Tierney Sneed

Tierney Sneed is a reporter for Talking Points Memo. She previously worked for U.S. News and World Report. She grew up in Florida and attended Georgetown University.

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In a process that has unfolded behind closed doors among tight-lipped Republican senators, the Senate is moving forward with its effort to repeal Obamacare, a conference-wide meeting planned for Tuesday, during which Republicans will hash out the major choices they’ll need to make in their legislation. But whether the options presented will appease the concerns of the dozen or so members who have claimed various sticking points or whose states pose unique challenges to the repeal effort remains to be seen. The senators had left for their Memorial Day recess last week saying that staffers were starting to work on draft legislation, but according to various reports, Republicans will only start writing legislative text for the thorniest issues after Tuesday’s meeting, with the hope for a vote in July or even late June.

“We’ve been talking about this for seven years, so now is the time to start coming up with some tangible alternatives and building consensus,” Sen. John Cornyn (R-TX) told reporters on Capitol Hill Monday afternoon.

Out of the 20 GOP senators from states that expanded Medicaid under Obamacare, at least a handful have come out against the way the program is phased out in the House repeal bill. Its provisions to defund Planned Parenthood, and to let states opt of certain Affordable Care Act consumer protections, have also come up as points of contention for some Republican senators.

The House bill, the American Health Care Act, would lead to 23 million people losing coverage, according to last month’s CBO report, while cutting $834 billion in Medicaid funding that goes on to finance $664 billion in tax cuts, mostly for the industry and high earners.

Senate Republicans have said they are writing their own health care bill, but so far have not been able to point to any major changes to the House proposal they intend to make, beyond reworking its tax credit scheme.

A question that has echoed around the upper chamber is whether Senate Republicans will repeat the dynamics of the House repeal effort, in which conservatives eventually get what they want while moderates are ultimately pressured to drop their grievances and fall in line.

Here are nine Senate Republicans who present specific sticking points in the repeal debate, and are the ones to watch:

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After years of defending a 2011 voter ID law in court, Texas Gov. Greg Abbott (R) signed into law Thursday changes to the ID scheme that weakened the requirements. The signed legislation, in effect, codifies a court-ordered agreement watering down the 2011 law, which was deemed by many the as toughest in the nation and had been struck down by multiple courts.

Under the new ID scheme, voters who don’t have one of the acceptable photo IDs can still vote if they show some other form of identification — like a utility bill or a bank statement — with their name and address. They also have to sign an affidavit confirming that they faced a “reasonable impediment” to acquiring the photo ID.

Texas Democrats are not happy with the stiff penalty, that included the possibility of jail time, imposed if it’s found someone lied in signing the affidavit. Meanwhile, the governor’s office also filed court documents Thursday night in the ongoing litigation around the 2011 law arguing that the new tweaks mean courts should no longer consider putting Texas under the process under the Voting Rights Act known as pre-clearance, which would require the state to get federal approval for any changes to its election policies.

Nonetheless, the passage of the law weakening the ID requirements represents a win for voting rights advocates, as Texas at least for now backs down from its efforts to implement the restrictive law.

After the GOP-led Texas legislature passed the law in 2011, it was blocked twice by the pre-clearance process. However, a 2013 Supreme Court decision gutted the VRA formula that had put Texas and other states under the pre-clearance process, a ruling that allowed Texas to implement the law. But over the course a years-long legal battle, multiple courts, including the very conservative 5th U.S. Circuit Court of Appeals, said the law had the effect of discriminating against minority voters.

A district court has twice said the law was passed with the intent of discrimination, which puts Texas at risk of being placed back under pre-clearance under a separate VRA provision that remains fully intact.

Abbott on Thursday also signed a law banning straight-party voting, which Texas Democrats opposed.

It’s become the knee-jerk reaction for Republicans, in light of an ugly Congressional Budget Office analysis of their Obamacare repeal bill, to point the finger at the non-partisan research agency instead.

