Talk:American Health Care Act of 2017/Archive 1

Medicaid
This article needs to expand a discussion for what it does to Medicaid. Here is a good source. http://healthaffairs.org/blog/2017/03/10/the-american-health-care-act-and-medicaid-changing-a-half-century-federal-state-partnership/

Table
I removed some information from the table. Per Manual of Style/Tables, "[p]rose is preferred in articles as prose allows the presentation of detail and clarification of context, in a way that a table may not." The table is present to show high-level differences and similarities, not to document every single change made by the AHCA. Orser67 (talk) 22:26, 11 March 2017 (UTC)

Committee amendments
Reminder for myself or whoever else might be interested: At some point we should add some material about the committee amendments that were proposed (and voted down); see here and here. Neutralitytalk 19:35, 12 March 2017 (UTC)

Should we add content on the responses to the CBO score?
Several Republicans have quibbled with the CBO's methods and credibility. It has been claimed that the CBO failed in forecasting Obamacare's effects, which PolitFact and FactCheck.Org have found is largely inaccurate: http://www.politifact.com/truth-o-meter/statements/2017/mar/12/mick-mulvaney/fact-checking-white-house-attack-nonpartisan-cbos-/ + http://www.usatoday.com/story/news/politics/2017/03/14/fact-check-how-accurate-were-cbos-obamacare-predictions/99157846/. Snooganssnoogans (talk) 15:13, 14 March 2017 (UTC)
 * Off in the weeds, IMHO. User:Fred Bauder Talk 15:18, 16 March 2017 (UTC)
 * We already very briefly mention this, under "Legislative process." Neutralitytalk 15:20, 16 March 2017 (UTC)

Bill numbers
I think, but am not sure, that the bill that passed the Ways and Means committee today was H.R. 1408. The bill text isn't up yet to compare it to the released draft text. Antony–22 (talk⁄contribs) 17:55, 9 March 2017 (UTC)


 * That bill isn't it. The "American Health Care Act" has no bill number.  Despite the name, this "Act" is not yet an act, and despite all the reporting calling it a "bill", it's not yet even that, either.  It's a pair of "legislative recommendations" (here and here), which were made by two House committees pursuant to a Senate Concurrent Resolution (S.Con.Res. 3), and which the House Budget Committee will now consider and then possibly introduce an actual bill.  It's not clear that even the House Budget Committee will propose a bill, because the resolution says that in the Senate, "[u]pon receiving all such recommendations, the Committee on the Budget of the Senate shall report to the Senate a reconciliation bill" (sec. 2001(c)), but in the House, it just says that the committees "shall submit their recommendations to the Committee on the Budget of the House of Representatives to carry out this section" (sec. 2002(c)), which I think means that the House Budget Committee can choose either to report a bill or to just wait for the Senate bill if it looks like it will be the same. Birdfern (talk) 19:43, 11 March 2017 (UTC)


 * There's still no bill number, but yesterday the recommendations were at last combined into a draft bill that actually calls itself the "American Health Care Act". I'll update the article. Birdfern (talk) 17:42, 14 March 2017 (UTC)


 * Thanks for doing the research on this. It's confusing when committees are passing bills that aren't actually bills.  Antony–22 (talk⁄contribs) 02:52, 17 March 2017 (UTC)


 * Yesterday it became H.R. 1628. Article updated. Birdfern (talk) 16:38, 21 March 2017 (UTC)

Trumpcare, Ryanncare, etc
Trumpcare is the most widely used nickname for this bill. It is in far more sources then any other word. I suggest we just use only Trumpcare for the nickname.Casprings (talk) 01:04, 17 March 2017 (UTC)
 * Trumpcare is more prominent than Ryancare, but there are still over 400,000 Google hits for it. – Muboshgu (talk) 01:17, 17 March 2017 (UTC)
 * Trumpcare is widely used, it has over 9 million searches. Ryancare has 800,000. That's hardly worthy of a mention. Especially considering Republicare has even more hits than Ryancare.Funkinwolf (talk) 14:32, 28 March 2017 (UTC)

Social Security savings from mortality
I cannot find the assertion that expected increases in mortality would save Social Security $3B (or any reference to mortality) in the Congressional Budget Office Cost Report. Would remove this statement OR provide reference. Debwe (talk) 18:33, 19 March 2017 (UTC)


 * Footnote f on page 33 of the CBO report reads as follows "Consists mainly of the effects of changes in taxable compensation on revenues. CBO also estimates that outlays for Social Security benefits would decrease by about $3 billion over the 2017-2026 period."


