Town Hall challenges: not just for Teahadists

[Greenbeard]

i'm for healthcare reforms too
but that doesnt mean i expect something particular in order to repeal this monstrosity

I understand that. I'm not a big fan of the health care bill, but I do think we need something in place of it.

And I was responding to somebody who said who says it needs to be replaced with something? Sarah Palin was for health care reform in the 08 election (obviously not reform of this kind). Yet nobody on the right is mentioning anything about reform.

I just want to know what happened to the GOP agreeing on no pre-existing conditions for being denied care, and no life limit caps on care. Both sides agreed to this not all that long ago-so why doesn't the GOP at least say ok these parts of the bill we like-we want to repeal the bill-then add these separate things.

You don't have to expect anything, but the GOP did support a few (not saying a lot) aspects of the health care in campaign mode-and I think people are frustrated as to why aren't they supporting those particular aspects now.

i doubt you will see those parts repealed
the support for ending that was strong on all points on the political map

What ideas in the ACA did the GOP support? A relatively cursory, incomplete look shows several.

In the official repeal-and-replace bill last session:

• High-risk pools (these are implemented on a temporary basis in the ACA and are proving, as critics have long suggested, to be a very ineffective way to expand coverage)
• Elimination of annual and lifetime caps
• Ending rescission
• Administrative simplification via the promulgation of federal standards for electronic transactions
• Extending dependent coverage past the age of 25
• Wellness and prevention incentives

In Paul Ryan's/Tom Coburn's bill(s):

• State-based health insurance exchanges
• Guaranteed issue rules
• Inclusion of mechanisms in exchanges to prevent "imposition of excessive premiums"
• The extension into the individual market of of advanceable tax credits for the purchase of qualified health insurance plans
• Inclusion of the value of health benefits on employees' W-2 forms
• Supplemental health care assistance for low-income families
• Efforts to reduce spending on Medicare Advantage plans
• Accountable care organization demonstration plans in Medicare
• Higher Medicare premiums for wealthier beneficiaries
• More data collection
• Demonstration grants to states to evaluate alternatives to their current tort laws
• Creation of a body to conduct and fund research on effectiveness of different health care services

In the Republican Study Committee's bill (e.g. Tom Price's bill):

• Advanceable tax credits to help low-income people pay for health insurance in the individual market
• Again with the high-risk pools
• Use of performance-based quality measures for physicians participating in Medicare
• Loan forgiveness for primary care providers

The Republican proposals also tend to favor strengthened authority/additional resources for cracking down on fraud in Medicare and Medicaid, ideas that made it into the ACA. The Republican bills also favored some form of interstate insurance sales. The incarnation of this that made it into the ACA most resembles that in Paul Ryan's bill: encouragement of interstate compacts that would allow plans issued in one exchange to be sold in another. The ACA goes a little further than Ryan's bill in that in addition to allowing interstate compacts, it calls for the creation of (private) nationwide plans that can be sold in any state.

The reality is that, for the most part, the philosophical division between the parties isn't nearly as big as it's made to seem for the purposes of political theater. There are policy differences in the details that need to be ironed out but cries of "Armageddon" were a bit over the top.

In fact, here's a charming story from just the other day. It should be relatively well-known by now that the centerpiece of the ACA's insurance reforms is the creation of state-based health insurance exchanges. Turns out even some in the Texas GOP are pretty warm to the idea:

AUSTIN – A key House GOP health policy writer has filed legislation to create a state-run health insurance exchange in Texas.

A bill by Rep. John Zerwas, R-Katy, would create a Texas Health Insurance Connector, or simplified insurance market.

It would serve as the state's insurance exchange as required under the federal health overhaul passed last year, Zerwas said Thursday.

"My opposition to the federal health care reforms is no secret, and I continue to support Attorney General Greg Abbott's efforts to have the law declared unconstitutional," he said.

"But the ‘connector concept' has been around for decades and did not originate with Obamacare," Zerwas said. "Quite frankly, it is something that we should consider on its own merits regardless of the fate of the federal reforms."

The message coming out there is "I oppose health reform...but I'll take the exchange idea."

Which, oddly, seems to mirror the national party's line: "I hate the ACA...but I'll take most of its main features."