Enders Game: #POTUS @RealDonaldTrump’s ObamaCare Repeal Trump Card

Update: Trump in Tennessee Tonight:



Presumably, among the topics will be ObamaCare repeal and replace. President Trump might also have a few choice words for the Obama appointed federal clown in Hawaii who issued a Temporary Restraining Order on the latest executive order travel ban. The order is bad enough but the reasoning based on the Establishment Clause is entirely ridiculous. Note: before the TRO expires there might just be a new Supreme Court Justice because Neil Gorsuch gets a hearing in the Senate on Monday and maybe just maybe he will get a vote soon.

President Trump has been Trumpnado-ing through today. President Trump in Michigan spoke to automobile company workers, unions, and management. President Trump promised to unshackle the automobile industry in this country and restore it to glory. “Buy American and Hire American” said POTUS with Mostest.

POTUS Mostest Trumpest will also be on Tucker Carlson’s show tonight after an early morning of Tweeting about Rachel Maddow’s disaster Tuesday night on TrumpTaxes. Is it 2018 already?

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It’s two trains running. Two trains running along two separate tracks and President Trump ready, willing, and able, to jump from Von Ryan’s Express to the TrumpTrain. President Trump is on Von Ryan’s Express on the healthcare debate for now, but it is very easy to see that President Trump has a very good grasp on the truth in this healthcare debate and might soon jump to the TrumpTrain.

Von Ryan’s Express, TrumpTrain??? There are three must understand truths about the current healthcare debate to be put into the context of everlasting truths of politics (everlasting truth such as that the prime directive for senators and congress-critters is to be re-elected).

Healthcare debate truth #1: ObamaCare is so bad it must and will be repealed and what will replace it will be much better than ObamaCare.

Healthcare debate truth #2: The current GOP public plan to replace ObamaCare is stupid and not very bright on policy and electoral grounds but the likelihood it will pass is very great because President Trump knows how to sell and for senators and House members the next election is always around the corner.

Healthcare debate truth #3: Trust President Trump on ObamaCare repeal and replace because this guy is very smart, knows what he is doing, and wants to truly repeal ObamaCare and replace it with something that provides healthcare, not merely inaccessible health insurance.

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Don’t trust President Trump for the reason that you are a cult member of a fan club that will excuse anything he does and will defend anything he does. Trust President Trump because he is smart, has a game plan to Make America Great Again, and will repeal/replace ObamaCare. Flim-flam con man Barack Obama was a two trains type guy too. But for Obama the two trains he hopped on were personal advancement gravy trains. Those always lead to a train wreak.

So what the Hell is President Trump up to?

On Wednesday, President Trump begins his sell pitch at a big rally. Another rally is scheduled and more are likely to come. President Trump will take to the road to sell something that is not particularly good. Yes, it is better than the ObamaCare America is oppressed by. But um, is it great? Um, no.

So what the Hell is President Trump up to?

What is President Trump up to? Well, President Trump on Von Ryan’s Express has to demonstrate he is making a good faith effort to pass the current bill the House leadership under Paul Ryan has written before Trump moves to change it. That bill is a mess on several levels but President Trump has to make a good faith effort to pass it so that he can say “I tried to pass this” just before he jumps to the TrumpTrain.

President Trump knows the mess that is the health insurance plan on Von Ryan’s Express. President Trump knows it is a mess because he is listening to the critics of the plan – critics who supported him during his election bid. Still President Trump, like a good businessman, is going forward with the Ryan express package to see how it plays out. It’s an opening bid.

Recall, how the Von Ryan Express Train tracks. It is a three phase plan. Phase I is to pass the current health insurance bill via the “Reconciliation” process. Using “reconciliation” to overcome the artificial 60 vote majority necessary to pass a bill through the Senate means that supposedly only matters of a strict budgetary nature get to be in the bill.

Phase II, is one we will discuss later.

Phase III, is the mirage that at some point the Obama Dimocrats will agree to provide the 60 vote majority necessary to pass all the really good stuff in health care reform, such as tort reform and the ability for Americans to buy insurance across state lines thereby bringing competition into the reform process.

