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Topic: GOP to cut Social Security, food stamps health care!

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untanglingwebs
El Supremo

The Slatest
Your News Companion
Dec. 9 2016 5:40 PM
Merry Christmas! Here’s a House Republican Plan to Cut Social Security.

By Jim Newell
183004795-rep-sam-johnson-rep-tom-rooney-and-michael-mccaul-on
Rep. Sam Johnson, left, in 2013.

Alex Wong/Getty Images

Just as the House of Representatives was leaving town on Thursday, veteran Rep. Sam Johnson—chairman of the Ways and Means subcommittee overseeing Social Security—released the Social Security Reform Act of 2016. The timing of the release, on the last day of the current Congress, suggests this was more of an opening volley in the Social Security reform effort. Johnson tells the Washington Examiner that he intended this release as the “start of a fact-based conversation.”

I had been previously unaware, since Donald Trump promised not to cut Social Security and House Speaker Paul Ryan doesn’t touch it in his “A Better Way” agenda, that we (“we”) were starting a conversation on Social Security anytime soon. But such is life under a unified Republican government.

The plan offers a model for what the GOP would do in a Social Security reform effort. The bill includes 15 specific changes, some of them more complex than others, and this letter from the chief auditor of Social Security analyzes each of them. Broadly: It would cut benefits without raising taxes. Some of the more recognizable changes include a gradual increase in the normal retirement age from 67 to 69 for those born in 1968 or later, and it would peg cost-of-living adjustments to chained CPI, a slower-growing inflation index. There are a lot of technical changes to the benefit formula, as well as additional "work incentives." (None of these changes would affect benefits for anyone currently at the normal retirement age, save for some of the highest earners.) Since implementing these cuts alone would make the law politically unpalatable, it would increase benefits for some of the lowest-income, longest-working earners, while the highest future earners would see the largest benefit cuts. But let’s be clear: most people would see cuts. Look for yourself, on Table B2!

I asked Johnson’s office on Friday afternoon if Social Security reform was something House Republicans would actually pursue in 2017, rather than just converse about abstractly. “Congressman Johnson is hopeful this will get the ball rolling on a much-needed conversation,” a spokesperson said. “Doing nothing or simply raising taxes won’t ensure that Social Security continues to be a program that our children and grandchildren can count on, just like seniors and individuals with disabilities do today.” So whether it’s starting a fact-based conversation, or getting the ball rolling on a much-needed conversation, the main point for the near-future seems to be: conversation. I will update if I hear back from Speaker Ryan’s office.

Democratic Minority Leader Nancy Pelosi’s office, however, released a statement Friday showing precisely how interested Democrats are in participating in this conversation with House Republicans:

“Apparently nothing upsets House Republicans like the idea of hard-working people getting to enjoy a secure and dignified retirement. While Speaker Ryan sharpens his knives for Medicare, Chairman Johnson’s bill is an alarming sign that Republicans are greedily eying devastating cuts to Americans’ Social Security benefits as well.



“Slashing Social Security and ending Medicare are absolutely not what the American people voted for in November. Democrats will not stand by while Republicans dismantle the promise of a healthy and dignified retirement for working people in America.”

As with Medicare voucherization, Democrats would be terribly, terribly upset if the Republicans made such a politically buccaneering move as trying to cut Social Security.

Jim Newell is a Slate staff writer.


Last edited by untanglingwebs on Fri Dec 30, 2016 12:15 pm; edited 1 time in total
Post Sun Dec 25, 2016 8:54 am 
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untanglingwebs
El Supremo

America’s concern for the poor is about to be tested

By Robert Greenstein December 26

Robert Greenstein is president of the Center on Budget and Policy Priorities.

Poor Americans are facing the gravest threat to the federal safety net in decades as President-elect Donald Trump takes office accompanied by a Republican-controlled Congress. The risks to essential benefits for tens of millions of low- and moderate-income Americans include losing coverage extended to them by the Affordable Care Act, threats to the fundamental structure of the Medicaid health-insurance program for the poor and further reduction of already squeezed funding for scores of other important programs serving the most vulnerable Americans.

