#the terms of the deal or ask if Vox would prefer he didn’t do it . Either way he gets away with it . (Though Vox does at times abuse this

[teamfortresstwo]

No thoughts head empty only Vox summoning Alastor while he was still alive and them just being cute together,,,

[maxbegone]

An Updated List of my Critical Role Fics

Pretty much all Vox Machina because I have a lot of feels, but I’m working on it

it feels like coming home

A year after he returns to Deastok, Tary and Lawrence finally reunite.

where we fall

A few days pass before Shaun Gilmore is told about Vax’ildan and his deal with the Raven Queen.

in another lifetime

Upon meeting the first de Rolo baby, Keyleth can’t help but think about what could have been.

thereafter

She meets him a century and a half after Vecna. Twelve years after Grog had passed, five after Vex, and too many after Percy.

A tale of Keyleth’s love and life many years after the fall of Vecna.

drabble 1: Cassandra

Cassandra had to admit that seeing Percy so lively and happy was refreshing, but it took some getting used to.

After all, the Percival she knew growing up kept to himself and his work. He wasn’t quiet, necessarily, just more of the bookish type who kept to his studying, and tinkering, and thinking. Truth be told, she was most like him.

prompt: grog babysits the littlest gnome

Grog watches Juniper while Scanlan and Pike go out for the evening

the smallest of things 

“Come on, Grog. You’re not going to hurt her.”

“But she’s so little.”

“Yeah, so are we, and you’ve had no problem holding us before!”

prompt: “well...I’m pregnant.”  (part one)

Vex was, in fact, pregnant. And she hadn’t told Percy yet.

baby de rolo arrives (part two)

Vex was slumped against her husband in the bath he had drawn for her. At full term, her back ached, her head was throbbing from being holed up in the castle all day, and she was growing restless. If she was being honest, she felt as if she was suffocating.

a continuation of this 

drabble 2: keyleth had too much to drink 

Vex was both in awe and completely concerned for her friend. She had already downed two glasses of wine and Grog had someone convinced her that taking shots of firewater was a smart thing to do. 

prompt: “I could spend the rest of eternity here with you like this.”

Sheets were never an issue for them, they usually ended up on top of them anyway, panting and sweating with tangled limbs in attempt to get as physically close as possible.

Percy preferred it like this; no cares in the world with just him and Vex in their own little bubble.

prompt: percy asks gilmore to help with the clocktower

Percy didn’t usually bother the sorcerer on shipment days, but this needed to be done as soon as possible. He made a mental note to send his friend several bottles of the finest wine from the cellar in Whitestone.

prompt: "I can't run from my feelings anymore."

Seeing Keyleth fight as well as she did, with her whole heart and all of her energy mesmerized Vax entirely. Very few people blow him away with what they do, and next to his sister, this girl, this bright, brilliant girl, did so every day.

because she is the sunlight

Nightmares had been frequent since the tomb. He doesn’t like to talk about it. He doesn’t like to talk about much that concerns him, he’d rather put his focus on his family. In his eyes, that’s much more important.

based off of this piece by @wendydoodles 

a crossing

She knew it was time, and had for a while now. She was old and frail, a little past a thousand years old. It was hard on Keyleth from the beginning; she knew her family would be gone long before she ever was and tried to prepare herself for the lonely life she would have to live. 

at long last 

a companion piece to a crossing

“Lady Vex’ahlia, Baroness of the Third House of Whitestone and Grand Mistress of the Grey Hunt.”

It was bound to be on the monument that was built in Whitestone, and followed by “Loving wife, mother, sister, and friend,” just like everything else. Cliche as it was, she accepted it, just like she accepted most other things. Keyword here being most.

anything for you, dear

Vex returns home after a long day to find Percy asleep and their daughter right along with him.

based off of this post by @captain-narava-felidae-riggs

prompt: Scanlan visits Kaylie at school

Like any other time, Scanlan sat in the courtyard outside of the school waiting for her. He was content as he played away on his shawm, eventually spotting Kaylie with a satchel over her shoulder and violin case in hand. Scanlan stood and waved.

the moment she knew 

She remembers watching when Scanlan fell the first time. She remembers watching when Scanlan fell the second time. Revivify failed and everything immediately turned to panic.

and there will be a crescendo in our story 

Once things settled again and everyone had somewhat parted ways, though only for a short while, Scanlan found Pike.

Or, their first date.

in absence 

He’s gone for six months. And then he’s back. But then he has to leave again.