 * I think this is where the number comes from, and I can't think off the top of my head of a reason that Social Security spending would increase under the bill aside from higher mortality levels. — Preceding unsigned comment added by 50.148.240.230 (talk) 02:50, 22 March 2017 (UTC)


 * Alternative explanation: If people nearing retirement became healthier, they might choose to delay retirement and thus take less in social security payments (in the short run, at least). JRSpriggs (talk) 05:15, 22 March 2017 (UTC)

CBO Projections
The current article states that "Under both current law and the AHCA, CBO assumes the health exchange marketplaces would remain stable (i.e., no "death spiral")." -- and then sites the CBO report. This is incorrect b/c the CBO does not assume they will be stable but projects they will be stable. This can be verified on page 2 of the CBO report sited. — Preceding unsigned comment added by 209.6.142.150 (talk) 19:25, 26 March 2017 (UTC)

Revised Bill & CBO Score
I narrowly contribute to this article, and probably don't have the time to look through the edit history. Do the ACA/AHCA comparisons account for the last minute revisions to the AHCA? Also, the CBO released a revised score – same amount will become uninsured, but it will be costlier than expected – has that been included? I think for posterities' sake it would be good to keep original AHCA language/CBO score and add commentary about revisions. Classicwiki (talk) 17:12, 24 March 2017 (UTC)


 * The changes mentioned in your source are from the early version of AHCA to the current AHCA to try to win more votes from factions within the Republican party, not changes from PPACA to AHCA. JRSpriggs (talk) 05:01, 25 March 2017 (UTC)

DeBonis reference
Reference 29. ab Mike DeBonis, Kelsey Snell & Sean Sullivan, bamacare revision clears two House committees as Trump, others tried to tamp down backlash, Washington Post (March 9, 2017). Second reference may or may not be correct. I would appreciate checking by another editor.--Dthomsen8 (talk) 21:22, 24 March 2017 (UTC)

Edit request
Please add the hatnote to account for



-- 70.51.200.162 (talk) 22:53, 26 March 2017 (UTC)
 * Yes check.svg Done Gulumeemee (talk) 06:52, 27 March 2017 (UTC)

Obama's comments
Discussion started here. Do what you want with copying the discussion or whatever.— Vchimpanzee  •  talk  •  contributions  •  18:15, 5 April 2017 (UTC)

Need a Discussion of the Domestic and Geopolitical Repercussions?
While the "dry facts" are somewhat well presented, this article seems to be completely lacking in any discussion of the real importance of this bill -- which I suggest is that the chaos surrounding the now-three attempts to even get it to the House floor have both split a previously-solid Republican majority and, for the President's first 100 days, largely paralyzed Congress. This is not at all an inconsequential occurrence, because of its domestic and international repercussions (such as contributing to a loss of faith in the U.S.'s ability to act decisively). 71.175.164.75 (talk) 15:08, 28 April 2017 (UTC)

Comparison between ACA and AHCA Chart Pre-Existing Conditions
While both ACA and AHCA ban discrimination on pre-existing conditions, it should be highlighted in the chart that AHCA allows insurers to charge additional premiums based on pre-existing conditions, whereas ACA does not. It's a pretty big difference, especially considering the premium multiplier for certain conditions might be x3,500% under AHCA.--12.233.203.201 (talk) 17:26, 4 May 2017 (UTC)

^ Still hasn't been updated. What is the point of locking articles subject to low risk of vandalism. It's censorship and defeats the purpose of wikipedia. — Preceding unsigned comment added by 2601:646:8780:5D0:951E:8F82:EE6D:323C (talk) 20:24, 4 May 2017 (UTC)