First, Republicans are expected to seek significant cuts in what’s known as non-defense discretionary spending, which includes many important programs for low- and moderate-income people, such as rental vouchers for low-income families, programs to fight homelessness, job training, funding for poor school districts, Head Start for young children and Pell grants to help low-income students afford college. The reason for these cuts is that, for the first time, starting next fiscal year, Republican leaders appear inclined to let the harsh “sequestration” budget cuts take full effect. That would shrink funding for this budget category to its lowest level in at least half a century, measured as a share of the economy. And even deeper cuts, as proposed by the most recent House Republican budget and the president-elect, are possible.

More broadly, congressional Republicans are likely to follow the course set in every House GOP budget since 2011, as well as the most recent final House-Senate budget, in 2015. Every one of those budgets secured the bulk of its savings from programs for low-income people. In the House GOP’s most recent budget plan, 62 percent of a stunning $6 trillion in budget cuts over 10 years would come from such programs.

Both Trump and House GOP leaders have also proposed large tax cuts that would mainly benefit the most well-off and could cost several trillion dollars over the next decade. That, in turn, would likely force further rounds of cuts in domestic programs in future years to address the resulting increase in budget deficits.

Do we really want to increase hardship for tens of millions of low-income people even as we shower tax cuts on people at the top?

Republicans have controlled both chambers of Congress in recent years, but their budget aspirations were checked by President Obama. With Trump about to take office, they will have the means to enact their radical visions into law. And they will likely have a key administration ally in Rep. Mick Mulvaney, a South Carolina Republican and hard-line conservative whom Trump has picked to run the Office of Management and Budget.

History shows that the biggest domestic policy changes generally come in a new president’s first year when the president's party controls all the levers of power in Washington and uses a fast-track budget process called “reconciliation” to ram through an agenda without needing a single vote from the other party.
3 ways making the poor prove they’re worthy of benefits is problematic


To achieve their goals, Republican leaders plan to push through two major reconciliation bills in 2017.

The first, which could pass as early as January, would repeal the ACA’s coverage expansions and most likely take effect at the start of 2019. That would double the number of uninsured Americans, from 29 million to 59 million, and leave the United States with a higher uninsured rate than before the ACA, the Health Policy Center at the Urban Institute estimates.

The second reconciliation bill could couple regressive tax cuts with a radical overhaul of Medicaid and possibly the Supplemental Nutrition Assistance Program (food stamps) and even the Supplemental Security Income program for the elderly and disabled poor — three core low-income assistance programs. If previous House GOP budgets are a guide, Republicans will likely seek to eviscerate the basic structure of these programs, under which there are minimum federal eligibility and benefit standards and all eligible families who apply for benefits receive them. Recent House GOP budgets would instead give states fixed, inadequate pots of money (likely block grants), with sweeping state flexibility to respond to the funding reductions by restricting eligibility and cutting benefits.

That’s what happened after the 1996 welfare-reform law replaced guaranteed cash assistance for eligible poor families with a block grant that gave states broad flexibility over the funds. A year before the law took effect, 68 of every 100 poor families with children received cash assistance. Today, just 23 of every 100 poor families do. A comparable shrinking of health, food and cash assistance under Medicaid, food stamps and SSI would take critical benefits away from tens of millions of struggling low-income families and children, despite research indicating that basic assistance for poor children can boost their educational attainment and their earnings potential in adulthood.

Franklin Roosevelt once said , “The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.” If so, America is about to be tested.
Post Wed Dec 28, 2016 1:33 pm 
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untanglingwebs
El Supremo

Tom Price's Plan To Destroy Medicare: "Balance Billing" Seniors Into Bankruptcy
By Dartagnan
Wednesday Dec 28, 2016 · 5:02 PM CST
Trump's HHS appointee Tom Price, tearing up Medicare as we know it.
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Donald Trump has nominated Tom Price, a “Tea Party" Republican Congressman from Georgia, as Director of the Department of Health and Human Services, the Federal agency that oversees Medicare, the nation’s largest and longest surviving health insurance program, serving those over 65 years of age, and those with disabilities.

Like nearly all of Trump’s nominees, Price is overtly hostile to the agency he has been designated to lead. His nomination was supported by the American Medical Association (AMA) because, contrary to what many Americans may believe, the AMA is traditionally a Republican- leaning organization made up of nearly a quarter of a million physicians whose financial interests are one of its primary motivators. In particular, both Price and the AMA are on the same page when it comes to a practice known as “balance billing."