Office of Management and Budget Director Mick Mulvaney took it a step further this week, by questioning the abilities of Holly Harvey, the head of its health analysis division, to be non-partisan.

“At some point, you’ve got to ask yourself, has the day of the CBO come and gone?” Mulvaney told the Washington Examiner Wednesday. “How much power do we give to the CBO under the 1974 Budget Act? We’re hearing now that the person in charge of the Affordable Health Care Act methodology is an alum of the Hillarycare program in the 1990s who was brought in by Democrats to score the ACA.”

Prior to coming on to the CBO in 2009, Harvey served in the Clinton administration’s Health and Human Services Department, according to the Examiner.

The CBO director, Keith Hall, who signed off on the CBO score of the GOP health bill, was the chief economist for the  Council of Economic Advisers in the George W. Bush White House and was handpicked by then House Budget Committee Chair Tom Price (who is now Trump’s HHS secretary) to lead the CBO.

Mulvaney, in the Examiner interview, said that the CBO’s assumptions about Medicaid cuts were “just absurd,” while suggesting a bias in favor of Affordable Care Act’s individual mandate, which the GOP bill would eliminate.

“If the same person is doing the score of undoing Obamacare who did the scoring of Obamacare in the first place, my guess is that there is probably some sort of bias in favor of a government mandate,” he said.

The CBO has found that that the Republican health bill, the American Health Care Act, would lead to 23 million people losing coverage, cut $664 billion in taxes (mostly for high-earners and the industry), while saving the government $119 billion. It also found the legislation would lower premiums considerably in some places, but with the trade-off of making health coverage more expensive for older consumers and those with pre-existing conditions.

They knew this fight was coming. And now the women’s health advocates and civil rights groups that have vowed to go to court to defend Obamacare’s contraceptive mandate have a better idea of what that fight will look like, thanks to a leaked draft proposal carving an exemption so broad you could drive a truck through it.

“Their intent is to try resolve the litigation,” Mara Gandal-Powers, senior counsel at the National Women’s Law Center, said of the leaked Trump administration language. “But, if they’re sick of litigation, that’s too bad. We are going to be continuing it.”

Hers and other groups, including the ACLU and the Center for Reproductive Rights, are gearing up for a legal battle over President Trump’s moves to weaken requirements under the Affordable Care Act that birth control be covered by insurers. The mandate has for years been the target of lawsuits from conservative and religious groups, but with Trump’s election and appointment of various officials skeptical of birth control coverage, the ground has shifted and the organizations that once stood with President Obama’s federal government in defense of the mandate will be spearheading the legal battles against Trump’s executive branch.

It took less than a few hours after the leaked draft exemption was published by Vox for warning shots to be fired promising lawsuits if the Trump administration goes forward with the carveout described in the leaked regulatory proposal.

“If this draft became the final rule, we would be suing,” Gandal-Powers told TPM Wednesday. “We think we have strong claims based on what is in here.”

Gandal-Powers would not go into detail about those potential claims—and whether they would focus on the substance of the rule or the fast-track process the Trump administration intends to use to implement it.

“We are considering all of our options,” she said

Other legal experts have said the aggressive approach the Trump administration is taking to hobble Obamacare’s birth control mandate makes their efforts more vulnerable to legal challenge, not less.

“It strikes me as quite likely that they are going to simply exchange one body of lawsuits for another body of lawsuits,” Timothy Jost, a health law specialist at Washington and Lee, told TPM Wednesday.

The draft rule allows employers of all shapes and sizes, as well as universities, insurers and even individuals, to refrain from offering or participating in coverage of birth control, on both religious and moral grounds.

“[T]his is about as sweeping an exemption as they could have written,” said Adam Sonfield, senior policy manager at the Guttmacher Institute, which studies reproductive rights issues, in an email.

The Obama-era accommodation for religious objectors that triggered a process by which employees could still get coverage would be available, but not required, under the draft proposal. Employers taking the exemption would merely need to communicate in their health plans that such services aren’t covered and notify employees of any change in benefits.

