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Healthcare/ACA 2017
#71
AMaybe. Or, maybe with the Obamacare penalty removed, subsidies removed, and the requirement to insure folks with pre existing conditions removed (meanimg insuring costs go down) people will begin cancelling like gangbusters while the insurance companies have a larger margin to reduce premiums to try to keep them or poach them.

Not saying this is a good dynamic, just saying chart ignores it.
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#72
Quote:

Originally Posted by Overlord View Post

Maybe. Or, maybe with the Obamacare penalty removed, subsidies removed, and the requirement to insure folks with pre existing conditions removed (meanimg insuring costs go down) people will begin cancelling like gangbusters while the insurance companies have a larger margin to reduce premiums to try to keep them or poach them.

Not saying this is a good dynamic, just saying chart ignores it.


I should've linked to the original source.  I'm nowhere near finished with the methodology, so I'm not quite sure it will have the info you were looking for, but here's everything:



http://www.taxpolicycenter.org/taxvox/re...any-others



http://www.taxpolicycenter.org/simulatio...s-dec-2016

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#73

John Boehner, who led many ACA repeal votes, thinks "repeal and replace" won't happen:



http://www.politico.com/story/2017/02/jo...ans-235303



Quote:

“[Congressional Republicans are] going to fix Obamacare – I shouldn’t call it repeal-and-replace, because it’s not going to happen,” he said.


It's amazing how quickly things change once you're not in power anymore.



Boehner's biggest thorn was the Freedom Caucus, though, and its members don't plan on being much of help.  If the ACA is fixed, a lot of Democratic votes will be needed.

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#74

The GOP Medicaid plan is essentially to not be poor:



http://www.cbpp.org/research/health/medi...illions-of



Quote:

House Republican leaders have announced that they plan to include either a Medicaid “per capita cap” or a Medicaid block grant, or give states a choice between the two, as part of the legislation to repeal the Affordable Care Act (ACA) that House committees will consider in March. A Medicaid block grant and a per capita cap are much more alike than different as they would both radically restructure Medicaid’s federal financing system and slash federal Medicaid funding for states.  This would shift significant costs and risks to states while harming tens of millions of vulnerable low-income beneficiaries who rely on the program.

The federal government now pays a fixed share of states’ Medicaid costs, varying by state but averaging about 64 percent.  Previous congressional Republican budget and health plans have proposed converting Medicaid into a block grant or imposing a per capita cap. Both would radically restructure Medicaid’s financing and have similar, deleterious effects on states and beneficiaries.  A block grant would cap federal funding for a state’s Medicaid program, with a state responsible for any costs above the block grant amount.  A per capita cap would cap federal Medicaid funding per beneficiary.  In other words, the federal government would pay its share of a state’s Medicaid costs only up to a fixed amount per beneficiary.  The state would be responsible for all costs above that per-beneficiary cap.


Also, Vox' analysis shows that the GOP's eventual ACA replacement is estimated to raise costs for 55-64-year-olds by $6,089



http://www.vox.com/the-big-idea/2017/2/2...s-increase



Quote:

Since Republicans haven’t agreed on a single replacement health care plan, it’s difficult to compare the Affordable Care Act with — well, whatever is to come. But all Republican proposals to replace or repair the ACA share a set of common elements. These elements would dramatically reduce the generosity of insurance, which would, yes, reduce premiums. But they would also increase consumers’ out-of-pocket costs, such as deductibles and copays, as well as their financial risk.



The ACA also subsidizes many consumers’ premiums through tax credits. The Republican plans would reduce those credits substantially for most people. Finally, the proposals would alter premiums by age, increasing premiums for older people and reducing premiums for younger people.



We’re presenting here the first analysis of the net financial impact on Americans of the proposed Republican modifications to health care premiums after tax credits, plus cost sharing. We estimate that the Republican approach would increase the average total cost for an individual covered by the Affordable Care Act by $1,744 per year. The impact would be particularly severe for individuals ages 55 to 64, whose total costs would increase by $6,089 annually.



Although premiums would be lower under the Republican plan, this decrease would be offset by an increase in cost sharing. Once the differences in tax credits are accounted for, the Republican plan would increase total costs for every age group except for those under 25. What’s more, families — as opposed to individuals — would see an even larger spike in total consumer costs. For families of every age (as determined by the age of the head of household), total costs would increase.

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#75

Oh, and the Trump Train has stopped.  It's being towed by the Paul Ryan Express:



https://twitter.com/jaketapper/status/83...5112088576



So, "access" it is.  Those promises Trump made about Social Security and Medicare on the campaign trail need to be in every Democratic commercial from here until 2020.