It's the practice of billing the patient for the difference between the sticker price and what insurance will pay. So if a hospital visit costs $1,000, but your insurance will only cover $300, some providers will "balance bill" you for $700.

“Balance billing” is commonly seen in private employer-based insurance plans when a patient uses an “out of network" provider. The practice, however, is partially restricted under the Affordable Care Act (which both Price and Trump have vowed to eliminate), and is essentially illegal under Medicare:

Under current law, Medicare has several financial protections in place that are designed to safeguard Medicare beneficiaries—seniors and people with permanent disabilities—from unexpected and confusing charges when they seek care from doctors and other practitioners. These protections include the participating provider program, limitations on balance billing, and conditions on private contracting.

A Kaiser study showed that one-third of people reporting difficulty paying their medical bills had been blindsided by the “out of network" charges imposed by hospitals and physicians. An overwhelming majority of those people had no idea they were being treated by an “out of network” provider. An example is when the hospital employs an “out of network" surgeon; this commonly occurs in emergency room treatment, for which the patient is essentially required to accept whatever care is available, or go untreated:

In 2011, the New York Department of Financial Services studied more than 2,000 complaints involving surprise medical bills, and found the average out-of-network emergency bill was $7,006. Insurers paid an average of $3,228 leaving consumers, on average, “to pay $3,778 for an emergency in which they had no choice.”

Tom Price wants to “reform” Medicare by allowing “balance billing” of Medicare patients, the practical effect of which, as Ryan Cooper, writing for The Week explains, would “[allow] doctors and hospitals to devour the nest eggs of thousands of American seniors:”

Permanently obliterating the financial security of helpless families with no or bad insurance as a loved one dies slowly and painfully of a chronic illness is a nice little profit center for providers. But it pales in comparison to the gravy train they might get if they can bring balance billing to Medicare.

Cooper observes that 55 million Seniors, many with significant retirement savings, provide a perfect target for medical providers to exploit. In 2011, Tom Price, Trump’s now-designated overseer of Medicare introduced a “Medicare reform" package designed to do just that. It received the AMA’s imprimatur of approval, since it allowed physicians to require their patients to pay the full balance of their unrestricted fees, even if far in excess of Medicare allowable charges, thus benefitting the physicians and providers that organization represents.

In 2011 we had a President Obama to assure such a plan to bankrupt Seniors through onerous medical bills would go nowhere. And many physicians, even some within the ranks of the AMA, are vehemently opposed to it.

But with Trump’s hand-picked man at the helm of HHS and a willing Republican Congress eager to dismantle Americans’ so-called “entitlement" to medical care, there is no reason to believe this scheme will not be enacted. While physicians would be constrained by the fee agreements they made with patients, the gross disparity of bargaining power between a sick elderly patient and one of the most powerful lobbies in the country is plain. As Cooper notes:

[T]hose contract prices are guaranteed to be vastly higher than what Medicare pays now. It will be akin to seeing an out-of-network provider on private insurance now, something that causes thousands of bankruptcies today.

“Balance billing” would be the first step toward the destruction of Medicare as we know it. It's not “health insurance" if obtaining appropriate medical care ends up risking your entire net worth, your retirement hopes, and anything you might want to leave to your children.
Post Thu Dec 29, 2016 1:56 pm 
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untanglingwebs
El Supremo

News
BREAKING: Republicans To Kick 10 Million People Off Food Stamps, Make 40 Million Uninsured
By Ivana M on December 24, 2016
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Donald Trump has won the White House. But it’s Republicans who have won Congress, and it’s House Speaker Paul Ryan who, in practice, leads those Republicans. And so for all the effort being made to divine what Trump really, truly thinks, the reality is it may matter less than what Ryan thinks — and that’s a question we already know the answer to.

Ryan has spent the better part of a decade crafting a coherent, sweeping agenda to reform and slash the American safety net. His agenda of slicing and dicing programs targeting America’s poor isn’t the agenda Trump ran on. But it’s one to which he’ll default. He’s already endorsed Ryan’s plans on Medicaid and has attacked food stamps at length. His vice president, Mike Pence, is a longtime friend and congressional ally of Ryan’s who if anything has argued for larger cuts than the ones Ryan wants.