President Obama’s Health and Human Services Department had argued during countless lawsuits and years of litigation that the government has a compelling interest in seeing to it that women received contraceptive coverage.  Yet the draft preamble to the new rule says, quite bluntly, that the Trump administration has concluded that such a compelling interest does not exist.

“What the Trump administration concluded was that the only way can get rid of this monkey on our backs is to conclude that there is no compelling justification, and so they go to great lengths to explain why there’s no compelling justification for requiring employers and universities to cover [birth control for] their employees or students,” Jost said

The draft document argues that there are many other ways women can access birth control outside of employer health insurance plans. It questions whether contraceptive access decreases the rate of unintended pregnancies, while arguing the mandate could lead to a “negative effect of changing sexual behavior” by providing birth control to teenage women.

The basis of the lawsuit is going to be that there is a compelling interest that is protected by the contraceptive rule,” Jost predicted.

Other sections of the Affordable Care Act may be invoked in a potential lawsuit challenging the proposed exemption, such as a provision outlawing HHS regulations that block “timely” access to health care therapies and one that bars gender discrimination in health programs administered by the executive branch.

Even before the leak of the draft of the rule, experts in administrative and health care law were speculating that rushing through the process was putting the rule change at risk in court.

The Trump administration has signaled it would be skipping the typical notice and comment period—which can take many months or even years—to rewrite the Obama-era rules, and instead push the regulatory change through what is known as an interim final rule. An interim final rule, once approved, will be go into effect once it is published and does not have to go through the process of public comments and agency response (though there will be a comment period after it’s implemented).

To invoke the process, the administration must claim it has “good cause” to use it, according to Nicholas Bagley, a University of Michigan law professor.

“When you invoke a good cause exemption, you have to offer an explanation for why that invocation is appropriate and your justification for skipping notice and comment can be challenged in court,” Bagley said.

Since the publishing of the draft, Bagley has expressed skepticism towards the administration’s good cause rationale in the leaked draft, which claims that going through the typical public comments process would “further extend the uncertainty caused by years of litigation and regulatory changes.”

It’s worth noting that the leaked document is a draft and not necessarily a final version. On numerous occasions under President Trump, draft proposals have leaked to public outcry, only to be significantly watered down once the official document is rolled out. And as part of the official process, the Office of Budget and Management is currently reviewing the proposal.

“They could decide it’s too risky to skip notice and comment” or suggest changes to the substance, Bagley said.

The Obama administration faced dozens of lawsuits, two of which reaching the Supreme Court, over their efforts to shore up the contraceptive mandate while accommodating religious objections. The first Supreme Court case, Burwell v. Hobby Lobby, resulted in a 5-4 court ruling that closely held, for-profit corporations must be eligible for an accommodation the HHS had offered religious non-profits. The second Supreme Court lawsuit, Burwell v. Zubik, targeted that very accommodation, which triggers the process by which a third party covers the services. The Supreme Court, at that point lacking a deciding 9th vote, punted by asking the government and the parties to come up with a compromise.


A draft of a proposed rule change to the Affordable Care Act’s contraceptive mandate leaked to Vox suggests that the Trump administration is planning a major carve-out to the mandate, which has been subject of intense legal volleying and political debate.

The draft rule, dated May 23 and posted by Vox on Wednesday morning, would allow any employer—from small mom-and-pop shops to publicly-traded corporations—to opt out of the mandate on religious or moral grounds. It would also let insurers refrain from covering contraceptives for religious or moral reasons. The draft rule would allow individuals with religious or moral objections to refrain from participating in plans covering contraceptives.

The leak comes after the Trump administration signaled it would scale back the mandate via an interim final rule, a fast-tracked process that would allow the regulation to go into effect immediately after it’s finalized. Earlier this month, President Donald Trump signed a vague executive order on religious freedom, and a notice that a proposed rule had been sent to the Office of Management and Budget, which must approve it, was posted last week.

