Good morning...So like I said, today is definitely the day when the House will vote on Trumpcare. Do they have the votes? Not really. Will they get them? Guess we'll find out. Oh, and the polls look horrible for anyone who votes for it.
Here's the reality that President Trump and Republican leaders are facing: They want to repeal Obamacare, but not the popular parts of Obamacare. But to the most conservative Republicans, and their supporters, repeal means repeal — which includes everything, whether it's popular or not.
That's why Trump and GOP leaders couldn't close the deal with the Freedom Caucus and vote on the bill yesterday. It's why they have the Koch brothers after them. And it's why, barring a miraculous turnaround, they're not getting any closer to a deal, certainly not one that can survive the Senate as well as the House.
Here's where things stand as of this morning:
This Qunnipiac University poll was a big wakeup call for Republicans yesterday: Americans oppose the GOP bill by a 3 to 1 margin. But wait, you say — wasn't Obamacare pretty unpopular at this point in its passage, too? Yes — but in that case, the public was just evenly divided on it, according to a Washington Post poll in November 2009.
That should have been a warning sign too, and it set the pattern for the public opinion troubles that followed. But if you think Obamacare had problems with the public, imagine what happens if Trumpcare becomes law.
Obamacare, November 2009:
Trumpcare, March 2017:
The Freedom Caucus isn't making it up when they say Obamacare's insurance regulations have made individual coverage more expensive. Insurers have been saying that for years, which is why they've wanted more flexibility.
One industry analysis, I'm told, estimated that individual health insurance premiums increased by 50-60 percent in just two years — between 2013, the year before Obamacare's main insurance regulations took effect, and 2015. That includes 13-17 percent from the essential health benefits. But the biggest increase — 30-35 percent — was due to "guaranteed issue," the requirement to cover pre-existing conditions.
And in a Fox News column, Stanford's Lanhee Chen, a member of the Axios board of experts, cites a 2013 report by eHealth, Inc. that said individual health plans with benefits similar to Obamacare's essential benefits were 47 percent more expensive than plans that didn't have them.
But the Kaiser Family Foundation has a good reminder of why the law added all of those regulations in the first place: because 27 percent of non-elderly adults were shut out of the market because of health problems. They dealt with things like multiple-page questionnaires about their health status, lots of different rates, and health plans that left out major categories of benefits, like prescription drug or mental health coverage.
And for anyone who thinks the Republicans should just get rid of the essential health benefits but leave the pre-existing condition coverage in place, the Center on Budget and Policy Priorities has this reality check: they're linked. If insurers don't have to cover those broad categories of benefits, the center writes, they'd steer sick people away by cutting benefits and raising out-of-pocket costs.
The kicker: You like having no annual or lifetime limits? Those are tied to the essential health benefits — so if you get rid of those, the ban on those payment limits would be "meaningless."
Remember that big measles outbreak in late 2014 that originated in the germ haven of Disneyland and spread because some people weren't vaccinated? Turns out it spurred parents to get their kids to the doctor, Bob Herman reports. Roughly 45 percent of California babies had the measles vaccine in 2014, but that jumped to 62 percent by the end of 2015, according to data from the health IT company Athenahealth. The increase is partially attributed to California creating some stricter vaccine requirements, partially attributed to fears of getting an infection from riding the teacups.
While everyone is transfixed over the "repeal and replace" fight — which is only about who gets what kind of insurance, if any, to pay the exorbitant cost of care — Steven Brill flags this important piece in Health Affairs that might go unnoticed.
Which it shouldn't. It's about the only plan to control costs that has actually been working, Brill notes. States such as Maryland continue to make progress using state rate setting regimes, which bring not just prices, but the volume of the services under control. "Rate setting works," report authors David Frankfort and Sara Rosenbaum, "because it consolidates the demand-side, thereby enabling the assertion of collective bargaining power and control of expenditures."
What we're watching today: House Trumpcare vote. Expected between 4 and 5 p.m. Eastern, per House Majority Leader Kevin McCarthy's office.
What we're watching next week: Depends what happens with the Trumpcare vote.
Thanks for reading, and stay tuned: firstname.lastname@example.org.