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#76

At this point, I would welcome the complete abolition of Medicare and Medicaid as a crowbar to get things rolling on single payer.  I cannot imagine having to deal with the constant flux of private insurance woes for the next several decades.

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#77

Getting single payer as a result of all of this messiness would make Irony my one true god.

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#78

Yep:



https://twitter.com/DustinGiebel/status/...8433351680

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#79

http://www.motherjones.com/kevin-drum/20...cal-genius



Quote:

Obamacare provides subsidies to those who need it most. The Republican plan provides subsidies to everyone, even if they're already well off.



Politically, you can see the attractiveness of the Republican plan. One of Obamacare's major failings is that its subsidies phase out too soon. The poor get Medicaid and the near-poor get generally decent subsidies, but the working class gets very little and the middle class is left out entirely. The Republican plan provides bigger subsidies for working and middle-class families, and does it by cutting subsidies for the poor.



In other words, it helps two groups who vote at high rates, and who often vote Republican.1 It hurts a group that doesn't vote much, and votes Democratic when it does. It's immoral on almost every level, but it's political genius.

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#80

The many faces of health care in the GOP right now:



https://www.washingtonpost.com/blogs/plu...2156680cb2



Quote:

For instance, Freedom Caucus members in the House (the chamber’s most extreme conservatives) have threatened not to support any bill that doesn’t repeal the ACA’s expansion of Medicaid, which has resulted in around 14 million additional poor Americans getting covered. Your average Republican doesn’t like the Medicaid expansion either, but many of them also realize that now that all those people are covered, kicking them off would be a political (not to mention a humanitarian) disaster. For example:

“I’m very concerned about [a proposal] that would repeal Medicaid expansion,” Sen. Shelley Moore Capito (R-W.Va.) said Wednesday. “I don’t think we’re going to go that direction. I hope not, in the House or here, but that would be a major source of concern for me.”



Asked if she is concerned about the House plan, which would repeal the extra federal money for Medicaid expansion, Capito said, “Yeah, I mean we need the extra federal money.”



Sens. Dean Heller (R-Nev.), Lisa Murkowski (R-Alaska) and Rob Portman (R-Ohio) also have concerns about repealing the Medicaid expansion. Three of them voting no would be enough to sink a bill in the Senate.



But conservative senators, who demand that the Medicaid expansion be repealed, also have enough votes to sink a bill. Sens. Ted Cruz (R-Texas), Rand Paul (R-Ky.) and Mike Lee (R-Utah) say that Republicans must vote again on the sweeping repeal bill passed in 2015, which did away with the Medicaid expansion.



What do West Virginia, Nevada, Alaska and Ohio have in common? They all accepted the law’s expansion of Medicaid, so those members’ constituents are at risk. And that’s not all. Cruz, Paul and Lee also object to a provision in the emerging plan that would replace the ACA’s subsidies for middle-class people with tax credits that could be used to buy insurance. Even though the tax credits would be far less generous and wouldn’t be given according to income (so Bill Gates would get the same credit that someone of his age working at McDonald’s would), that’s still too much for those conservatives, who consider it an “entitlement” that violates their small-government principles.



So you’ve got ultra-conservatives who aren’t willing to accept a half-measure (backed up by right-wing pressure groups) at odds with ordinary conservatives who’d like something that minimizes the upheaval and political risk of repeal. Their differences look irreconcilable, and if either group bails, repeal is dead. It’s even possible that what Ryan and other leaders come up with will be unacceptable to both groups, losing support from both the right and the left within the GOP. If there’s a solution to that conflict, no one seems to have located it yet.

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#81

I was reading an interesting hypothesis today that the "real" positive effect of Obamacare (people who could not previously obtain insurance due to pre-existing conditions being able to do so) is actually not an insurance issue.



If someone has pre-existing/current healthcare needs, and they are now allowed to buy insurance, is it really insurance?  Arguably, it isn't.  Insurance is a guarantee against future unknown risks.  If you know the risks/treatments at the time you buy the policy, you aren't really buying insurance at all, what you're actually buying is health care (albeit one that is organized through an insurance entity).



This whole system is such a fucking disaster.  We have a fractured mess of private and public insuring entities, none of which is efficient and all of which leads to market distortions.

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#82

Here's a long interview with Rep. Kevin Brady, the Chairman of the House Ways and Means Committee, on taxes.  On health care, he essentially admits that he's okay with coverage loss:



http://www.vox.com/policy-and-politics/2...adjustment

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#83
Quote:

Originally Posted by Iron Maiden View Post
 

Here's a long interview with Rep. Kevin Brady, the Chairman of the House Ways and Means Committee, on taxes.  On health care, he essentially admits that he's okay with coverage loss:



http://www.vox.com/policy-and-politics/2...adjustment



So what do you think we should do, Iron Maiden?