The draft rule published by Vox says that the goal of the departments behind the proposed regulation—the Department of Health and Human Services, the Treasury and the Department of Labor—”is to provide rules so that the healthcare system can be inclusive or people who have different conscientious views on certain sensitive matters.”

“Expanding the exemption removes religious and moral obstacles that entities and certain individuals may face who otherwise wish to participate in the healthcare market,” the draft rule goes on to say.

It requires religious objectors to communicate in their plan documents that contraceptive services would not be covered, and also to inform their employees of any change in benefits, according to Vox.

An accommodation process created by the Obama administration that triggered coverage of contraceptive services by a third party administrator would still be available to, but not required of, employers opting out of the mandate under Trump’s draft rule. Thus, it is possible and perhaps likely that women working for objecting employers would lose their birth control coverage.

The White House and the departments involved with the draft rule did not respond to Vox’s requests for comment.


Senate Republicans are considering overhauling a long-standing tradition for processing judicial nominees to thwart potential Democratic obstruction of President Trump’s picks to fill the federal bench. Ironically, it’s a custom GOP lawmakers themselves took advantage of to block numerous judicial nominees under President Obama, creating the glut of vacancies on the bench they now seek to help Trump fill.

The custom is known as the home-state “blue slip,” and it has allowed senators to block judicial nominees hailing from their own states. The “blue slip” refers to the physical blue slips the two senators representing the state from where a judge is being nominated must turn in for the nomination to advance to a committee hearing. In theory, the custom is supposed to encourage the White House to get input from the Senate in choosing federal judges. However, under Obama, GOP senators withheld blue slips to block nominees — even ones they previously backed — as a way of foiling his agenda and leaving the vacancies open for a future Republican president.

The “blue slip” tradition is now in the cross fire of conservative groups, and key GOP senators are expressing openness to changing the way the blue slips are considered, according to reports in the Washington Post, The Hill and Politico.

Republicans fear that Senate Democrats will now give them a taste of their own medicine, amidst reports that Democrats like Sen. Al Franken (D-MN) and Sen. Bob Casey (D-PA) were considering withholding blue slips from appeals court nominees from their respective states.

“If that happens, you might see a shift in the blue slip tradition,” Sen. Tom Cotton (R-AR) said earlier this month.

“We can’t allow Democratic senators to continue to obstruct this president’s agenda. If they’re just arbitrarily not returning blue slips, we have to consider changing that tradition,” Cotton went on to say.

GOP senators are being cheered on by conservative legal groups like the Federalist Society– whose former leader Leonard Leo is consulting with the Trump administration on judges — and by media figures on the right like radio host Hugh Hewitt, on whose show Cotton made his comments.

Republican senators are particularly focused on changing the blue slip rules around appeals court judges, while perhaps preserving the custom for district court nominees, according to the Washington Post.

“Everybody agrees that blue slips on federal district judges are appropriate where the districts are contained within a state, and that’s been the tradition,” said Sen. John Cornyn (R-Tex.), the Senate majority whip who also serves on the Judiciary Committee. “My sense is that we’re going to establish a pattern where a blue slip at the circuit-court level is an expression of advice but is not determinative as to whether that judge will be confirmed or not.”

Because blue slips are a courtesy and not a hard and fast rule, the lack of a blue slip for a nominee could simply be ignored by Republican leaders.

Democrats are, not surprisingly, pushing back against a potential change. In a memo this week, Sen. Dianne Feinstein (D-CA), the top Democrat on the Judiciary Committee, called the elimination of blue slips “a move to end cooperation between the executive and legislative branch on judicial nominees, allowing nominees to be hand-picked by right-wing groups,” according to the Post.

Senate Judiciary Chair Chuck Grassley (R-IA) has previously vowed not to change the rules, and his spokesperson told the Post that he “fully expects senators to continue to abide by that tradition.”

But in a recent C-SPAN interview he signaled openness to changes geared specifically to appeals court nominees.