What’s more, Trump enters office as a historically unpopular president distrusted by his own party in Congress. He’s not in a position to dictate to them what he wants. To keep them on his side, he’s going to have to do what they want. And what they want — and have repeatedly voted to pass in recent Congresses — is Ryan’s budget.

This is a disaster for America’s poor.

“I’ve been working on these issues since 1972,” Robert Greenstein, the founder and president of the Center on Budget and Policy Priorities and Washington’s leading advocate for poor and low-income Americans, says. “This is by far the gravest threat to the safety net, and to low-income people, that I’ve seen in my close to half a century of working on these issues. I think there’s a potential in the first seven months, by the August recess, for Congress to pass policies that do more to increase poverty and hardship and widen inequality than we’ve seen in half a century.”

Ryan’s proposals would repudiate the federal government’s 50-year guarantee of medical care and food to America’s poorest residents, a promise generated by Lyndon B. Johnson when he made food stamps permanent in 1964 and created Medicaid in 1965. The expectation has not always been met, especially for childless adults, whom Medicaid largely did not cover until the Affordable Care Act, and whom non-expansion states still don’t offer coverage to. But for the poorest families with children, those two programs were there, providing at least modest assistance in desperate times.

If Paul Ryan and his allies in the House enact their domestic agenda, this promise will fall apart. The Affordable Care Act will be repealed, but the damage will hardly end there. Medicaid will see its funding gutted, federal guarantees of coverage and access removed, and its status as an entitlement upon which poor Americans can depend destroyed. The Supplemental Nutritional Assistance Program (SNAP, or “food stamps”) will be slashed and turned over to states, which will likely use the money as a slush fund for other endeavors.

The safety net will not be repealed in one blow. States will still get some federal money to run weaker, less comprehensive versions of Medicaid and food stamps. But if the experience of block granting welfare in the 1990s is any guide, no state will have a program anywhere near as generous or comprehensive as the ones they did have. The 1996 welfare reform law effectively rendered welfare dead, according to sociologists of poverty, particularly in the eyes of the extreme poor, who ceased to see it as a program that can help them at all. If Ryan’s policies are enacted, that same fate could await food and medical assistance for the poor. Not for nothing, the disabled and elderly Americans who rely on Medicaid for long-term care will see support slashed as well.

This is an agenda that goes further than just repealing President Obama’s signature accomplishments. It’s an agenda that guts LBJ’s, that declares war on the Great Society and subjects it to death by a thousand cuts. And while programs for the aged, like Social Security and Medicare, have the president-elect’s backing, there’s no indication that Donald Trump will do anything to stop the gutting of Medicaid and food stamps.

The effects of Obamacare repeal have, rightly, received copious attention in the wake of the election. The repeal bill Congress is likely to take up would deny 22 million people insurance and, even if accompanied with a promise of a replacement bill later on, could rather quickly throw the entire insurance market into disarray.

“That’s a very dicey scenario if a replacement isn’t in well before the end of 2017,” Larry Levitt, a senior vice president at the Kaiser Family Foundation and health reform expert, says. “Otherwise, the ACA [Affordable Care Act] would still be in effect, and the Trump administration would have to run an open enrollment period for 2018, which I imagine is not a prospect they’d relish. With a highly uncertain future, I would expect insurers to exit the ACA marketplaces and the individual market in droves. The individual insurance market would be in chaos. This would affect not only low-income people receiving ACA subsidies, but also people like the self-employed, farmers, and small-business owners buying their own insurance.”

And it’s a safe bet that replacement, at least as contemplated by Republicans in Congress, will not cover anywhere near as many people as the Affordable Care Act currently does.

Paul Ryan’s “A Better Way” plan foresees replacing the ACA with a system with much lower regulatory burdens for insurers (partly achieved by enabling the selling of insurance across state lines, which would effectively ban states from enacting stricter regulations), more health savings accounts, and a refundable tax credit available for all to purchase coverage. The latter replaces the current sliding-scale tax credits of Obamacare, which grow with need to help those at the bottom more.

The right-leaning Center for Health and Economy estimated that the plan would reduce insurance overall by 4 million over time. But there’s reason to think that number is much too low. As Levitt explained to me, the lower regulatory requirements will lead to skimpier, less valuable insurance plans that also cost less. “Would people at least buy something, even if it’s skimpy, since they’d otherwise be forgoing the tax credit?” he asks. “Or would many decide that the skimpy insurance is so lousy it’s not worth the trouble? We don’t know for sure how people would respond. It is a safe bet, though, that the insurance people would get would cover less than what they get under the ACA.”