Based off of my persephone au

something to go by

So, rather early, they headed back to Castle Whitestone, Percy to draw himself a bath and Vex to her old room where Velora slept. That poor girl had been through so much, too much for a girl as young as she was.

Or, Vex tells Velora that her big brother had left her something very important before his departure with the Raven Queen. 

I promise you the world, just stay by my side

Vax would have to think back to the time he and his sister were children in order to find a moment that could quite compare to this. 

you are in every way wonderful 

It had been a hell of a few long days for them. Everyone was off at a tavern drinking themselves into a stupor. Vex was probably charming her way through drinks, or stealing from her brother, for that matter. But Percy opted out of this one, telling the group he was exhausted, which was the honest truth, and that he just wanted to go to bed.

but with me, you are magnificent

This is how Percival sees Vex’ahlia

[bountyofbeads]

https://www.vox.com/platform/amp/policy-and-politics/2019/1/10/18175273/trump-speech-immigration-slats-wall?__twitter_impression=true

realDonaldTrump is a ENDANGERING the lives of REAL Americans more so than IMMIGRANTS could ever do. #Trump is a NATIONAL SECURITY THREAT, HEALTH THREAT, ECONOMIC THREAT, ENVIRONMENTAL THREAT, Etc. by continuing this #trumpshutdown #GOPshutdown and #MitchShutdown.

All the DAMAGE being done by Trump and the Republicans to REAL AMERICANS and the COUNTRY is SIMPLY being done to FULFILL a CAMPAIGN PROMISE and his WHITE SUPREMISTS BASE. Think💭 about that🤔🤔🤔😡🤬🤢🤮

#WeWillRemember #NeverForget

#EndTheShutdownNow

#VoteBlueToSaveAmerica

#VoteBlue2020

#VoteBlueNoMatterWho

#WhenWeAllVote

#impeachtheMFNow

Senate Republicans overwhelmingly passed a bill to fund the government, without wall money, in December. But they don't seem willing to cross Trump to end the current shutdown stalemate.

The more Trump talks, the less likely it is he’ll get his precious steel slats

To get things done, the president needs to shut up.

By Matthew Yglesias  | January 10, 2019 10:20 am | VOX | Posted January 11, 2019 |

According to reporting from the New York Times’s Peter Baker, President Donald Trump believed in advance of his Tuesday night Oval Office address that speaking to the public about his desire for a border wall was pointless.

And, according to Baker, he did not want to make the publicity stunt trip to the Texas border zone that is scheduled for Thursday.

“It’s not going to change a damn thing, but I’m still doing it,” Trump reportedly said before gesturing at some of his communications aides and saying he’s going to do it despite his doubts because “these people behind you say it’s worth it.”

Trump, however, was right. Time and again, even presidents who are universally regarded as eloquent public speakers and effective public communicators — think Ronald Reagan or Barack Obama — have tried and failed to bring public opinion around to their point of view by talking about it. Trump is not a charming, eloquent figure in their mold. The presidential “bully pulpit” is one of the office’s real powers, but it simply doesn’t work the way proponents of this kind of table-pounding strategy want it to.

And that goes double or triple for a crude and unpopular president like Trump. The place for him to make progress toward his goals on border security is the obscure back rooms of Congress where deals can be cut and priorities swapped. Talking about his agenda in high-profile ways — and dramatizing his commitment to it by shutting down the government — is completely counterproductive, serving only to fire up millions of banal Democrats who’ve never in their lives held an opinion about what kind of border security measures are appropriate in rural West Texas in order to oppose Trump at every turn.

Presidential speeches don’t persuade the public

George C. Edwards, a Texas A&M political scientist, undertook a comprehensive study of presidential speechmaking and public opinion for his 2006 book On Deaf Ears: The Limits of the Bully Pulpit.

What he finds is, basically, it doesn’t work: High-profile presidential addresses simply fail to influence public opinion.

At times, we end up mythologizing presidential communications in ways that are at odds with the public record. Edwards notes, for example, that FDR gave “only two or three fireside chats a year, and rarely did he focus them on legislation under consideration in Congress.” Of that group, the most clearly legislative-focused one was his 1937 advocacy for his court-packing plan — a plan that failed. And while some of the chats advocating for greater US involvement in World War II came to look prescient after Pearl Harbor, that doesn’t mean they were actually persuasive at the time.

