House bill strips away more coverage, but passes despite no cost estimate

Developments on Day 105 of the Trump Administration:

On 3rd Attempt, House Narrowly Repeals ObamaCare

At the third attempt, the GOP-dominated House of Representatives votes to dismantle the main provisions of the Affordable Care Act.

The revised bill — rushed through without an economic assessment from the Congressional Budget Office and stripping away more provisions for care in significant concessions to Republican conservatives — passed on a 217-213 vote.

The White House succeeded after intense lobbying because almost all conservatives of the Freedom Caucus, who doomed the first effort, switched to a Yes vote. In contrast, Republican moderates only added one No, and in the end, only 20 GOP legislators opposed the measures.

The bill now heads to the Senate where it faces the challenge of a more-moderate Republican bloc as well as ongoing unanimous Democratic opposition.

The initial version of the bill was projected to take care away from 18 million Americans by 2018 and 26 million within the next decade, restoring the number of uninsured to the level of 2009 when ObamaCare came into effect.

While those with pre-existing conditions are still technically guaranteed coverage, the loosening of provisions on premiums means that many may find it too expensive. States are given more flexibility in defining what areas are or are not covered, and the range of pre-existing conditions has been expanded — critics noted that injuries from rape and sexual assault are now included as are many long-term medical needs.

Writing in The Washington Post, Paul Waldman summarizes some of the effects if the bill becomes law:

*Takes health insurance away from at least 24 million Americans; that was the number the CBO [Congressional Budget Office] estimated for a previous version of the bill, and the number for this one is probably higher.

*Revokes the Affordable Care Act’s expansion of Medicaid, which provided no-cost health coverage to millions of low-income Americans.

*Turns Medicaid into a block grant, enabling states to kick otherwise-eligible people off their coverage and cut benefits if they so choose.

*Slashes Medicaid overall by $880 billion over 10 years.

*Removes the subsidies that the ACA provided to help middle-income people afford health insurance, replacing them with far more meager tax credits pegged not to people’s income but to their age. Poorer people would get less than they do now, while richer people would get more; even Bill Gates would get a tax credit.

*Allows insurers to charge dramatically higher premiums to older patients.

*Allows insurers to impose yearly and lifetime caps on coverage, which were outlawed by the ACA. This also, it was revealed today, may threaten the coverage of the majority of non-elderly Americans who get insurance through their employers.

*Allows states to seek waivers from the ACA’s requirement that insurance plans include essential benefits for things such as emergency services, hospitalization, mental health care, preventive care, maternity care, and substance abuse treatment.
Provides hundreds of billions of dollars in tax cuts for families making over $250,000 a year.
Produces higher deductibles for patients.

*Allows states to try to waive the ACA’s requirement that insurers must charge people the same rates regardless of their medical history. This effectively eviscerates the ban on denials for preexisting conditions, since insurers could charge you exorbitant premiums if you have a preexisting condition, effectively denying you coverage.

*Shunts those with pre-existing conditions into high-risk pools, which are absolutely the worst way to cover those patients; experience with them on the state level proves that they wind up underfunded, charge enormous premiums, provide inadequate benefits and can’t cover the population they’re meant for. Multiple analyses have shown that the money the bill provides for high-risk pools is laughably inadequate, which will inevitably leave huge numbers of the most vulnerable Americans without the ability to get insurance.

*Brings back medical underwriting, meaning that just like in the bad old days, when you apply for insurance you’ll have to document every condition or ailment you’ve ever had.

Some GOP legislators admitted that, with the White House and Republican leadership anxious for a victory, they had not even read the provisions of the bill:

But Donald Trump celebrated, saying he is confident that the bill — titled the American Health Care Act — will pass the Senate and calling Obamacare “essentially dead”: “This is a great plan. I actually think it will get even better. This is a repeal and replace of Obamacare. Make no mistake about it.”

Despite the lack of any supporting evidence, he proclaimed, “As far as I’m concerned, your premiums are going to come down.”

In an ironic sequel, Trump went from the quickly-arranged celebration to a meeting and press appearance with Australian Prime Minister Malcolm Turnbull, where the US President hailed Australian health care as “much better” than that of the US.