 * This is misleading. Higher premiums for pre-existing conditions are only allowed after the State gets a waiver and then only if some means is provided to compensate the patient for the higher premium. JRSpriggs (talk) 09:28, 5 May 2017 (UTC)


 * In support of my previous comment, see the upper right corner of page A4 of "The Washington Times" of Wednesday, May 17, 2017. The article "White House presses states to request Obamacare waivers" by Tom Howell, Jr. (which is mostly about ACA) says the following about AHCA: "Under the bill that passed the House this month, states could opt to waive the part of Obamacare requiring insurers to cover a slate of benefits such as maternity and mental health care and let them charge sicker patients more than healthy ones, so long as they used risk-sharing pools." (emphasis added). JRSpriggs (talk) 03:55, 18 May 2017 (UTC)


 * Still better, the Washington Post's fact checker Glenn Kessler (journalist) writes (on page A4 of The Washington Post for Sunday, May 21, 2017) about the coverage of pre-existing conditions under the House-passed version of AHCA (see ):
 * Thus, four things would need to happen before someone would be affected: You live in a state that seeks these waivers; have a lapse in health coverage for longer than 63 days; have a preexisting condition; and buy insurance on the individual market.
 * A person who fell into this category would face insurance rates that could be based on their individual condition, for one year. (States that seek a waiver would need to provide ways to help make up the difference in costs.) After that, people would qualify for prices at the community rate, rather than based on their individual conditions.
 * Notice the parenthetical insert in the second paragraph. JRSpriggs (talk) 06:33, 23 May 2017 (UTC)

Health Care vs. Health Insurance
Editors please be careful to use the word "insurance" when talking about insurance, because insurance is not care, it is how we (presently) pay for care. For example this phrase:
 * healthier persons to remain outside of the market, causing overall health care costs to rise

seems incorrect on its face: if healthy people are not buying insurance, it may drive insurance prices up for the remaining less healthy pool, but total care costs may actually decline due to reduced consumption. 72.208.150.248 (talk) 14:51, 5 May 2017 (UTC)

Trying to draw attention to the above edit request with this tag:

Please change all occurrences of "health care" to "health insurance" when the subject under discussion is insurance. 72.208.150.248 (talk) 18:42, 27 May 2017 (UTC)
 * Red information icon with gradient background.svg Not done: please establish a consensus for this alteration before using the template. – Train2104 (t • c) 17:22, 6 June 2017 (UTC)

Views of experts should be under Reactions
"Views of experts" should be headed under "Reactions" not "Overview" as all the opinions stated are reactions and not summaries of the bill. — Preceding unsigned comment added by Itskenbro (talk • contribs) 14:55, 5 May 2017 (UTC)

H.R.1628: one bill, introduced March 20, 12 days after hearings?
According to congress.gov, H.R.1628 was introduced in the House on March 20, 2017. The Initial version section of this article begins,
 * The two bills that constituted the AHCA were introduced into the House Energy and Commerce Committee and the House Ways and Means Committee on March 8, 2017

Problems here:
 * March 8 is 12 days before March 20. Is it possible that the March 8 hearings were for an un-introduced draft of the bill that hadn't even been assigned a bill number? Or, were the March 8 hearings for some other bill that was superseded by H.R.1628?
 * H.R.1628 is one bill, not two, in any case.
 * the CNN article actually says that the one bill was referred to the two committees, not that there are two bills. Also the New York Times article referenced right after the excerpt above says that two committees approved one bill, so our Wikipedia article is wrong.
 * the CNN article, with the same URL as before, has changed date, authors, and title, and would now be referenced thus:

Action required:
 * Determine if the March 8 hearings were for another numbered bill, or for an unnumbered bill that became H.R.1628, or whatever.
 * Explain how the bill heard in two committees on March 8 relates to H.R.1628, which seemingly wasn't introduced until March 20.
 * Correct "The two bills that constituted the AHCA" to "The AHCA", or some other wording that discusses only one bill.