A Drew DeSilver article for the Pew Research Center from 2013 reminds us that a string of Oval Office addressed by Ronald Reagan failed to move the needle on voters’ view of providing aid to the Contras in Nicaragua, George W. Bush’s congressional address on behalf of comprehensive immigration reform left opinion flat, and George H.W. Bush’s speech defending his bipartisan congressional budget deal did nothing to change views.

Indeed, the general tendency is for public opinion to move in the opposite direction from the president’s preferences — a regulatory model that’s known as the thermostatic model of public opinion.

Reagan was an influential president because public opinion became very conservative in the late 1970s, leading to election results in 1980 that allowed him to govern effectively while the strong economic rebound in 1983-’84 helped him secure a landslide reelection bid. But according to Edwards, “surveys of public opinion have found that support for regulatory programs and spending on health care, welfare, urban problems, education, environmental protection and aid to minorities increased rather than decreased during Reagan’s tenure,” while support for higher military spending fell.

The longer he stayed in office, in other words, the less the public worried that liberals were out of control and the more they worried that traditional liberal priorities were being neglected.

Similarly, public opinion on immigration keeps becoming more favorable the longer Trump persists in office. The good news, for him, is that as president, he has formidable tools at his disposal to shift policy in ways he thinks are important. But to make that happen, he needs to shut up.

Presidential involvement is counterproductive in Congress

Bipartisan dealmaking gets done all the time in Congress, even in today’s polarized atmosphere. But the key to getting a bipartisan deal done is typically for the president to avoid putting his hands all over it.

The landmark Every Student Succeeds Act that passed Congress in late 2015, for example, obviously wouldn’t have passed unless it incorporated a lot of education policy ideas that the Obama administration was on board with. But it was put together quietly, by negotiators from both parties, without a lot of presidential tweets and speechmaking.

The downside of this, from Obama’s point of view, was that signing it doesn’t count in the public imagination as an Obama achievement or a major win for his administration. But precisely because it didn’t count as a big “win” for Obama, congressional Republicans could sign on to it.

As the University of Maryland’s Frances Lee explains in her book Beyond Ideology: Politics, Principles, and Partisanship in the United States Senate,members of Congress have two different kinds of preferences. Preferences on issues are amenable to compromise because you can either accept half a loaf or else swap something you care about for something you don’t care about. But the preference to win is inherently zero-sum. For Republicans to get Democrats to agree to something on substance, they can’t also demand that Democrats hand them a political win.

In this view, there is no more catastrophic intervention possible than Sen. Lindsey Graham (R-SC) chiming in to remark that “if Trump caves, it’s the end of his presidency.”

This may be a good way to motivate Republicans to hang with Trump even if they don’t really agree with his strategy. But House Democrats are going to look at that kind of effort and redouble their resolve to resist Trump. If you actually want the $5.7 billion appropriation to build steel slats, you need to lower the stakes, not raise them.

Trump has created a mess with no way out

Republican senators have taken to pointing out on social media that various prominent Democrats, including Hillary Clinton and Barack Obama, have in the past voted for broadly similar fence-building measures.

But that merely goes to show how poorly the GOP has played its hand here. If Trump had simply stayed quiet and let congressional allies ask for a $5.7 billion fence appropriation, Democrats would have shot back that $5.7 billion is an awful lot of money and asked what they’re getting in exchange. Negotiations over appropriations are never easy, but both parties usually manage to come out of them with their top priorities intact.

The awkward problem for Trump would be that this steel bollard structure doesn’t seem like the 30-foot concrete wall he described during the campaign. But if he’d stayed quiet and reluctantly signaled willingness to sign a fence-rather-than-wall bill, he could’ve gotten it done.

Instead, while whipping his base into a wall fervor, he also created anti-wall enthusiasm on the Democratic side. Then he redefined “the wall,” and suddenly fencing he’d previously deemed inadequate and Democrats deemed unobjectionable became subject to the exact same polarization dynamics.

Then in the Oval Office speech, he made things worse again: He explicitly linked the slat wall not to some narrow technical Border Patrol objective about funneling people away from some specific patch of land, but to the entire Trumpian worldview, in which immigrants are coming over the border to kill you.

Taken literally, of course, it doesn’t have to be this way.

First-term Texas Republican Rep. Dan Crenshaw, for example, gestured toward a deflationary account of what’s at stake that could conceivably have worked in Congress had Republicans pursued it.

The problem is that Crenshaw blames “Democrats” who “are pretending” that this is a high-stakes political battle about the big beautiful wall that Trump made the centerpiece of his 2016 campaign message. However, it’s clearly Trump who’s to blame.