“It’s much more a White House decision on Circuit judges than the District Court judges,” Grassley said, according to Politico. “I mean this is going to be an individual case-by-case decision, but it leads me to say that there’s going to have to be a less strict use or obligation to the blue slip policy for circuit, because that’s the way it’s been.”

Trump’s role in shaping the federal judiciary was a key rallying point for conservatives wary of his unorthodox candidacy during the 2016 presidential race. His appointment of Neil Gorsuch to the Supreme Court seat vacated by the late Justice Antonin Scalia — an appointment he was only able to make thanks to unprecedented Senate GOP obstruction of Obama’s own nominee, Merrick Garland — was considered a major win for the conservative legal movement. Now he has more than 120 lower court vacancies to fill, vacancies still open in part because of Republicans’ withholding of blue slips of Obama nominees.


Alice Ollstein contributed reporting.

House Republicans promised that their hastily passed Obamacare repeal legislation wouldn’t weaken pre-existing conditions protections — even as it let states permit insurers to charge sick people more and whittle down benefits — but the Congressional Budget Office reported Wednesday that under the GOP plan sick people would face substantially higher premiums and in some cases be priced entirely out of the market.

Faced with the new independent analysis, some Republicans admitted that they’d like to see some tweaks to their ideas as the Obamacare repeal effort proceeds in the Senate. But many dug on in on waiver provision that passed the House and claimed the CBO was not getting the full picture.

“There’s about four different layers that exist to cover pre-existing conditions, beyond which one isn’t even spoken about, which is one of the most important, and that’s just the personal responsibility we have in our lives that’s not even mentioned in there,” Rep. Brian Mast (R-FL) told reporters.

Rep. Peter King (R-NY) took issue with the CBO’s estimate for how many people will live in states taking the waivers under the GOP plan.

“I don’t know how CBO would know that,” King said. “This is going to be a political decision made in the states, I don’t know how the CBO becomes a political expert.”

Not everyone was dismissive of the CBO’s findings, and pointed out that the Senate is working on its own repeal bill that, if passed, will have to be reconciled with the House version.

“Obviously, the Senate is going to work on whatever waiver might or might not be proposed and you’re going to come back to conference,” Rep. Mark Sanford (R-SC) said. “I think there’s gong to be a couple more bites at the apple in terms of further refining the bill based on that CBO report.”

Less than a month ago, top Republicans were promising that their bill, the American Health Care Act, was not a violation of of their vows to protect people with pre-existing conditions. Majority Whip Steve Scalise (R-LA) swore that “everyone” with a pre-existing conditions would keep their coverage. House Speaker Paul Ryan (R-WI) touted “VERIFIED” talking points claiming people with pre-existing conditions were “protected.”

The provision that set off alarm bells among patient advocates was an amendment spearheaded by New Jersey moderate Rep. Tom MacArthur (R) that offered waivers to states to opt out of some of the Affordable Care Act’s insurer mandates, including its rule barring insurers from charging people more for premiums based on their health status.

The CBO said in the report released Wednesday that about half of Americans live in states that would not take waivers and one-third live in states that would seek only “moderate” changes to Obamacare’s insurer mandates, specifically its provision requiring insurers to offer 10 broad coverage areas. But one-in-six Americans would live in states that took a more aggressive approach to the waivers and would seek to allow insurers to charge more based on one’s health status. There, the CBO predicted variations in premiums so wide that it did not provide an average estimate for them, while warning of increased instability in the individual market.

“Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly,” the CBO said.

Furthermore, the CBO said that the $8 billion in funding for states that was added after the MacArthur amendment, to appease spooked moderates, “would not be sufficient to substantially reduce the large increases in premiums for high-cost enrollees.”

In reaction to the CBO score, MacArthur employed the well-honed technique of brushing off the expertise of the non-partisan research agency, telling TPM he “fundamentally” disagreed with the “biased” report.

