Monday, January 9, 2017

Last Call For That Death Spiral Thing

Republicans are busy putting out press releases that they and they alone can save the "failing" health care sector by repealing Obamacare, but the reality in hospitals and doctor's offices and urgent care clinics across the country is that the GOP plan to repeal the law without an alternative will cause tens of billions in economic damage and hurt millions of Americans, and health care providers and insurance companies are now in a state of near-panic.

Hospital and health plan leaders talk in almost apocalyptic terms about what might lie ahead if Republicans abolish Obamacare without a blueprint for its replacement. 
Their doomsday scenario: Millions of people could lose their health care coverage, hospitals could hemorrhage cash and shocks to the $3 trillion-a-year health system could send ripples through the entire economy.

“That transition period is going to be like that slow-moving tsunami that we know is coming, and we can watch it and try to prepare for it — but in the aftermath of the tsunami, there’s devastating loss that we never could have planned for,” said Heidi Gartland, vice president for community affairs and government relations at Cleveland-based University Hospitals Health System. 
Hospitals estimate that repealing Obamacare could cost them $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis" if sick people are unable to get care. Even before that happens, though, uncertainty about what might replace the law and how it could affect the bottom lines of hospitals, in particular, has spurred CEOs to cut spending. 
“Everybody is going to continue to belt tighten and take action fearing the worst is going to happen,” said William Conway, CEO of Detroit’s 1,300-physician Henry Ford Medical Group. 
That anxiety has already claimed casualties: The Advisory Board Company, which provides services to health care firms, announced last week that it is laying off 220 people because hospitals hit the brakes on spending following the GOP sweep. Providers warn the situation will worsen the longer Congress goes without passing a replacement as fears of mounting losses prompt decisions to close programs, trim staffs and curtail care.

The healthcare sector is already starting to weaken as a result.  Without knowing what's coming, the industry can't plan, won't hire, and is resorting to hunkering down until the storm is over.

Unfortunately, this storm is going to cost lives too, lives ruined by Republicans. It won't be mere statistics, either.

But this is what the GOP promised to do.  Following through on that promise is a lot harder than they realized of course. Vox's Sarah Kliff notes that repeal is starting to look very shaky in the Senate.

Republicans are struggling to maintain party unity on leadership’s preferred “repeal and delay” strategy. There are at least seven Republican senators who have expressed reservations about the idea of repealing Obamacare and setting a deadline a few years in the future to come up with a replacement. Three defections from the 52-member Republican Senate caucus would be enough to sink a repeal-and-delay bill, which would need 50 votes to pass. I expect this list of seven to grow, as there are still dozens of senators who haven’t voiced an opinion either way on the matter. 
Republican governors are trying to slow down Obamacare repeal. Governors who expanded Medicaid are starting to voice concern about the effect of repeal in their states. This includes Republican Govs. John Kasich of Ohio and Rick Snyder of Michigan. “Our hospitals needed Medicaid expansion,” Kasich told reporters last week. “It has worked very well in this state.” 
The Republican Party is fracturing around Obamacare in ways we haven’t seen before. This is happening for a simple reason: It’s really, really hard to end health insurance benefits for 20 million Americans, especially when you don’t have a plan for what comes next. I still think repeal is the most likely outcome of this debate — it just doesn’t seen nearly as certain possibility as it did a month ago.

If Americans figure out the first thing the GOP does for them is take away their health insurance and access to health care, they are going to revolt as they did in 2006 and 2008.

But even if the GOP doesn't go through with repeal, the uncertainly may kill Obamacare anyway.

The Obama Machine Revs Up

President Obama will not be going quietly into that good night, no matter how many folks on the right (and left) wish he would just disappear and quietly take up painting like Dubya did.  The Obama campaign infrastructure is evolving into a network to train the new Democratic party leaders of tomorrow, and their first order of business is to get the ball rolling for 2018 and beyond.

Already, former aides are revamping Organizing for Action, the group formed out of his old campaign structure. No longer about backing up Obama’s agenda in the White House, it will be a nexus for training activists and candidate recruitment, reshaped both by Trump’s win and some of the factors that contributed to Hillary Clinton’s loss. 
Though OFA has been mostly quiet over the last two months and made no formal announcements, its Chicago headquarters has been filling up with new hires, including several old campaign aides, who are planning to focus on the mechanics of campaigns, from running Obama-style persuasion programs, integrating data and running paid canvassing operations. Though the first goal is designing the program for what they’ll aim to make hundreds of workshops nationwide, there’s already talk moving toward endorsing candidates
And Obama has identified a few issues that would draw him out directly: a Muslim ban, though he still considers the chances of that remote, or moves that would cut back on the protections he put in place for the children, known as “dreamers,” who were brought to the country illegally as minors and who’ve been living here since. 
“If he deports thousands of kids,” Obama has said several times in private meetings of late, according to people present, “I don’t know that I can sit on the sidelines.” 
Also potentially on the list: a move by Trump to unravel the Iran deal or the Paris climate accord, or the shape of an Obamacare repeal and replacement. 
“If things rise to the level where it’s a statement of who we are as a people and as a country, things that are important to him, then depending on the circumstances he will engage and he will talk,” said one of the people familiar with thinking about the post-presidency. “But this is now the moment where the next generation of Democratic or progressive leaders steps up and engages in the political fight, however defined and broadened.”

This is absolutely the right move here by President Obama and the Democrats.  Rather than crawl home and lick their wounds, or worse, approving Trump's agenda through "bipartisan cooperation", he's standing up to organize and to fight back.

I'd love to see workshops here in Northern Kentucky.  Democrats have gotten pummeled here, and it would be excellent to have some organizing resources to turn to.  Matt Bevin is expected to today wipe out the Bluegrass State's long union tradition with a few strokes of his pen.  Sign me up to start fighting back.

Checking Up On The Cabinet

The All-New Reince Priebus did his best Sunday to normalize the notion that Trump cabinet picks don't need background checks for ethical reasons, because these people are way too busy to be slowed down by your "ethics rules" and that should be good enough for America, so shut up.

Fox News host Chris Wallace asked Priebus on Sunday if the Trump administration would consider delaying the hearings until the background checks were complete.

"No," Priebus replied. "They have to get moving. I mean, they have to move faster. And they have all the information. These are people that have been highly successful in their lives. They need to move quicker."

"The fact is there's no reason," he continued. "I mean, it's the first week of January, they have all the details that they need, they have all the information that they need. It's no different from any other new administration coming in and the American people demand it."

"Change was voted for and change we will get."

Got that?  No reason for ethics checks, because shut up that's why.

Democrats need to put a stone cold stop to this idiocy, but I wouldn't count on them to be able to do much without at least some GOP defections in the Senate.  And I don't see that happening.  Why would Republicans stand up to Trump now?


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