You don’t shut down the government over a dispute between a $1.3 billion and a $5.7 billion appropriation — you pass a continuing resolution while you keep talking it over. But Trump has drastically elevated the stakes, over and over again, by shutting down the government, equating the proposal with his wall, and concocting a fake border crisis to which somehow a multi-year construction project is an urgently needed solution.

It’s incredibly stupid, and Republicans like Crenshaw who know better need to talk to Trump about it, not their political enemies. Reopen the government, start tweeting about something else, let congressional appropriators do their boring horse-trading, and they will find some money for some steel slats.

But to get that, Trump needs to be willing to humble himself on the fence-versus-wall semantics and step out of the spotlight. And that doesn’t sound like Trump at all.

[theconservativebrief]

The Trump administration is releasing rules that would make it easier for small businesses and self-employed individuals to buy insurance that does not comply with Obamacare’s insurance regulations, another front in the White House’s attempts to undermine the law.

Association health plans, the subject of the new rules, do not have to follow the same rules as individual policies sold under Obamacare, meaning they are not required to cover all of the essential health benefits mandated by the Affordable Care Act, like maternity care, an important piece of the law’s protections for people with preexisting conditions.

Trump had asked federal agencies last fall to look for ways to expand the use of association health plans — groups of small businesses that pool together to buy health insurance — and to broaden the definition of short-term insurance, which is also exempted from the Affordable Care Act’s rules.

Overall, the Trump administration is expected to make cheaper plans with skimpier benefits more available — and while that may be a better deal for healthy people who do not receive federal assistance, experts worry the push toward these plans will damage the ACA’s marketplaces. Costs could rise for federal taxpayers who must cover the higher costs for subsidized customers, and higher-income people who nevertheless need more comprehensive insurance could be forced to choose between paying more for the more expensive Obamacare plans or buying skimpier coverage that might not cover what they need.

“The president still firmly believes that Congress must act to repeal and replace Obamacare, but before that can be done, this administration must act to provide relief,” Andrew Bremberg, who oversees domestic policy at the White House, told reporters last year. “We expect these policy changes to potentially benefit tens of millions of Americans over time.”

During an impromptu end-of-the-year interview with the New York Times, Trump touted the expansion of these association health plans and the repeal of Obamacare’s individual mandate in the Republican tax bill as his big wins against the health care law in 2017.

“We’ve created associations, millions of people are joining associations. Millions. That were formerly in Obamacare or didn’t have insurance. Or didn’t have health care. Millions of people,” he told the Times. “That’s gonna be a big bill, you watch. It could be as high as 50 percent of the people. You watch. So that’s a big thing.”

The president was surely overstating the impact of his executive order. But policy experts warn that together, these changes could represent a serious threat to Obamacare: Trump wants to open more loopholes for more people to buy insurance outside the health care law’s markets, which experts anticipate would destabilize the market for customers who are left behind with higher premiums and fewer insurers.

Association health plans are exempted from core Obamacare requirements like the coverage of certain essential health benefits. The final rules also allow some individuals to join these plans too, the Wall Street Journal reported, which could hurt the individual insurance marketplaces by drawing younger and healthier people away from them. In much the same way, short-term insurance could also take healthier people out of the law’s markets.

The effect won’t be immediate and its extent is unclear. Some actuaries expect short-term insurance plans and the repeal of the individual mandate to damage the Obamacare markets more than association health plans. But Trump and the GOP’s actions collectively do present a long-term risk to the ACA.

“The clear intent of the executive order is to create a parallel insurance market exempt from many of the consumer protections in the Affordable Care Act,” Larry Levitt at the Kaiser Family Foundation told me last year. “This has the potential to siphon off healthy people with skinnier benefits and cheaper premiums, leaving behind a sicker pool of people under ACA plans.”

An association health plan, as Vox’s Sarah Kliff has previously explained, is a way for a group of small businesses to pool together to buy insurance, giving them more purchasing power and access to cheaper premiums. A group of bakeries, for example, might form a bakers association and purchase health coverage together. The most famous examples have been farm bureaus, which allowed independent farming businesses to band together and get insurance.

Before Obamacare, national associations could pick and choose which states’ insurance rules they wanted to follow and use those rules to guide the plans they offered nationwide. The bakers association could choose to follow the rules for, say, the Alabama insurance market, which mandates coverage of relatively few benefits, for all its bakeries in New York, a state with many mandates.

