senate Parliamentarian also agreed that those provisions were not permitted under reconciliation, which basically killed the ability of the Senate to pass the AHCA, and which led to the "skinny repeal" effort:

https://www.vox.com/policy-and-politics/2017/7/27/16051170/s...

Albaby
Print the post Back To Top
No. of Recommendations: 3
They had to work within that framework, not change it (or eliminate it).

Well, they could blow it up, certainly. Skinny repeal contained state waivers that would have allowed the states, as I understand it, to get rid of essential benefits and community rating.
What else do you want? Assuming the GOP hadn't been constrained by the filibuster, what possible construct could they have created that wouldn't have made things MUCH worse for the elderly rural Trump voter?
The most important effect of Obamacare's private part was that it provided enormous subsidies precisely to this group.
This was done by taxing rich people and some medical businesses, and imposing costs on healthy young people through the community rating.

What could the GOP possibly have come up with that A) got rid of the taxes and B) didn't impose massive costs on the core Trump constituency (either through increased premiums, lower tax subsidies, or less coverage)?

The only thing the GOP ever had to offer its voters on healthcare was a s***sandwich.

Also, if they HAD gotten a majority for one of their AHCA variants, do you really believe they would have let the fact that it would have violated filibuster rules stop them?
Print the post Back To Top
No. of Recommendations: 0
Assuming the GOP hadn't been constrained by the filibuster, what possible construct could they have created that wouldn't have made things MUCH worse for the elderly rural Trump voter?

They probably would have killed the exchanges, community rating, and all the rest outright - and replaced it with their usual mix of policy proposals: deregulation of insurance markets, ability to purchase insurance across state lines. It's hard to say for sure, because until they actually go through the exercise of whipping a bill, there's no way to know: while the parties both advocate "health care reform" from time to time, you don't know where they'll land until they start drafting and whipping a bill that can pass.

This would indeed have had a negative effect on some elderly rural Trump voters. But you probably would have had some restoration of DSH payments to rural hospitals and other mechanisms to balance it out.

More importantly, the ACA exchanges haven't exactly been great for rural communities. Unlike urban areas, most rural counties ended up with few participants in the exchanges (about half of all counties in the U.S. have only a single provider in the exchanges, and nearly all of them are rural). Those communities featured the highest costs for coverage, and that's where the narrow-network policies predominated. The exchanges have largely benefited urban and suburban communities, where populations are high enough and there are sufficiently large numbers of providers that multiple insurance plans can thrive on the exchanges.

https://www.kff.org/health-reform/issue-brief/insurer-partic...

Also, if they HAD gotten a majority for one of their AHCA variants, do you really believe they would have let the fact that it would have violated filibuster rules stop them?

Yes. Absolutely. Once the Senate Parliamentarian ruled against them, Senate rules would require a 60 vote majority to override the Parliamentarian. To move forward, they'd have to amend that rule, and de facto eliminate the filibuster. And McConnell doesn't have either the votes or IMHO the desire to do that.

Albaby
Print the post Back To Top
No. of Recommendations: 1
They probably would have killed the exchanges, community rating, and all the rest outright - and replaced it with their usual mix of policy proposals: deregulation of insurance markets, ability to purchase insurance across state lines

Most of this they would have accomplished anyway with their waivers.
And - I don't know how much you remember of the debate, but the pre-existing condition protection was THE sticking point for the GOP holdouts in the Senate.
I really don't see how a wholesale abolition of Obamacare would have gotten past that problem.


And let's face it, if the GOP had had a few more senate seats (54+), they'd have blown up/replaced Obamacare one way of the other.
So, they would have gotten their way with WAY fewer than 60 votes.

How likely is it that the Democrats will have 60 Senate votes within the next two decades?
The main effect of the filibuster is going to be to block ANY possibility of ANY Democratic legislation, while the GOP, which appears to be mostly set on wrecking stuff, will continue to implement its agenda.
Print the post Back To Top
No. of Recommendations: 0
I don't know how much you remember of the debate, but the pre-existing condition protection was THE sticking point for the GOP holdouts in the Senate. I really don't see how a wholesale abolition of Obamacare would have gotten past that problem.

Because they would have been able to craft new things - perhaps even things unrelated to pre-existing conditions - that could bring those Senators on board. A similar dynamic happened with the ACA in the first place. Reid had to throw in a number of very state-specific provisions that addressed the concerns of Senators like Nelson (NE), Nelson (FL), and Landrieu (LA).

Mitch McConnell is very good at the part of his job where he has to whip support for a bill. I think it's inconceivable that if the GOP only had to get 50 votes and could write whatever they wanted into a bill that he wouldn't be able to get it done.

Albaby
Print the post Back To Top
No. of Recommendations: 0

Mitch McConnell is very good at the part of his job where he has to whip support for a bill. I think it's inconceivable that if the GOP only had to get 50 votes and could write whatever they wanted into a bill that he wouldn't be able to get it done.


He almost got it done anyway. So in the case of the ACA, the filibuster was worth maybe 2 Senate votes or so?
Print the post Back To Top