House Republican "moderates" sign on to gutting the ACA Medicaid expansion

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Punchbowl News provides valuable daily intelligence as to the progress of the Republican reconciliation package, but they have this story exactly backwards:'

The red lines begin: A dozen House Republicans say no to big Medicaid cuts

News: If you’re looking for a sign that House Republicans are getting worried about cuts to Medicaid, here it is.

A dozen House Republicans are warning GOP leaders that they won’t back a reconciliation package that includes massive cuts to Medicaid, according to a letter first obtained by Punchbowl News.

What the letter* actually does is sign onto the hard-right Republican plan, advanced by House Energy and Commerce Chair Brett Guthrie, to defund the ACA Medicaid expansion, which covers 20 million low-income adults. Ending the ACA’s 90% federal funding for the expansion population yields $561 billion in “savings” over ten years, according to the Congressional Budget Office. It’s the centerpiece of meeting the $880 billion 10-year cut target established for the Energy and Commerce Committee by the House budget resolution.

Will Medicaid drown in a high risk pool? (updated)

Update, 5/3/17: $100 billion over ten years for high risk pools, as speculated below? Ha ha ha -- a HRP patch has been proposed, and it's all of $8 billion over 5 years. That's after a $15 billion "invisible risk" fund was tacked onto a $115 billion state stability fund... the math outlined below still broadly applies. As Larry Levitt said of the $15b infusion, it's all chump change. And they're making the ACA look simple.
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Rumor has it that Republican leadership may lure "moderates" holding out against AHCA passage by throwing perhaps $100 billion over ten years into high risk pools. Moderates could then declare themselves satisfied that prospective individual market enrollees who have pre-existing conditions will have access to coverage.

Leaving aside the historic poor performance of high risk pools, this reinforces my fear that all the public hand-wringing about medical underwriting is a smokescreen, giving moderates cover to eventually sign onto a bill that still rolls back the Medicaid expansion and cripples all Medicaid via per capita caps.

In fact, the patchwork of funding grants slapped onto the bill via amendment  (pregnant women and addiction! invisible risk! more medical expense deduction!) can be used to obfuscate and only modestly soften the original AHCA's basic math: over ten years, $1.2 trillion in healthcare spending cuts offsetting $880 in revenue loss stemming from repeal of the ACA's taxes and mandates. In the original bill, the spending cuts include:

"It is whatever Obama wants" -- a counternarrative peeks out

Most of what I read about the House-Senate negotiations on the stimulus bill emphasized what was cut out of House appropriations: aid to states, some subsidies for Cobra healthcare benefits, $16 billion for school buildings. Also, dilution of the total by including the $70 billion patch to the alternative minimum tax, rather than handling that separately, later. Rolled, rolled, rolled by Republican 'moderates,' went the narrative.

Politico's David Rogers tells a different story:

“Basically, it is whatever Obama wants,” said one House staffer up all night sorting through Appropriations accounts. From investments in new energy initiatives, broadband, high speed rail, and health information technology, Obama gained a foothold. Yet with continued market turmoil and a troubled economy, action was a first priority for the administration.

According to Rogers, Obama got much of what he wanted by agreeing to shave his middle class tax cut, "to $400 for individuals and $800 for couples — down from $500 and $1000, respectively. This was estimated to save at least $20 billion and was seen as a good faith effort to move the negotiations along."

Moreover, Rogers claims that Obama may end up with his 80 Senate votes after all. That sounds pretty rich now that Gregg Judd's withdrawn, the Republicans have circled the wagons, and people wonder whether a fillibuster in the Senate may yet be possible. But who knows which way the wind will blow by next Monday?

Today's Times story also showed some of the cuts in proposed spending to be more of a compromise than original reports suggested. It seems that $25 billion, not $40 billion, was cut from the House's proposed $79 billion in direct aid to states. The shave on Cobra health insurance subsidies to the unemployed was relatively moderate, from 65% of the cost over 12 months to 60% of the the cost over nine months - though temporary Medicaid coverage for the jobless who have no Cobra to fall back on was cut entirely.

Obama may have given up least on alternative energy investment. An advocate I know was thrilled with this synopsis from RenewableEnergyWorld.com:

The bill will be a boon for the renewable energy industry. All of the provisions that were contained in the Senate version of the bill were retained. In addition, the grants in lieu of tax credits clause that the House version of the bill contained made the final package.

The renewable energy, transmission and energy efficiency measures of the bill are outlined below.

The new bill contains $20 billion for tax incentives for renewable energy and energy efficiency over the next 10 years including:

• A three-year extension of the production tax credit (PTC) for electricity derived from wind (through 2012) and for electricity derived from biomass, geothermal, hydropower, landfill gas, waste-to-energy and marine facilities (through 2013).

• Grants of up to 30 percent of the cost of building a new renewable energy facility to address current renewable energy credit market concerns. The grant money was originally slated to go through DOE, but RenewableEnergyWorld.com is now hearing that the money will be distributed through the Treasury Department.

• Establishment of a new manufacturing investment tax credit (ITC) for investment in advanced energy facilities, such as facilities that manufacture components for the production of renewable energy, advanced battery technology and other innovative next-generation green technologies.

• Clean renewable energy bonds for state and local governments.

• Extensions for tax credits through 2010 for purchases such as new furnaces, energy-efficient windows and doors or insulation.

• A tax credit for families that purchase plug-in hybrid vehicles of up to $7,500 to spur the next generation of American cars.

In addition, $30 billion will go to smart power grid, advanced battery technology and energy efficiency measures including the Smart Grid Investment Program to modernize the electricity grid to make it more efficient and reliable, U.S. development of advanced vehicle batteries and battery systems through loans and grants.

If there's another turn of the screw and Obama does indeed get a fat handful of Republican Senators on board, ththe country may get used to him getting his way, as it did to Reagan early on. The money carved out of the stimulus may prove to be money well unspent.