The result was often health insurance that skirted state rules and was a better deal for businesses with young and healthy employees, who are likely to prefer skimpier health plans. A former insurance regulator described the situation prior to the ACA to Kliff as being “a race to the bottom, with some associations offering lower-cost plans that covered virtually nothing.”

Obamacare changed these rules. Association health plans were treated as small businesses and were therefore required to cover all of the law’s mandated benefits.

Essential health benefits, requiring that insurers cover everything from hospital care to prescription drugs to maternity care, are central to the ACA’s insurance protections: They prevent plans from crafting their coverage to attract mostly young and healthy customers at the expense of older and sicker people.

Trump is rolling back those changes. Under the executive order, new regulations are expanding the use of association health plans, easing federal rules that require associations be from the same state and that prevent associations from forming exclusively to provide health coverage.

The result could in many cases be that these new association health plans would be considered large employers when it comes to health insurance. Large employers are not subject to the same rules as individual or small-group plans under Obamacare. Most notably, they do not have to cover all of the law’s essential health benefits or meet the requirement that insurance cover a minimal percentage of a person’s medical bills.

Association health plans will be freed to craft skimpier (and cheaper) health plans that appeal only to businesses with younger and healthier employees. Small businesses left in Obamacare’s marketplace would likely face higher costs and fewer options as the market became less attractive to insurers.

“It will destroy the small-group market,” Tim Jost, a law professor at Washington and Lee University who generally supports Obamacare, told me before the order was signed. “We’ll be back to where we were before the Affordable Care Act.”

The final regulations expanded access to association health plans beyond small businesses, too, by allowing self-employed individuals with a shared interest (industry or geography, for example) to join these groups.

The individuals likely to flee the Obamacare markets for association plans would probably be younger and healthier, leaving behind an older, sicker pool for the remaining ACA market. That has the makings of a death spiral, with ever-increasing premiums and insurers deciding to leave the market altogether.

“The ability for individuals to purchase health insurance through an association really puts the individual market at risk and destabilizes it over the long term,” Kevin Lucia, who studies the market at Georgetown University, told me before the order had been signed. “When you have market segmentation, it over time leads to higher premiums and it becomes less attractive to carriers.”

Are you an Obamacare enrollee interested in what happens next? Join our Facebook community for conversation and updates.

Original Source -> Trump is finalizing one of his big proposals to undercut the ACA

via The Conservative Brief

[stormdoors78476]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[exfrenchdorsl4p0a1]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[rtscrndr53704]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[rtawngs20815]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[repwincostl4m0a2]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[repwincoml4a0a5]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[grgedoors02142]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[repwinpril9y0a1]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[chpatdoorsl3z0a1]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[pat78701]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[porchenclose10019]

New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee

Apparently yanking away the funds that allow millions of people to get health insurance isn’t enough for some House Republicans.

Now they also want to gut the Affordable Care Act’s protection for people with pre-existing conditions.

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

A main goal of the proposal is to win over conservative House members who last month opposed the GOP repeal bill because, in their view, it still left too much of the 2010 health care law in place. Rep. Mark Meadows (R-S.C.), chairman of the conservative House Freedom Caucus, helped to craft the amendment. And although he has not yet declared support for it publicly, a few other conservatives have signaled they may be ready to switch from no to yes.

It’s easy enough to see why. If enacted, it would allow states to re-create the conditions that existed before the Affordable Care Act took effect ― a time when insurance premiums were cheaper, chiefly because insurers didn’t have to pay the big medical bills of people with serious conditions.

At the same time, the new proposal leaves intact most of the initial bill’s big financial changes. Those include shifting the law’s health insurance subsidies, which would offer less help to poor people, and dramatically cutting funds for Medicaid, which would free up money for tax cuts for the wealthy.

But conservative dissension wasn’t the only obstacle to passage last time around.

Moderate Republicans also objected to the bill, citing, among other things, the huge loss of insurance coverage it would cause. The Congressional Budget Office predicted that the number of uninsured Americans would climb by 24 million if the law took effect ― partly because people would lose financial assistance they need to pay for health insurance, and partly because people depending on Medicaid would no longer be eligible for it.

Instead of addressing those concerns ― say, by pulling back on the huge Medicaid cut ― this proposal seems to make repeal even less palatable to moderates. By gutting the protection for people with pre-existing conditions, the proposal attacks a feature of the health care law that has been wildly popular, even with Republicans. It also violates a key promise that virtually every Republican, including President Donald Trump, has made repeatedly.