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Before we return to “what the Hell is President Trump up to?” let’s deal in this section of our analysis with the dull policy stuff. Hey, it’s only life and death, not the fun stuff we like in politics. But the policy stuff does matter. If you get bored with policy, just skip this section.

What’s the problem with the Von Ryan Express plan? First and foremost, the author. Paul Ryan. Let’s all agree that Paul Ryan is a male Nancy Pelousy. That’s unfair. Paul Ryan is smart and Paul Ryan is kinda cute unlike Nancy Pelousy. But like Nancy Pelousy, Paul Ryan could not sell lemonade in August heat, shovels in winter pre-snow storm, nor life insurance on board the Titanic in it’s last hours. Indeed the more Paul Ryan talks, the more likely the Paul Ryan train goes off the tracks.

Earlier this week the Congressional Budget Office issued it’s assessment of Ryan’s health insurance scheme. Ryan began to appear on television to laud the CBO report as wonderful. Everyone else in the administration spoke with a degree of intelligence and essentially blasted the CBO report. Paul Ryan? Well, something’s not right with that boy.

Compare and contrast Paul Ryan and Newt Gingrich’s response to the CBO report:



If that’s an example of Paul Ryan “excited” we feel sorry for his wife. Paul Ryan, blue eyes aside, simply is at a par with Nancy Pelousy when it comes to believability. We don’t doubt he knows what he is talking about, but his interest appears to be to demonstrate he knows what he is talking about instead of convincing the public that he is telling the truth. Something is just not right with that boy, the way he talks and talks a little too fast and slippery.

Bottom line is that best message came from Newt. Even Office of Management and Budget Director Mick Mulvaney made a better pitch than Ryan on the hostile Morning Joe show:



Mulvaney is right: Care is what matters, not coverage. It’s a critique we made of ObamaCare since 2009. ObamaCare fed the health insurance companies money forced from Americans via the coercive force of government but the insurance deductibles were so high many Americans could not access the insurance they paid dearly for.

Avik Roy, of Forbes Magazine, frequently agreed with points we made about ObamaCare. Avik Roy makes the case much better than Paul Ryan for why the CBO report is kinda useless and sorta good news:

Believe It Or Not, CBO’s Score Of House GOP Obamacare Replacement Is Better Than Expected

The non-partisan Congressional Budget Office has estimated that 24 million fewer people will have health insurance by 2026 under the House GOP plan to replace Obamacare. That projection is unsurprising, and quite likely overstated. But what is surprising about the CBO report is the ways in which it makes the GOP bill look better than expected, and how it points to how the bill can be improved. [snip]

The first thing to know about the CBO is that it has long had problems modeling how a competitive, individual insurance market would work. This is reflected in their frequently revised estimates as to how many people would enroll in Obamacare’s insurance exchanges.

As the below chart shows, in 2010, when the Affordable Care Act was passed, CBO estimated that 21 million people would enroll in the ACA exchanges in 2016. The actual number was closer to 10 million. Even now, CBO believes that 18 to 19 million people will soon be enrolled in the exchanges, when in fact enrollment is degrading under current law, and will likely end up stabilizing at about 10 to 11 million. [snip]

This chart is relevant to our discussion of the GOP plan in two ways. First, it shows that the CBO is far from infallible; indeed, its projections of ACA exchange enrollment have been wildly off.

Second, as CBO notes in the first paragraph of its report on the AHCA, “CBO used its March 2016 baseline with adjustments for subsequently enacted legislation, which underlies the resolution, as the benchmark to measure the cost of the legislation.” That baseline is off by 7 to 8 million in future exchange enrollment; hence, the impact of the AHCA is also off by the same amount.

An even bigger problem is that the CBO has long believed that Obamacare’s individual mandate has near-magical powers to compel people to buy health insurance. There is little evidence to support this claim.