Australia has universal public health care.

TOP PHOTO: Donald Trump and House Speaker Paul Ryan in the White House Rose Garden after House passage of the American Health Care Act (Evan Vucci/Reuters)

Trump Signs Religious Freedom Order — But Is It “Meaningless”?

Donald Trump signs an executive order mandating “religious freedom”, but there is debate over whether it has any significance.

Trump signed the order at a White House ceremony, surrounded by the nuns of the Little Sisters of the Poor. The order were able to gain a legal exemption from ObamaCare.

Trump said he would prevent the federal government from “bullying and even punishing Americans for following their religious beliefs.”

The order directs the Treasury to not take “adverse action” over churches or religious organizations for political speech. The 1954 rule has rarely been enforced — only one church is known to have lost its tax-exempt status as a result of the prohibition on electioneering from the pulpit — but Trump declared, “This financial threat against the faith community is over.”

A far more detailed draft of the order, leaked earlier this year, included provisions on “conscience protection” for faith-based ministries, schools, and federal workers across an array of agencies.

Analysts across the political spectrum asserted that the order accomplishes little. Robert George, a Princeton University professor and leading expert on religious liberty, called the order “meaningless” and “a betrayal”.

The Heritage Foundation’s Ryan Anderson, a proponent of strong legal protections for religious liberty, was disappointed.

The American Civil Liberties Union, which envisaged a lawsuit against the order, said that this was no longer necessary.

Meanwhile, Trump announced he would visit three global religious centers as part of his first overseas trips as President. He said he will go to Saudi Arabia to “begin to construct a new foundation of cooperation” to combat terrorism, to Israel, and to the Vatican with a meeting with Pope Francis.

House Renews Investigation of Trump-Russia Ties

The House Intelligence Committee renews its investigation of the links between Donald Trump’s associates and Russian officials, with closed-door testimony from FBI Director James Comey and National Security Agency head Michael Rogers.

Comey and Rogers testified at the committee’s initial hearing on March 20, but proceedings were suspended by committee chairman Devin Nunes as he collaborated with the White House about next steps. Nunes’ recusal as chair, amid criticism from other committee members and a possible investigation by the House Ethics Committee, opened the way for Thursday’s resumption.

Witnesses in further sessions will include former Acting Attorney General Sally Yates, after her appearance was blocked by Nunes in March.

Offering no details of Thursday’s testimony, ranking GOP and Democratic members Mike Conaway and Adam Schiff said it was “a valuable opportunity” to follow up on the March 20 hearing in which Comey confirmed the FBI was investigating possible “coordination” between the Trump campaign and Russia in the 2016 election.

State Department Proposes Collection of 15-Year Travel History & 5-Year Social Media History From Some Visa Applicants

The State Department proposes an extensive collection of information, including a 15-year travel history and a 5-year social media history, from visa applicants from some countries.

The Department said the proposed collection is needed “to more rigorously evaluate applicants for terrorism or other national security-related visa ineligibilities”. It did not specify which countries would be targeted.

The information would include the “source of funding for travel” in the past 15 years; address and employment over 15 years; names and dates of birth of all current and former spouses and/or civil partners, children, and siblings; and “social media platforms and identifiers, also known as handles, used during the last five years and phone numbers and email addresses used during the last five years”.

Homeland Security Chief Denounces Senator’s “Outrageous” Tweets About Mother-and-Child Deportation

Homeland Security Secretary John Kelly criticizes Senator Bob Casey’s “outrageous” tweets urging the halt of the deportation of a Honduran mother and 5-year-old child.

Casey tweeted on Wednesday about the imminent deportation and followed up Thursday writing about Donald Trump, Chief of Staff Reince Priebus, the Department of Homeland Security, and Immigration and Customs Enforcement:

Kelly responded, “You can’t pick and choose the laws you follow. I can’t pick and choose the laws I enforce.”

He said he had tried to call Casey five times and asserted that the mother was denied the opportunity to stay in the US by multiple courts, including the Supreme Court.

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