How The Proposal Guts Pre-Existing Condition Protections

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

By now, most people know that the Affordable Care Act protects people with pre-existing conditions. But not everybody realizes that the law accomplishes this through several mechanisms that interact.

The law doesn’t simply prohibit insurers from denying coverage outright to people with medical problems, it also prohibits insurers from charging those people more ― or from selling policies that skimp on or leave out key benefits, rendering insurance useless to people who depend on those benefits.

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

This approach provides access to people with pre-existing conditions in theory but not in practice. Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

The proposal comes with plenty of caveats, like requiring states to seek waivers from the Department of Health and Human Services before eliminating those rules on insurance. These protections don’t appear to mean a whole lot, however, because the conditions for getting the waivers are broad and easy to satisfy.

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well.

And, of course, the high-risk pools wouldn’t do much good for the millions who now depend on either Obamacare’s financial assistance or its expansions of Medicaid for coverage ― and would lose it once the money for those programs was taken away from them.

Curiously, the bill would leave the Affordable Care Act’s consumer protections in place for members of Congress and their staffs, as Sarah Kliff of Vox reported.

It’s Hard To Know How Serious This Is

Exactly how House Republicans will react to this proposal remains to be seen. In the last few weeks, moderates within the GOP caucus have become, if anything, more outspoken about their determination to keep some of the law’s consumer protections in place. And House leadership has been relatively quiet about the negotiations, which have apparently been driven by the White House.

Meanwhile, polling has detected a clear shift in public opinion away from repeal. According to a Washington Post-ABC News poll that came out Tuesday, 61 percent of Americans said they prefer Congress “keep and try to improve” the 2010 health care law, while 37 percent say they want Congress to “repeal and replace it.”

The same poll found that 70 percent of Americans favor requiring all states to prohibit higher premiums for people with pre-existing conditions, while 62 percent favor requiring all states to make plans cover essential benefits including “preventive services, maternity and pediatric care, hospitalization and prescription drugs.”

In other words, strong majorities oppose both of the key provisions in this new plan. That doesn’t mean it can’t pass. But it means that Republicans voting for it would be risking a pretty big political backlash ― while making insurance less accessible for some of the people who need it most.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from DIYS http://ift.tt/2oIo0YS

[nothingman]

Will Donald Trump make the Cabinet great again?

Recent reports suggest that once in office, the president-elect may delegate a great deal of policymaking authority to his 15 Cabinet secretaries, rather than managing things hands on or through White House staff.

Trump is planning to give his Cabinet “unusually wide latitude,” Politico’s Josh Dawsey and Andrew Restuccia reported earlier this month, citing sources close to the transition. They added that Trump’s own role would likely be that of a “chairman-of-the-board style manager,” focusing on “high-profile issues, publicity and his brand.”

This would come as a contrast to the increasingly White House–dominated systems recent presidents have set up — and that secretaries have chafed at, viewing many White House staffers as overly political and power-hungry micromanagers. “Never has the job of Cabinet secretary seemed smaller,” Glenn Thrush wrote in a 2013 feature on President Obama’s team.

For a president who has little interest in the nitty-gritty of policy, this seems to make a whole lot of sense. Why not let the Cabinet secretaries — many of whom are successful businessmen or generals — run their own shops? That would bring different voices into the policymaking process rather than centralizing power in the White House yet again.

Here’s the problem: This has been tried before, several times, and it never seems to work out. “My reaction is that that will last until the first few Cabinet meetings,” says Andrew Rudalevige, a political science professor at Bowdoin College.

Indeed, from Richard Nixon through Obama, nearly every new president has come into office vowing to empower his Cabinet, but eventually ended up reining them in and empowering the White House instead.

That’s because there’s a structural problem here: The president and his White House team are charged with coming up with an overall strategy for the administration’s success, but each Cabinet official tends to end up primarily concerned with his or her department’s particular set of issues. This is a recipe for conflict. For example:

Some Cabinet secretaries go off message and earn the White House’s ire by creating inconvenient headlines.

Other secretaries become viewed as having “gone native,” advocating for their own department’s interests over what the White House sees as the greater good.

Fights over personnel are constant, with the White House wanting to install loyalists to the president and Cabinet officials seeking their own people. (We’re already seeing some under Trump.)

Some Cabinet secretaries lose out in power struggles with White House staffers, who themselves naturally want more influence in the administration.

Eventually, recent presidents have generally concluded that a having a Cabinet full of independent actors is more trouble than it’s worth. And while it’s not impossible for Trump to defy this historical trend, he’d have to solve some serious incentive problems — and be a strikingly good manager — to pull it off.