“They won’t opine on how much premiums will come down if a state takes both waivers” MacArthur said, noting that CBO gave premium reduction estimates for states that took no waivers and for states that sought a partial waiver on Essential Health Benefits.

“Suddenly, they can’t come up with an estimate if a state takes two waivers? They just acknowledge that it will go down way more. That to me is disingenuous. There is a number,” he said.

House Freedom Caucus Chair Mark Meadows (R-NC), who worked on the amendment with MacArthur, was reportedly caught off guard Wednesday night when reporters pointed him to the CBO report’s section on pre-existing conditions.

By Thursday he was more defensive, telling reporters that he found it “disappointing” that it was “long on rhetoric but short on support for where that rhetoric came from.”

He said that he intended on having a follow-up meeting with the CBO.

“I’m not saying it’s incorrect, but I don’t have enough information to say whether it’s correct or not,” Meadows added.

Senate Republicans will begin working on a draft of health care language over next week’s Memorial Day recess as the next step in their effort to dismantle the Affordable Care Act. It’s unclear what sort of proposals will be drafted, who exactly will be working on the text, and how the legislation will differ from the House GOP’s Obamacare repeal bill.

“Over the break, initial legislation will be drafted and…we’ll have actually have a basis to discuss some of these things,” Sen. Ron Johnson (R-WI) told reporters Thursday after a health care working group meeting. “We’ve had some very fulsome discussions, very genuine input, and that input is now going to be collated by committee staff and leadership staff and they will produce a product — we’ll have a draft bill — that we can have further input on.”

Sen. John Cornyn (R-TX), the majority whip, confirmed that some “base language” was going to be worked up for GOP senators to look at when they return from recess.

Cornyn and other Republicans coming out of Tuesday’s working group expressed optimism that GOP senators were getting closer to bridging gaps among the conference in order to get the 50 votes necessary to pass a repeal bill.

“There is no final agreement yet, this is a process,” Cornyn said.

The next step in the negotiations was to get some proposals in writing to be passed around internally, Republicans said.

“A number of individuals are putting various ideas to paper,” Sen Ted Cruz (R-TX) said.

But Sen. Mike Rounds (R-SD) cautioned that even with some text being drafted, Senate Republicans still had a lot of work to do.

“What we have been advised is that at some stage of the game, you’ve got to have people start to begin the boiler plate that makes up a bill, but it’s a long ways from having all the concepts incorporated,” Rounds said.


In the weeks since the unwieldy and politically unpopular task of dismantling the Affordable Care Act fell to the GOP Senate, Republican senators have been able to punt on some of the tough decisions in writing their repeal legislation until after they saw what the CBO said about the House Obamacare repeal bill.

That CBO report has now landed, and it doesn’t make GOP senators’ lives any easier. Wednesday’s report reinforced the many problems and ugly trade-offs in the House bill that Senate Republicans have been struggling with for months. It also dropped in their laps a new problem that was a result of an amendment added to the House bill that was scored for the first time in Wednesday’s CBO report: What to do about people with pre-existing conditions, whose protections under the ACA are significantly rolled back in a provision that allow states to opt out of Obamacare’s insurer mandates?

Here are five points on how the CBO score puts the big squeeze on Senate Republicans:

The waivers make pre-existing conditions protections very messy, if not impossible.

The big question for the CBO was the impact of a major, last-minute addition of a waiver provision to the House bill, which stands to violate GOP promises to protect those with pre-existing conditions.

The CBO found that one-sixth of Americans would live in states that would seek waivers so aggressive that it would create a wide variation in premiums for which the CBO did not even provide an estimate average. In those places, the individual market would grow increasingly unstable over time, as healthy people flocked to less generous plans that were allowed to medically underwrite based on health status. People with pre-existing conditions would in turn see premiums rise until some were priced out of coverage entirely. The extra $8 billion funding added to the House bill to subsidize them would not be “sufficient to substantially reduce” their “large increases” in premiums, the CBO said.