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#84

For all intents and purposes, the GOP is the actual 'death panel' that they were going on and on about prior to the rollout of the ACA.




The GOP's Obamacare repeal plan is out--and it's even worse than anyone expected




--summary from the above LATimes piece--


-The proposal defunds Planned Parenthood.
-The bill effectively shuts down private health insurance coverage for abortion.
-The individual and employer mandates are eliminated.
-Essential health benefit rules are repealed.
-Income-based premium subsidies would be replaced by age-based subsidies
-The Medicaid expansion is killed.
-All of Obamacare’s taxes are repealed, another boon for the rich.

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#85
Quote:
Originally Posted by VTRan View Post
 

For all intents and purposes, the GOP is the actual 'death panel' that they were going on and on about prior to the rollout of the ACA.



So what do you think we should do about the healthcare situation in this country VTRan?

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#86
Quote:

Originally Posted by Overlord View Post
 


So what do you think we should do about the healthcare situation in this country VTRan?



First, all the retrograde and ignorant Republicans need to be voted out.


Then a good first step would be to cut the insurance industry out of the picture all together and adopt 'medicare for all'....single payer.  We've tried the health ins. industry way of doing things and it's shown to be unsustainable in it's current incarnation.


Rates go up,


more people can't afford ins.,


health ins. industry raises their prices to maintain their profits with less people on their roles,


more people drop their insurance because it becomes unaffordable


repeat.



FWIW- I have directly benefited from the implementation of the ACA and continue to do so.....so, getting rid of it hits home for me.


I feel that healthcare should be a human right for everyone.



So, howabout you, OverL? What should we do?

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#87
Quote:
Originally Posted by VTRan View Post


FWIW- I have directly benefited from the implementation of the ACA and continue to do so.....so, getting rid of it hits home for me.


I feel that healthcare should be a human right for everyone.



Since we appear to be on a "full disclosure" kick: I have directly been harmed by the implementation of the ACA, and this will continue.



This dynamic of different segments of U.S. society being adversely affected by private health insurance regulations is going to repeat over and over again until there is a recognition that the only mechanism to ensure a uniform, fair distribution of health costs across society is with a single payer system.



And the absolutely best way to ensure that an honest discussion of this topic never happens is for Kang v. Kodos/Republican v. Democrat discussions to continuously occur over and over again.  The Democrats had the best chance ever to demolish the private insurance oligopoly and they fucking blew it with what appears, more and more, to be a terribly flawed half-measure.  If I'm 25, why the fuck am I even considering signing up for any private health insurance plan currently being offered?  And don't tell me about the mandate, there are no enforcement provisions and the monetary penalty is too low to matter.

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#88

I used to pay out of pocket for better part of a decade for health ins.  Every year, the costs went up at least 10-15%....and this was long before the world ever heard of the ACA....and the amount of coverage was going down. Higher co-pays, higher deductibles, more expensive prescriptions.



The old way wasn't working and while the ACA is, admittedly flawed, it was the only way to stick a foot in the door of the health ins. industry....and FOR PROFIT industry that would just as soon only insure people that are 100% healthy. Even then, this same industry, when confronted with having to pay out for coverage, would bend over backwards to NOT pay out.  I had a friend that worked as a claims adjuster and one of the main components of his job was to deny payments and/or negotiate the lowest possible $$ possible.



The only chance the Dems had to start a reform of the healthcare ins. industry was/is the ACA. Any other options would not have passed. There was little to no chance of having a single-payer/medicad/cal legislation pass thru congress.



I'm all for having a politically bi-partisan plan for universal healthcare in this country....but that isn't going to happen because the GOP is so adamantly opposed to any change to the status quo.


The GOP had seven years....SEVEN FUCKING YEARS...to offer up any sort of alternative to the ACA. What we got was them voting, what 50+ times to blindly repeal it.



I'm sorry but recent history shows that conservative republicans don't really give a shit about the American people....unless of course those people are unborn fetuses or big business $$$ donors.


Name one positive program that the Republicans have implemented in the last decade....



IMO...it is Repub vs. Dem and it's only been the Dems that have shown themselves (flaws and all) to have any sort of vision for the future.



The GOP just wants to start a new Gilded Age by destroying any sort of progressive societal advances. Fuck the GOP.

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#89

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#90

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#91
Quote:

Originally Posted by Overlord View Post
 


So what do you think we should do, Iron Maiden?