“The Cabinet” isn’t really a thing anymore

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An illustration of George Washington and his Cabinet. Things have changed since then.

New presidents with little experience in the executive branch often idealistically believe they can use the Cabinet better than their predecessors, either through greater delegation or by relying on it as an advisory body.

Nixon initially pledged to “strengthen the Cabinet,” Jimmy Carter said he believed “in Cabinet administration of government,” and Ronald Reagan said the Cabinet would be his “inner circle” and “almost like the board of directors,” as Rudalevige recounts in The Presidency and the Political System.

But using the full Cabinet as an advisory body is hard in practice. For one, it’s too big these days — there are 15 full department secretaries and seven other Cabinet-level officials. More importantly, the various secretaries often have little relevant knowledge or experience about the issues their counterparts in other departments are facing. So as a rule, modern-day Cabinet meetings have been purely for show.

As a result, Cabinet secretaries end up being less attuned to the political, strategic, and messaging priorities of the White House. That’s in part simply because of where they sit and whom they see and talk to every day. It’s also in part due to their own bureaucratic incentives and self-interest.

“The reality is that Cabinet secretaries’ duties and inclinations often put them on a collision course with White House staffers, who are trying to rein them in and harness them to presidential priorities,” writes James Pfiffner, a public policy professor at George Mason University.

“Presidents making these decisions at the start of their terms are starting at the lowest point of knowledge about how bureaucracy works and how the government works,” says Matthew Dickinson, a political scientist at Middlebury College. “But then you get into the governing details, and you realize you’ve delegated authority to, say, Betsy DeVos, who’s decided to pick a fight with the teachers unions, or Rex Tillerson, who’s gone out pursuing a solution to the Mideast problem that’s contrary to what you want.”

It’s easy for Cabinet secretaries to step on the White House’s message

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Attorney General Eric Holder repeatedly ran afoul of the Obama White House early in his tenure.

In early 2009, President Obama was desperately trying to woo rural red-state Democratic senators, knowing he’d eventually need their votes for his health reform bill. His White House staff knew this was one of the president’s top priorities, and that other issues — like new gun control legislation — would have to take a back seat.

Attorney General Eric Holder, however, didn’t get the memo. Back during the campaign, Obama had said he’d push for renewing the expired ban on assault weapons. So when Holder was asked about the topic at the press conference, he said the administration planned to do just that. And as Daniel Klaidman recounts in his book Kill or Capture, White House Chief of Staff Rahm Emanuel was not exactly happy about it:

Emanuel was furious. He slammed his desk and cursed the attorney general. Holder was only repeating a position Obama had expressed during the campaign, but that was before the White House needed the backing of pro-gun Democrats from red states for their domestic agenda. The chief of staff sent word to Justice that Holder needed to “shut the fuck up” on guns…

The conflict between Holder and Emanuel — which recurred again and again on various topics over Obama’s first two years — is just one example of how a well-meaning Cabinet secretary can end stepping on the White House’s preferred strategy or message of the day. Thrush’s piece on the Cabinet contains a similar tale about Energy Secretary Steven Chu, who committed the awful crime of publicly discussing climate change when the administration wanted to focus on jobs.

Neither Holder nor Chu was trying to undercut the president or his positions. But the Senate math on health reform and the White House message of the day on the economy just weren’t at the forefront of their minds, since they were spending more time on their own issue areas. So they end up being viewed as troublemakers by a monomaniacally focused White House.

“If you are letting the Cabinet do what it wants, you will have lots of different stories, and it’s harder to control the narrative of your administration,” Rudalevige says. For Donald Trump in particular — who always wants to be the center of attention — he may not be so thrilled if his Cabinet secretaries keep making news that he doesn’t like.

Many Cabinet officials get “captured” by their departments

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Caspar Weinberger loved spending cuts when he was at OMB, but not so much once he moved to the Defense Department.

But some Cabinet clashes with the White House have deeper roots than a simple lack of message discipline. When appointees go off to head their respective departments, many suddenly ... change.

“It’s quite standard for political appointees to come in and then be exposed to the mission of the agency, and have senior staff brief them, to learn something about the agency and enlarge their perspective. And they end up moderating some of their views,” Harvard law professor and former Obama climate adviser Jody Freeman recently told Vox’s Brad Plumer.

And in the most extreme cases, these appointees become viewed as championing their department’s interests, or the interests of the constituents the department is closest to, over the president’s own priorities.