In other words, either a few million people lose insurance and many more are transferred into significantly worse insurance, or many millions will lose insurance and fewer retain it but see its quality go down. As my colleague Sarah Kliff explains, the effects of the other main congressional replacement plan, Senate Finance Chair Orrin Hatch’s Patient CARE Act, are similar. Center for Health and Economy projects 4 million fewer insured; the RAND Corporation projects 9 million.

Trump’s replacement plan, such as it is, is even worse. The Committee for a Responsible Federal Budget estimates it’d spare just 1 million people who’d otherwise lose insurance through Obamacare repeal. Full repeal without replacement takes insurance away from 22 million; Trump’s plan takes it away from 21 million. The difference is minimal.

But it doesn’t end with Obamacare. One of the biggest policy areas where Trump and Ryan are in agreement is Medicaid block granting. They don’t just want to revert Medicaid to the less generous program it was before the Affordable Care Act. They want to cut the program’s budget by about a third and hand the remaining money back to the states.

The human toll here could be immense. The Urban Institute’s analysis of the fiscal year 2013 House budget — one prepared by Ryan and closely resembling subsequent budgets — found that its cuts and block granting would kick 14 million to 20 million people off the Medicaid rolls. That’s in addition to everyone who’d lose coverage through ACA repeal. And because most of these people are extremely poor, the odds of them finding private insurance to replace Medicaid are quite low. So if Medicaid is block granted and cut, and the ACA repealed and replaced according to Trump’s plan, the total increase in the uninsured could very well reach 30 million to 40 million.

And the human toll won’t just consist of an increase in the uninsured population. Block granting will wreak havoc on the safety net for people with disabilities. Medicaid is the main source of funding for long-term care for disabled people who need it, and block granting would eliminate its role as an entitlement.

“If block granting proceeds, it would enable state officials to kick disabled adults and children out of life-preserving services for reasons of budget constraints, pressure from influential providers seeking to promote other business models, or any reason at all,” Ari Ne’eman, a former member of Obama’s National Council on Disability, writes. “Under a block grant, disabled Americans might effectively lack any rights to support services under federal law.”

Read in full on VOX: The War on the Poor: Donald Trump’s win opens the door to Paul Ryan’s vision for America
Post Fri Dec 30, 2016 12:16 pm 
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untanglingwebs
El Supremo

House, Senate headed for clash on Medicare
BY ALEXANDER BOLTON - 01/01/17 10:30 AM EST 4,194


Senate and House Republicans are headed for a clash over whether to tackle Medicare reform under President-elect Donald Trump.

Senate Republican leaders prefer to focus narrowly on an ObamaCare replacement bill that does not contain changes to Medicare — a cautious approach that reflects their slim majority.

But House Republicans, firmly in control of the lower chamber, want to aim higher. They say unified Republican control of government is a chance to finally enact the entitlement reforms that they’ve been talking about for years.

Rep. Pete Roskam (R-Ill.), a member of the Ways and Means Committee, which has jurisdiction over healthcare, said voters have endorsed the Republican argument that Medicare needs to be reformed.

“The changes in Medicare that we have proposed have been litigated and the country has said, we’ll entrust you with very big majorities,” Roskam said. “Republicans keep talking about these things and keep winning. The question isn’t whether to do them, it’s when to do them.”

The wild card in the debate is Trump.

He pledged during the campaign not to cut Medicare, Medicaid or Social Security, but his Cabinet selections have cast doubt on that promise.

House Budget Committee Chairman Tom Price (R-Ga.), whom Trump tapped to serve as secretary of Health and Human Services, is a leading advocate of Medicare reform, as is Rep. Mick Mulvaney (R-S.C.), his choice to head the White House budget office.

Speaker Paul Ryan (R-Wis.) said shortly after the election that Medicare and Medicaid would have to be reformed to some extent as part of the effort to replace ObamaCare.

“ObamaCare rewrote Medicare, rewrote Medicaid, so if you’re going to repeal and replace ObamaCare, you have to address those issues as well,” Ryan told Fox News.