Sorry, I missed your post.



Single payer is the dream, but I'm not quite sure we'll ever see it.  Sorry to hear you were personally affected by the ACA.  It's certainly not perfect, and you're not the only person I know who's been affected.



Considering who's in charge right now, I'll take any positives we can get.  I think tonight's bill won't ever get through for many reasons; too many Republicans have already said they won't vote for a plan that nixes Medicaid and there are many who won't support anything less than fully getting rid of the expansion.  Sens. Bill Cassidy of Louisiana and Susan Collins of Maine - Republicans - probably have the closest plan I would accept under the circumstances:



http://www.theadvocate.com/baton_rouge/n...3cac2.html



Quote:

Two Republican senators said Monday that they'll propose legislation that lets states keep former President Barack Obama's health care overhaul or opt for a new program providing trimmed-down coverage.



The plan by Sens. Bill Cassidy, of Louisiana, and Susan Collins, of Maine, would retreat from years of GOP cries to repeal Obama's law and replace it with a still undefined Republican alternative. It comes as GOP lawmakers face pressure from President Donald Trump to quickly void and replace the health law and as Republicans continue hunting for a proposal that would unite them.



Cassidy seems to be interested in making sure a lot of people stay insured:



https://twitter.com/StevenTDennis/status...2149798912

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#92

Reason isn't thrilled with the bill, if everyone was wondering what the conservative outlook is on this:



https://reason.com/blog/2017/03/06/the-g...-is-here-i



Quote:

The bill would replace Obamacare's subsidies with a system of tax credits and halt the law's Medicaid expansion at the end of the decade while grandfathering in many beneficiaries over the long term and giving states $100 billion in funding to work with to care for hard case patients. All in all, it's a fairly conventional Republican plan, modified in ways designed to mitigate recent political objections.



The tax credit is, for the moment, the most controversial component of the legislation. As in previous drafts of the bill, the credits are refundable, meaning that individuals will be eligible for them even if their total tax liability is lower than the amount of the credit. The federal government would pay people, even if their federal tax bill was zero. It's a subsidy, basically, rather like the one in Obamacare. Conservative legislators have argued that such a system would be little more than Obamacare lite. Sen. Rand Paul (R-Kentucky) has complained that any refundable credit is tantamount to "a new entitlement program."



Unlike Obamacare, which bases its credits on income, the GOP bills we've seen so far are based on age. That creates another set of political headaches, because it means that wealthier folks get tax credits, and because it means that older people would get less help than under Obamacare, in hopes of creating a scheme that lures more young and health people into the system.



The bill released tonight attempts to mitigate these problems by capping the refundable credit so that households earning more than $150,000 would be reduced, and individuals making more than $215,000 would get nothing at all. But that still leaves a credit that is refundable for most people, and adds a bit of additional administrative work: Under Obamacare, judging an individual's employment and income has proven more than a little difficult, and the same would continue to be true here.



So Republicans would be replacing one set of insurance subsidies with another set of insurance subsidies, while killing the individual mandate but leaving many of the law's insurance regulations intact (with a penalty for insurance gaps). There's a reason that legislators like Michigan Rep. Justin Amash are already referring to it as "Obamacare 2.0."

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#93

Look at this:



https://www.theatlantic.com/internationa...it/259153/




It's so backwards.  How did we get here?  At some point over the last 60-70 years, has it not been made abundantly clear that healthcare is too expensive and too difficult of a question to be left up to consumers and private industry to self-regulate?  How have we, as a nation, not collectively realized that core healthcare services simply should not be a for-profit industry.  There isn't even a public option to buy into the medicare or medicaid systems, for fuck's sake.  How obvious of a stopgag solution is that?  I mean, HOW COMPLETELY FUCKING OBVIOUS.  Just let Medicare/Medicaid set a price and let people buy in.  At least that would give people an alternative from the private insurance monolith.



I am so exhausted by the Obamacare debate when it's obvious the ACA was a half-assed compromise designed to put a band-aid on the real problem.  Our system of health care in this country is fundamentally broken.  The ACA absolutely did two or three necessary things that would be absolutely terrible to get rid of ... but it's really tough to get excited or enthusiastic about it.



Everyone benefits from people being healthy, getting preventative care,and not slamming hospitals and emergency rooms with uninsured patients.  It's just so discouraging.

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#94
Quote:
Originally Posted by Iron Maiden View Post
 

Reason isn't thrilled with the bill, if everyone was wondering what the conservative outlook is on this:



https://reason.com/blog/2017/03/06/the-g...-is-here-i




If Obamacare's largely toothless penalty isn't encouraging the young and healthy to purchase overpriced individual health plans, how the fuck is that version of health care reform supposed to do the trick?