The Ryan plan, AHCA, gets mathed by Avik Roy. Roy checks out the numbers. Roy understands the CBO is a mess that does not know its ass from its mouth. The CBO has made 24 million people mistakes before. Roy has numbers upon numbers to make his case. Roy declares the CBO estimates on who loses coverage might be off by 19 million people.

Avik Roy has many prescriptions for what ails Paul Ryan’s plan. A lot of those prescriptions are tinkering with a Rube Goldberg contraption, but unfortunately America’s health care system, or rather health insurance system is a Rube Goldberg contraption.

On the fiscal front, Avik Roy has some flowers for Paul Ryan:

The bill’s arbitrary 30 percent surcharge for those who buy coverage outside of open enrollment might actually make the risk pool less stable, and ought to be replaced by a much more flexible regulatory regime.

And we haven’t even gotten to the AHCA’s profound fiscal effects. The bill would cut taxes by $1.2 trillion, and spending by $880 billion, for a net deficit reduction of $337 billion. And that’s before you take into account the macroeconomic effects that those tax cuts would have on economic growth, and thereby on greater tax revenues.

Over ensuing decades, the fiscal impact would be even greater, because the bill entails the most significant effort at entitlement reform in American history. Incoherent GOP hard-liners like Rand Paul, who claim that the AHCA is a “new entitlement,” are displaying their unseriousness about a bill that reduces federal spending by more than $2 trillion over the next 20 years.

With all this wonderfulness, why so much upset? Here’s InsureBlog:

Republicans’ latest attempt to change Obamacare is nothing more than misdirection. It replaces “subsidies” with “tax credits”, continues Medicaid expansion until an election year (when nothing gets done), and keeps the most costly items such as guaranteed issue, community rating, and no pre-existing conditions exclusion in place.

It eliminates the individual mandate and creates a new continuous coverage rule allowing insurers to charge 30% higher premiums for up to 12 months to those who have a break in insurance coverage greater than 63 days. The new rule, like the mandate tax, has no teeth.

Speaking of taxes, it eliminates almost $600 million over ten years – which is a good thing. Except for the fact that over half of that amount does nothing to reduce or influence costs of health care or health insurance. More than half ($275 million) is going back to high income earners who are currently paying more in taxes for Medicare and investment income. We should also note these two taxes aren’t indexed so as incomes rise more of us would pay these over time.

For Medicaid, it would roll back the enhanced matching rate for the expansion population. This has serious implications for states who fell hook, line, and sinker for the bait of government funding that they knew wasn’t financially sustainable. [snip]

We should have known this was going to be a poo-poo platter. Anything short of full repeal – which takes 60 senators to accomplish – is nothing more than lip service.

Yikes! That’s a scorcher. They’re not alone. Here’s Senator Tom Cotton interviewed by Hugh Hewitt:

HH: So what can be done? I’ve talked to the Speaker, I’ve got to the Leader. I’ve talked to Cathy McMorris Rodgers is on today, Mick Mulvaney, Tom Price. They all say it’s a three-step dance because of the Senate reconciliation rule. So you know those rules. Working within the rules, how can the Senate improve its bill, or how can the House send to the Senate a bill that fits within the guardrails of reconciliation and allows for 51 votes that improves the individual market?

TC: Hugh, there is no three-phase process. There is no three-step plan. That is just political talk. It’s just politicians engaging in spin. This is why. Step one is a bill that can pass with 51 votes in the Senate. That’s what we’re working on right now. Step two, as yet unwritten regulations by Tom Price, which is going to be subject to court challenge, and therefore, perhaps the whims of the most liberal judge in America. But step three, some mythical legislation in the future that is going to garner Democratic support and help us get over 60 votes in the Senate. If we had those Democratic votes, we wouldn’t need three steps. We would just be doing that right now on this legislation altogether. That’s why it’s so important that we get this legislation right, because there is no step three. And step two is not completely under our control.

And there’s the rub. Are there three steps? Is there only a two-step? Is there only one step?

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So, what the Hell is President Trump up to? Is President Trump doing a three step waltz, a lively little country two-step, or the singular Trump stomp? Got a dance card?

President Trump has more than a dance card. President Trump has a Trump card, or two.