Let's figure this out and get it right.
 * References

—Anomalocaris (talk) 02:29, 9 May 2017 (UTC)


 * Regarding the two bills: I think that this came from some talk early on about "repeal and replace" being done in three stages: (1) a bill (HR1628) written to include as much as could be done under the constraints of budget reconciliation (necessary to avoid a filibuster in the Senate), (2) changes to regulations issued by the department of Health and Human Services, and (3) a follow-on bill which would require some votes from Democrats to finish the changes, e.g. to put Congressmen and their staffs under the insurance schemes of their home States rather than under the District of Columbia (which presumably would stick with full Obamacare). JRSpriggs (talk) 03:47, 9 May 2017 (UTC)


 * Americans for Tax Reform describes three possible follow-on bills here. JRSpriggs (talk) 06:35, 25 May 2017 (UTC)

Kaiser Family Foundation assessment of the May 2017 version of AHCA
http://kff.org/health-reform/issue-brief/gaps-in-coverage-among-people-with-pre-existing-conditions/

I don't have time to edit at the moment, so someone should add this. KFF "estimate that 27.4 million non-elderly adults nationally had a gap in coverage of at least several months in 2015. This includes 6.3 million people (or 23% of everyone with at least a several-month gap) who have a pre-existing condition that would have led to a denial of insurance in the pre-ACA individual market and would lead to a substantial premium surcharge under AHCA community rating waiver." In other words, 6.3 million people can be expected to pay higher premiums because they have preexisting conditions. Snooganssnoogans (talk) 11:37, 17 May 2017 (UTC)

Title
The Act is now called the Better Care Reconciliation Act. That's its official name. Can the title be changed to better and more accurately reflect this change? Also, BRCA is mentioned in the newest CBO report released today. thank you.--Smghz (talk) 21:32, 26 June 2017 (UTC)
 * That is only the name of the Senate's version. The House's version is still called the "American Heath Care Act". The name of the Senate version could be changed by an amendment. And even assuming it is not changed, the joint committee which would attempt to reconcile the two versions would have to choose which name to use before any possibility of it being passed into law. So let us leave the name alone for now. JRSpriggs (talk) 02:58, 27 June 2017 (UTC)
 * Actually, what will happen is that they will debate the house bill and this will be the Senate majority leaders substitute admendment at the very end of the process. Once it passes, it's very likely that the house will will just bring it up for a vote and that it will pass. In other words, if it becomes law, the Senate versions name is likely it.Casprings (talk) 03:05, 27 June 2017 (UTC)

Status of reconciliation eligibility
Passing the BCRA in the Senate with only a majority (escaping a filibuster) requires that it qualify as a reconciliation bill under Senate rules. The ruling is made in the first instance by Elizabeth MacDonough, the Parliamentarian. I edited the article to present this as an "if" matter. User JRSpriggs changed the passage to assert that MacDonough had upheld reconciliation, but gave no citation.

In a quick search I find only a right-wing source, the Washington Examiner, which three weeks ago ran a story headlined "House Obamacare repeal bill meets Senate rules for simple majority vote". The text, however, makes clear that this was an assertion by the Republicans on the Budget Committee. Since that story I've read several other stories treating the issue as being still up in the air. Does anyone have a good source for an actual ruling by the Parliamentarian on the 2017 version of the bill?

This is a critically important subject. McConnell will have a difficult enough time corralling 50 Senators and has no hope of getting 60. I've flagged the new edit with "Citation needed" but, because of the importance of the point, I don't think we should let the unsupported assertion remain very long unless someone can substantiate it. JamesMLane t c 21:05, 27 June 2017 (UTC)
 * Good point. We should have a ruling already. The Atlantic reports it should be soon. VP Pence could decide to ignore MacDonough if she rules it fails to comply with the Byrd Rule. I assume since the vote was delayed and the CBO score was released, we can expect to see a ruling after the recess. Either way, it would be great for these details to appear in the article! Classicwiki (talk) (ping me) 06:16, 29 June 2017 (UTC)