Senate Republicans have been generally open to a waiver idea, but many have insisted they want people with pre-existing conditions protected. So cleaning up that mess will be a top priority.

There’s no escaping 23 million people losing coverage.

The CBO’s top line coverage number was bad the first time the AHCA was scored and it hasn’t budged much since. Twenty-three million fewer Americans will have insurance by 2026 under the House-approved bill, which is hardly better than the 24 million in coverage losses predicted under the initial version. That downward tick in coverage losses comes in part, the CBO said, because the individual marketplace will be less attractive and more employers will thus continue to offer coverage than was projected in the March version of the legislation.

The first time around some Republicans cast doubt on the CBO’s predictive abilities and that strategy is already in play now. Nevertheless, some GOP senators have recognized those coverages numbers are far from ideal and floated more robust tax credits or a softer cushion to the Medicaid cuts as a way to improve them. The problem there, however, is that those tweaks will likely require more funding, and the Senate’s bill will still have to reduce the deficit by $119 billion over 10 years.

Medicaid remains the elephant in the room.

One of the biggest challenges in the Senate is an aspect of the House bill that hasn’t changed since the March CBO score: its massive cuts to Medicaid, which is at the heart of the legislation.

Of the 23 million fewer covered Americans under the GOP House plan, 14 million lose coverage due to the House bill’s phaseout of the Medicaid expansion and its overhaul of the larger program from an unlimited match rate to a capped system that limits funding on a per enrollee basis.

This gutting of Medicaid saves the government $834 billion, which in turn finances the $664 billion in tax cuts to industry and high earners under the House bill. But the Medicaid cuts also pits expansion state senators against non-expansion state senators. And the formula used to cap the traditional program hits different states in different ways, also complicating the bill’s path to 51 votes for Senate passage.

Older people and poor people lose out under the GOP’s tax credits.

Wednesday’s CBO report reinforced a point made in its analysis of the original version. AHCA’s tax credit scheme severely shortchanges lower income consumers and older people, the latter a key GOP constituency. That constituency is hit a second time by a provision in the bill that allows insurers to charge older consumers more than young people, when compared to the ratio allowed under current law.

A 64-year-old at 175 percent of the poverty level who lives in a non-waiver state will pay eight times more in net premiums than under the current law.

Senate Republicans, led by the conference’s No. 3 Sen. John Thune (R-SD) have promised that they will rework the tax credits so the burden on older and lower-income people is less pronounced. But doing so may require shifting some of the tax benefit away from young and healthy people, who Republicans want to incentivize into buying insurance to make the risk pool less expensive.

Premiums in some places drop, but the costs are picked up elsewhere.

There was one number in the CBO report Republicans are likely to tout. The CBO predicted that about one-in-three Americans will live in states that seek waivers for “moderate” changes to the ACA’s insurer rules that would bring average premiums down by 20 percent by 2026 while maintaining relatively stable marketplace.

But those tweaks come with their downsides.

“Although premiums would decline, on average, in states that chose to narrow the scope of EHBs, some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care,” the CBO said, referring to the ACA’s 10 Essential Health Benefits, that states would be able to opt out of or rewrite under the GOP plan.

For years, Republicans have bashed Obamacare for how deductibles have increased under its implementation. Senators will now be contemplating a plan that will even further raise out-of-pocket costs.

Just in time to serve as a prebuttal to a much-anticipated CBO House GOP Obamacare repeal bill score, the U.S. Health and Human Services Department released a study showing, in the words of its spokesperson, that under the Affordable Care Act, “the status quo is unsustainable”

The study, conducted by the Office of the Assistant Secretary for Planning and Evaluation, found that average premiums in the 2017 HealthCare.gov exchanges used by 39 states were about double the average premiums in the entire, pre-ACA 2013 individual market.

Not surprisingly, the study made its way onto the Twitter feeds and into the floors speeches of the GOP lawmakers currently seeking to dismantle the Affordable Care Act.

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