This effect can sometimes be rather comical. During the Nixon administration, Caspar Weinberger served as budget director and loved spending cuts so much he was dubbed “Cap the Knife.” But when he was moved to head the Defense Department under Reagan, he suddenly grew to love defense spending increases so much that some renamed him “Cap the Ladle.”

Nixon aide John Ehrlichman referred to this phenomenon as “going native.” He had a point, Rudalevige argues, writing that “presidents constantly and correctly worry that department heads have divided loyalties … [that] the secretaries may become champions of the department as an institution.” He adds: “Departments owe too much to too many political actors for presidents to fully trust their chiefs’ motives or advice.”

Who gets to pick Cabinet officials’ subordinates?

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Trump’s pick for Defense Secretary, James Mattis, has reportedly had difficulty agreeing with the White House staff on department hires.

The president of the United States is responsible for filling more than 4,000 executive branch positions — many of which are sub-Cabinet posts strewn around the various departments, and therefore subordinate to the Cabinet secretaries.

Naturally, Cabinet secretaries would like to have a major say in who will be working for them. But appointments are one of the president’s most important powers. On the one hand, they serve the classic patronage role of rewarding supporters. On the other hand, the president wants people who will work for him rather than against him in key jobs.

Furthermore, there are structural reasons for the White House and Cabinet to disagree on sub-Cabinet appointments. The secretaries fear the White House “will weigh too heavily the political service of the appointee and will neglect the expertise, managerial ability, and compatibility of the nominee with the other executives in the department,” Pfiffner writes for the Presidential Transition Project. Conversely, “the White House staff tends to suspect that Cabinet secretaries are likely to recruit people who are loyal to the Cabinet secretary but not necessarily to the president.”

Presidents who give away a great deal of their appointment power to their Cabinet secretaries quickly usually regret it (as both Nixon and Carter did). “They wind up with departments that aren’t necessarily on the president’s page, but rather working for each Cabinet office,” Rudalevige says. “You can argue from a technocratic competence perspective that that’s a good thing. But from the president’s perspective, he’s trying to herd 4 million cats toward his preferred policy outcomes, and [the appointment power] is not really a resource he can afford to give away.”

The Reagan transition, meanwhile, took a different approach — carefully vetting appointees in the White House personnel office, making sure those chosen would be loyal to the president and would work to carry out his agenda. “We wanted our appointees to be the president’s ambassadors to the agencies, not the other way around,” Reagan aide Ed Meese later wrote.

Similar conflicts are already taking shape under Trump. The Washington Post’s Josh Rogin reported earlier this month that Defense Secretary-designate James Mattis and the Trump transition team were having “an increasingly acrimonious dispute” over DOD jobs. The Trump people didn’t want “NeverTrumpers” rewarded with jobs, while Mattis was unimpressed at the names they were offering him instead.

The White House staff naturally wants power and control for themselves — and many truly are closer to the president

Jabin Botsford/The Washington Post via Getty

Jared Kushner and Steve Bannon will be powerful voices in the White House.

Finally, delegation to the Cabinet often doesn’t work out in practice because the White House staff doesn’t want it to work out. Those staff members tend to be ambitious people who want influence and control, and often they’re both physically and substantively closer to the president than the Cabinet secretaries are.

This is the case for Trump as well. His White House is filled with campaign loyalists such as chief strategist Steve Bannon, counselor to the president Kellyanne Conway, and National Security Adviser Michael Flynn — as well as the president-elect’s own son-in-law, Jared Kushner. So when they claim to speak to the president and to know what he would want, their claims will sound plausible.

Meanwhile, out of all Trump’s Cabinet appointments, he appears to be personally close to just a few — such as Steve Mnuchin at Treasury (his campaign fundraising chair), Wilbur Ross at Commerce (a longtime friend), and Jeff Sessions at Justice (who often traveled with Trump during the campaign). Many of the others — like Rex Tillerson and James Mattis — Trump barely knows. A few he seems to have barely spoken to.

In theory, delegation of substantial power to the Cabinet could work if the president empowers people he fully trusts in those positions and is comfortable making do with only a weak White House staff. Neither appears to be the case for Trump.

“If the president can set priorities that are widely shared by those who work for him, the management process is much easier,” says Dickinson. “If he doesn’t, that leads to competing power centers and rivals.”

Such competition has often led to a midterm shake-up, in which the president concludes his administration is a mess and decides to solve it — by centralizing more power in the White House.

via Vox - All