Trump hating CNN knows President Trump has a Trump card:

In an Oval Office meeting featuring leaders of conservative groups that already lining up against House Republicans’ plan to repeal and replace Obamacare, President Donald Trump revealed his plan in the event the GOP effort doesn’t succeed: Allow Obamacare to fail and let Democrats take the blame, sources at the gathering told CNN.

In his meetings with conservative leaders President Trump has repeatedly declared that he is open to negotiations. The Medicaid funding provision until 2020? That might be hauled to 2018. The “tax credits” for lower income people some see as subsidies? That might be a tougher negotiation because former Freedom Caucus member Mike Mulvaney wants that to stay.

Mike Mulvaney now works for President Trump but he has lots of credibility with his former Freedom Caucus members, who are the fiercest critics of the Ryan plan. But any negotiations with “conservatives” might lead to trouble with “moderates”:

In addition to Medicaid changes, some White House officials are also pushing for the inclusion of provisions making it easier to buy health care across state lines. Senate budget rules, however, bar the upper chamber from including on a fast-tracked bill any provisions that don’t have a significant budgetary effect.

Rep. Dave Brat on Monday told POLITICO conservatives were asking the White House to back these kinds of free-market provisions. The Virginia Republican said the Freedom Caucus is also encouraging Trump officials to press for provisions that would enact into law any deregulations Health and Human Services Secretary Tom Price plans to make administratively for the insurance market.

“Trump ran on this competition across state lines, bringing the price down, and so, that is the huge piece that, I think, if we can get that in the bill, then I think we can make some progress and I think get a lot of people to yes,” Brat said.

So while GOP leaders, including Speaker Paul Ryan, adamantly support the idea of allowing people to purchase insurance across state lines, they don’t think it can be included on the replacement bill under Senate rules. [snip]

The manager’s amendments are likely to bring additional savings, according to the White House officials, and would help the plan get through the House, where the Freedom Caucus has lined up opposition against the plan. But it would likely make passage in the Senate more difficult, several Capitol Hill officials said. That’s because many Senate Republicans — and more than a few House GOP lawmakers — hail from states that took the Medicaid expansion, and they’re unlikely to support a quick phase-out of the expanded program. [snip]

Leadership sources, however, have not ruled out changes to the bill altogether, and many senior House GOP sources believe there might be a manager’s amendment. But they have to ensure the changes will get several conservatives to “yes” if it’s actually made, while maintaining moderate Republican support. They can only afford to lose 21 Republican votes.

Oy vey! What a mess. Game over! Nothing can save this. It’s over for Trump, again. Well, there are some Trump cards still left to be played.

Remember “Phase II”? Phase I is the reconciliation process to pass the turd. Phase III is the delusion of goodies at the end of the road. But we never discussed Phase II. Phase II is the Trump card no matter what happens in Phase I. With Phase II, President Trump can force reality onto everybody as the 2018 elections draw close, ever closer every day. Phase II is the Trump card:

How Trump can use Obamacare to kill Obamacare
The same executive authority the Obama administration used to implement the law may now be used to dismantle it. [snip]

“For me, it’s a mix of irony and schadenfreude,” says Josh Blackman, a law professor who’s written two books that criticized the Obama administration’s implementation of the law. “I’ve warned for years that, with a new president in the White House, the exact same powers could be used for different purposes. That’s what we’re seeing now, to a T.

Trump’s order, which encourages Health and Human Services, the IRS and other agencies to work toward dismantling the ACA, doesn’t confer any new powers on the executive branch. But Trump explicitly instructs his agencies to use their existing powers to weaken the law “to the maximum extent permitted by law,” regardless of congressional action to repeal it.

That could be devastating to Obamacare because the Obama administration relied on its executive authority to set up the law.

Its implementation depended critically — and depends critically — on rules and guidance that HHS and other agencies have put out,” says Nicholas Bagley, a University of Michigan law professor who supports the ACA. “There are literally thousands of decisions that had to be made” by the administration — and “any decision that the Obama administration had the discretion to make, in principle, the Trump administration can revisit.”