“Because of ObamaCare, Medicaid is in fiscal straights,” Ryan added. “Medicare has got some serious problems because of ObamaCare. Those things are part of our plan to replace ObamaCare.”

Ryan said this month during an appearance on CBS’s “60 Minutes” that Medicare “goes bankrupt in about 10 years” and warned “the more we kick the can down the road, the more we delay, the worse it gets.”

Ryan’s “Better Way” plan calls for repealing “the most damaging Medicare provisions contained in ObamaCare” and adopting “bipartisan reforms that make Medicare more responsive to patients’ needs” while also “updating payment systems that are outdated and inefficient.”

Ultimately, many Republicans would like to transform Medicare from a fee-for-service program that provides virtually unlimited coverage to one where the government contribution per patient is more fixed. Under such a system, the thinking goes, beneficiaries would have more incentive to control their medical cost.

Ryan has championed the idea of premium support, under which Medicare would be an option for seniors alongside plans from private insurers. The competition could save money in markets where consumers have a wide array of options.

Other possible reforms that the GOP could pursue include raising the Medicare retirement age and implementing means testing, which could limit benefits for wealthier people or charge them extra fees.

Price, before he was picked by Trump to oversee federal healthcare programs, told reporters that House leaders would pursue Medicare reform in 2017.


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He predicted a reform bill would protected by special budgetary protections known as reconciliation that prevents Senate filibusters, but did not say whether the Medicare changes would be part of the same package to replace ObamaCare.

Republicans pushing for action on Medicare say the next Congress, which convenes in January, might be their best opportunity to overhaul Medicare before it hits a funding shortfall in 2028.

“It’s inextricably linked from the textbook standpoint. It’s something that ought to be done,” Rep. Mark Sanford (R-S.C.), a member of the Budget Committee, said of replacing ObamaCare and reforming Medicare.

But Sanford questioned whether some of his colleagues would be willing to face the political risk that comes with changing Medicare.

From a political standpoint, it probably won’t be [linked] because it involves hard lifting that brings with it real pain that’s not politically popular,” Sanford added.

The appetite in the House to go big reflects their safer majority. They will control 241 seats next year, compared to 194 for Democrats — a huge margin that would likely require a wave election to reverse.

Senate Republicans, who will have 52 seats compared to the Democrats’ 48, have more to worry about in the 2018 midterms. They’re slamming the door on talk of linking Medicare reform to the ObamaCare replacement bill.

Senate Republican Policy Committee Chairman John Barrasso (Wyo.), a doctor and the leadership’s expert on healthcare issues, said the funding shortfall is Medicare is a “tidal wave” facing policy makers because “10,000 Baby Boomers turn Medicare-age every day.”

“We need to have the discussion, but I don’t think that it should be part of the repeal and replacement of ObamaCare,” he said.

Senate Health Committee Chairman Lamar Alexander (R-Tenn.) has the same view.

He warns Republicans should be careful about “biting off more than you can chew.”

Replacing ObamaCare with what his party hopes will be a system that offers more choices and lower costs, “is a lot to get done and will take all of our best efforts,” Alexander said.

“We should put the solvency of Medicare aside for another day.”

When Congress passed ObamaCare in 2009, Republicans criticized Democrats for expanding the social safety net without doing enough shore up Medicare, a program headed toward insolvency.

Ryan still sees that as one of the major flaws of ObamaCare, according to Rep. Pat Tiberi (R-Ohio), a senior member of the Ways and Means Committee.

“I think the Speaker would agree with that today,” he said.

Democrats counter that the GOP’s drive to repeal ObamaCare will only make Medicare’s problems worse. They point to trustees reports that state that the healthcare law extended the life of the Medicare trust fund by 12 years.

The question now facing Republicans is whether they want to create a new system to replace ObamaCare without addressing Medicare.

“There’s tension on both sides of the answer,” said Rep. Michael Conaway (R-Texas). “The things we will do in lieu of ObamaCare will be difficult.

“Do you bite off too much trying to tackle both at the same time?” he asked, expressing skepticism that Congress could accomplish too herculean tasks simultaneously.”

At the same time, he noted, “We have to renegotiate Medicare.”

“If we can do them both at the same time that would be great because the sooner we get Medicare done, the less draconian the changes will have to be,” he added.
Post Mon Jan 02, 2017 6:04 am 
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