 * It would be nice to have a ruling already, but I think the situation is more fluid. According to this source, the process "involves a string of meetings" and may also involve changes to the bill.  For example, many of the Republicans would like to retain the AHCA provision that would defund Planned Parenthood.  It may be, however, that that provision is ruled ineligible for reconciliation treatment.  In that event, McConnell could change the draft by deleting the Planned Parenthood stuff.  So we might have successive rulings on multiple versions of the bill.  Anyway, your Atlantic article and the source I linked make clear that there is no ruling at this time, so I'm changing the language that I had questioned. JamesMLane t c 07:12, 4 July 2017 (UTC)


 * It is not a single binary decision. Rather it is a filter which excludes certain kinds of provisions in the bill and thus certain otherwise-possible amendments which might be offered. It will not directly cause the defeat of the bill, but will make an agreement harder to reach. JRSpriggs (talk) 04:14, 5 July 2017 (UTC)

Left bias of this article
Because the main-stream media, especially the New York Times and the Washington Post, has an extreme left-wing bias even in their news articles (let alone editorials and opinion articles), this article has been tainted by that bias. For examples: Opinion polls are not evidence of any fact regarding the morality or viability of the various health care schemes (ACA, AHCA or BCRA), and yet those polls are included as if they were. Republicans are accused of sabotaging Obamacare when they are merely trying to protect people from being injured by it or protect USG and its constitution from being undermined by it. Republicans are accused of trying to give "tax cuts" to the wealthy when they are merely trying to prevent the hard-earned income of people (of any economic class) from being confiscated. JRSpriggs (talk) 05:49, 4 July 2017 (UTC)


 * Wikipedia reports facts, including facts about significant opinions. We should not say that the AHCA would sabotage the ACA but we can report that criticism.  The way to improve the article is not to delete the information, but to add more.  You could properly add rebuttals of any criticism if the rebuttal comes from a significant commentator and is reported by a reliable source.  For example, there are probably such statements from Republican officials (electeds like Paul Ryan, appointeds like Steve Mnuchin), conservative media like National Review, or other establishments like the U.S. Chamber of Commerce.  You seem to have a libertarian bent so maybe you'd find something from the Cato Institute.  One of those would qualify for inclusion, as opposed to some self-published right-wing blogger.


 * I'd caution you, however, that this article is about the ACA repeal bills. It is not about libertarian philosophy that taxation is theft or the like.  To call the AHCA provisions "tax cuts" is neutral.  Wikipedia should not say that the bill prevents "the hard-earned income of people (of any economic class) from being confiscated" any more than it should say that the bill is a shameless and immoral giveaway to the Republican Party's corporate paymasters. JamesMLane t c 19:10, 4 July 2017 (UTC)


 * It is not neutral to suggest that a cut in taxes is a giveaway. Rather, a cut in taxes (except for refunded tax credits) is the reduction or cessation of a taking. That is a fact, not a matter of opinion. JRSpriggs (talk) 08:51, 9 July 2017 (UTC)


 * The word "giveaway" does not appear in the current text of the article. You're giving the impression that you'd regard anything other than a libertarian screed as biased.  Incidentally, "giveaway" could properly appear in the article if we were reporting a significant opinion, e.g. if some Democratic Senator denounces the bill in those terms.  We can also report facts about significant conservative or libertarian opinions about the bill.  Both these inclusions would have to be held in check, because we don't need to record the opinion of every Senator plus every Representative plus every newspaper columnist or Fox News host, but it's proper for us to give the reader the basics about conflicting opinions. JamesMLane t c 07:27, 10 July 2017 (UTC)

Unlike tax cuts, government spending does not create jobs when one accounts for the depressing effect on the private sector of wasting resources. There is no stimulus from government spending to be lost by BCRA. Thus the section American Health Care Act of 2017 is incorrect. JRSpriggs (talk) 15:02, 16 July 2017 (UTC)
 * Economist would disagree.Casprings (talk) 15:19, 16 July 2017 (UTC)
 * Economists actually think stimulus spending has a higher multiplier (more "bang for the buck") than income tax cuts, as tax cuts can be saved. Crowding out does not always happen; no matter how big the deficits got post-crisis, interest rates fell anyway. See the article on the Balance Sheet Recession. When you have a big savings surplus and households and businesses are deleveraging, government can step in without bidding up interest rates.Farcaster (talk) 11:05, 17 July 2017 (UTC)
 * Regarding the jobs, credible sources are saying cutting spending will cost jobs. Do not confuse facts with truth; facts are something everyone can look up and agree that the source did indeed say it; facts are from sources of varying credibility. Truth is the realm of the Almighty.Farcaster (talk) 11:10, 17 July 2017 (UTC)