A big, complex law always requires a lot of the details to be filled in through regulation, but that was particularly true of Obamacare. [snip]

Many of the law’s most controversial elements, like which Americans would be exempt from the mandate requiring most Americans to purchase insurance coverage, were administration decisions. Obama’s HHS secretary was also empowered to flesh out the important details about the benefits that Obamacare insurance plans were required to cover, from mental health to maternity care. Even Healthcare.gov — the much-maligned website that turned into the linchpin of Obamacare enrollment efforts — was built out through executive authority.

The vast, and at times, legally questionable decisions undertaken by the Obama administration may also set precedent for the Trump administration to do the exact same thing. Both Blackman and Bagley agree the administration’s 2013 decision to delay Obamacare’s employer mandate was unlawful; House Republicans even sued, although their challenge was thrown out in court. Trump could now cite that delay as precedent for declining to enforce provisions that he dislikes.

The Trump administration could also issue a slew of waivers to exempt Americans from the ACA’s individual mandate — although the Obama administration already broadened those exemptions in 2013, after the political outcry from Americans whose plans were canceled because they didn’t meet Obamacare criteria.

The “‘like it, keep it’ fiasco” set a precedent for Trump too, says Bagley.

At the time, the administration said it would give hardship waivers to Americans who had difficulties paying for coverage under the ACA. But “if you define the hardship as that, then every American is facing higher premiums because of the ACA, one way or another,” says Blackman. “Obamacare is itself the hardship.”

House Republicans also sued and won an initial ruling over the Obama administration’s payments to subsidize health care costs such as co-pays and deductibles for Obamacare enrollees under a certain income level. A federal court agreed the funds were illegally appropriated; the Obama administration appealed that decision. But Trump could discontinue the appeal, and hold that over Democrats in negotiations to replace the law: If he chooses to discontinue those payments, health insurers — which would be on the hook for those payments even if the government funding dried up — would probably flee the markets or jack up prices next year. Millions of ACA customers would likely see their premiums spike and their plans become unaffordable.

“If Trump were to stop the cost-sharing payments, he could send the individual insurance markets into an immediate tailspin,” says Bagley. “It would be an extraordinary hit.”

So what do we think happens? What are the Trump cards?

We believe that Phase I, amended by a managers amendment that will improve the bill, will pass the House and Senate because failure to do so would threaten the reelection of too many Republicans (and Dims in red states too). So the Republican opposition to Phase I in both the House and Senate will fail and Phase I of repeal/replace will happen.

If we are wrong and Phase I does fail or looks like it is about to fail, President Trump can implement Phase II and thereby force a revisit of Phase I by one and all – Democrats responsible for ObamaCare and the current mess as well as Republicans. President Trump can basically gut ObamaCare like a fish via Secretary Price.

President Trump can basically agree to the federal court ruling and stop immediately the cost sharing program and thereby destroy ObamaCare with the excuse that he is obeying a federal court order. End of the world ensues for Obama Dimocrats.

There is another Trump card to play: blow up the filibuster and pass whatever you want with 51 votes in the Senate. Better to blow up the soon to be destroyed filibuster in year one of Trump than year 4 or 8. The sooner the better.

But if you want to keep your filibuster you can keep your filibuster – although there is another Trump card to play:

“Under the Budget Act of 1974, which is what governs reconciliation, it is the presiding officer, the vice president of the United States, who rules on what’s permissible on reconciliation and what is not. [snip]

Cruz said this process would allow Republicans to include a number of provisions that would make the health care reform bill much more attractive to conservatives.

For example, Cruz notes that Republicans could “repeal all of the insurance regulations in Obamacare that have increased premiums,” in particular one that decreased competition by preventing insurers from selling across state lines.

Any more Trump cards? Well, under immigration reform President Trump could invite doctors and medical professionals from around the world to come to America and bring down costs. You know that ol’ law of supply and demand.

As Rahm Emanuel said to Barack Obama “never let a good crisis go to waste.”

President Trump has a lot of Trump cards to play.

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