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#95
AFreedomWorks, Heritage and Club for Growth are coming out against the proposal for not being conservative enough. Pence insists that this is only the first stage and some wonderful changes, including allowing insurers to sell across state lines in a race to the bottom, are forthcoming.
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#96

http://howmanyiphonesdoesitcost.com/

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#97
A[Image: 400]
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#98
Quote:

Originally Posted by Draco Senior View Post

FreedomWorks, Heritage and Club for Growth are coming out against the proposal for not being conservative enough. Pence insists that this is only the first stage and some wonderful changes, including allowing insurers to sell across state lines in a race to the bottom, are forthcoming.


I'm really not sure "race to the bottom" is a term that applies in this context.   Allowing insurers to offer national plans is a step in the right direction of ANY healthcare reform.

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#99
AIt certainly does, and it's a concern that plenty of healthcare wonks bring up whenever the GOP proposes it. https://www.bloomberg.com/view/articles/...save-money

http://www.latimes.com/business/hiltzik/...story.html

"On the face of it, lowering state-level barriers to health insurance sales would launch a race to the bottom akin to what happened with credit-card regulations after 1978. That’s when the Supreme Court ruled that credit card regulations could be exported by banks located in one state to customers located anywhere else. (This was no reactionary ruling, by the way; it was a unanimous opinion, written by arch-liberal William Brennan.) The result was that credit card-issuing banks set up shop in places like South Dakota and Delaware, which had virtually no usury laws, effectively nullifying other states’ limits on credit card fees and interest rates.

One can envision a similar reaction in health insurance. The Affordable Care Act sets nationwide standards for minimum benefits and consumer protection that must be met by every plan in the individual market, but many states have standards even stricter than these. California, say, would still have the right to impose tough regulations on insurers domiciled in the state.

But the prospect is that Blue Shield of California would no longer be issuing policies to Californians; the state’s residents would have the choice of Blue Shield of Texas or Louisiana, or nothing. As industry expert Richard Mayhew of Balloon-juice.com observed early this year, if a law was passed granting a national license to any insurer in any state, “the state with the weakest and most easily bought regulatory structure would have 98% of the viable insurance companies headquartered there within nine months.”
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Quote:
Originally Posted by Draco Senior View Post

It certainly does, and it's a concern that plenty of healthcare wonks bring up whenever the GOP proposes it. https://www.bloomberg.com/view/articles/...save-money

http://www.latimes.com/business/hiltzik/...story.html

"On the face of it, lowering state-level barriers to health insurance sales would launch a race to the bottom akin to what happened with credit-card regulations after 1978. That’s when the Supreme Court ruled that credit card regulations could be exported by banks located in one state to customers located anywhere else. (This was no reactionary ruling, by the way; it was a unanimous opinion, written by arch-liberal William Brennan.) The result was that credit card-issuing banks set up shop in places like South Dakota and Delaware, which had virtually no usury laws, effectively nullifying other states’ limits on credit card fees and interest rates.

One can envision a similar reaction in health insurance. The Affordable Care Act sets nationwide standards for minimum benefits and consumer protection that must be met by every plan in the individual market, but many states have standards even stricter than these. California, say, would still have the right to impose tough regulations on insurers domiciled in the state.

But the prospect is that Blue Shield of California would no longer be issuing policies to Californians; the state’s residents would have the choice of Blue Shield of Texas or Louisiana, or nothing. As industry expert Richard Mayhew of Balloon-juice.com observed early this year, if a law was passed granting a national license to any insurer in any state, “the state with the weakest and most easily bought regulatory structure would have 98% of the viable insurance companies headquartered there within nine months.”


The regulatory/statutory structure underlying the selling of insurance policies (perhaps most importantly, the massive system of "bad faith" laws that cannot be avoided simply by relocating to another state) is not analogous to those concerning the loan industry.



I'm not sure why 50 different bureaucracies is, in concept, a good idea, but I suppose we have bigger problems in the health care realm right now.

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Oliver spells it out.....



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heh....



Trump's team will try to discredit the CBO assessment of its health care bill this week.



Here are 13x he used CBO estimates to attack Obama



 

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CBO announces 14 million would lose their health coverage next year alone. By 2026, over 50 million people would lack insurance compared to about 28 million under the current law. Average premiums will climb between 15-20% by 2019, and older enrollees would get charged an average of five times as much as younger ones.



https://twitter.com/AP/status/841381571743604736

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In other words, its political suicide for the GOP to run with this.  Believe it truly is DOA.

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lmao



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