 * A full-time job or equivalent requires at least a certain minimum amount of resources (speaking here of good and services, not money) to provide for the needs of the employee (food, clothing, shelter, transportation, etc.) and the work-space, tools, and raw materials consumed by his job. A large part of the output of production in the private sector must be used for that purpose in order to be able to continue or grow production. Diversion of resources to non-productive purposes (such as monument building, war, imposing and complying with taxes and regulations, and extending the lives of dying people) or less than optimally productive purposes will reduce the resources available to provide jobs. If carried too far, this could resulting in a shrinking economy and general impoverishment. Government spending is, in most cases, a means of causing such a diversion. Thus as I said, government spending depresses the economy. It does not stimulate it. JRSpriggs (talk) 11:50, 19 July 2017 (UTC)

Rename article to "Republican Health Care Reform Effort of 2017"
The title of the bills seems to be less important then the overall efforts. Should we consider renaming the article?Casprings (talk) 20:02, 7 July 2017 (UTC)
 * The name of the article is the name of the legislation, as widely reported in multiple sources, and the most likely search term for someone looking for information about the legislation. There is no legislation called the "Republican Health Care Reform Effort of 2017".  This article is about the specific legislation, not about other Republican health care reform initiatives.  See Healthcare reform in the United States for an article more generally about health care reform.   General Ization   Talk   20:05, 7 July 2017 (UTC)
 * It's called 2017 Patient Protection and Affordable Care Act replacement proposals -- 65.94.42.131 (talk) 13:25, 18 July 2017 (UTC)
 * Definitely not. Cassidy-Collins has a separate article; it may be possible to write a general article after something definitive happens but it isn't possible now. Power~enwiki (talk) 04:20, 9 July 2017 (UTC)

Removing banners
Is the article at a point where the banners can be removed?Farcaster (talk) 17:43, 7 July 2017 (UTC)
 * Lateeeee reply but I would say no because the article is incredibly difficult to read and the situation is quite fluid. Although, as the person who put the tags up I could be biased. Classicwiki (talk) (ping me please) 04:40, 26 July 2017 (UTC)
 * The "current event" hat has to stay, the others can go. Power~enwiki (talk) 03:58, 28 July 2017 (UTC)

So, which bill is the Senate actually debating?
I can't figure it out. I heard skinny repeal, etc. Casprings (talk) 19:33, 25 July 2017 (UTC)
 * Okay, it is the Obamacare Repeal Reconciliation Act, that is what is being read on the floor now. Here is a link that has the bill and the CBO Score: https://www.vox.com/platform/amp/health-care/2017/7/19/16000616/senate-health-care-bill-republicans-obamacare-repeal-delay Casprings (talk) 19:41, 25 July 2017 (UTC)

Health Care Freedom Act
Okay, the Senate just released their substitute. I moved the article based on the new amendment, and put a copy of that amendment into the article. Will put sources here, as I find them, to tell what the amendment does.Casprings (talk) 02:16, 28 July 2017 (UTC)

So, the best I can tell (and this would be WP:OR, from reading the "skinny bill", this basically does 3 things. 1. eliminates the individual mandate. 2. Allows states to waive out of pre-existing conditions. 3. Defunds planned parenthood. Casprings (talk) 03:02, 28 July 2017 (UTC)


 * We need a section on process. For example: https://www.vox.com/platform/amp/policy-and-politics/2017/7/27/16054140/gop-health-bill-policy-process-appalling . This is insane the way this has gone down. Casprings (talk) 03:35, 28 July 2017 (UTC)