From Andy Slavitt, who has been one of my ‘go-to’s’ on Healthcare. He always tells what’s up and breaks it down in simple, explainable language.

Andy Slavitt‏Verified account @ASlavitt

1/ I am leaving 4 intense days in DC & now have a very different theory of what’s going on in HC. Will tweet soon.

Follow if interested.

2/ GOP is now trying to create what I call “synthetic repeal.” Before I explain what that means let me tell you why this is happening.

3/ GOP has 7 years of promises and a lot of fundraising to pay back. Moore’s win in AL punctuates the point that the R base is very unhappy.
4/ GOP needs to compete in primaries & fundraise. Make no mistake that is a 2018 reality weighing on them.
5/Three strategic choices: a- say repeal failed & move on b- promise to try again next yr c- “synthetic repeal” First step is “c”.
6/ Synthetic repeal allows them 2 say: sure, we didn’t repeal the ACA because of RINO holdouts, but before long it will be effectively done.
7/ Synthetic repeal goes after ALL the big cahuanas: huge Medicaid cuts, pre-ex protections & the mandates. WITHOUT REPLACEMENTS.
8/ CBO would score the synthetic repeal an absolute disaster.
9/ The tools for synthetic repeal are: – An Executive Order coming next week – The budget/tax plan – Sabotage of the ACA (not even denied)
10/ The EO allows “association health plans”– ability for plans to be offered with no pre-ex protections & turn ACA into a high risk pool
11/ In states that have done things like this, like TN, premiums have skyrocketed and competitors have left the market.
12/ This Executive Order next week is a massive undermining of state’s, insurance markets & American families.
13/ Anyone will be able to create a plan that usurps state authority. And across state lines. Graham Cassidy “state’s rights”
14/ The tax cut is the other side of the nickel of Medicaid cuts. Rs will need Medicaid 2 deal w $1 trillion+ shortfall 2 balanced budget.
15/ From their standpoint, either vehicle could work.
One Senator said to me tonight: the health care bill was about hidden tax cuts. Now the tax bill is about hidden health care cuts.
16/ In fact, I’ve heard some say tax vehicle will be easier for Rs because opposition won’t recognize it as a health care fight.
17/ Sabotage effort 2 drive up prices w no CSR payment, limit enrollment, deny/ignore state waivers is designed to beat the ACA unworkable.
18/ Someone in a position to know i surer thinking told me Assoc plans & sabotage will leave markets bare in ’19 so ppl have no options.
19/ Many states will have exclusionary plans 4 healthy (like pre-ACA days, big MCD cuts. Budget also allows mandate to be cut, ⬆️ premiums.
20/ Synthetic repeal would butcher ACA beyond recognition. GOP could back 4 a draconian full repeal w yes votes coming out of necessity.
21/ The troubling part (yeah, there’s a troubling part) is it can be done with much less public recognition of it all. Cc: boiling frog.
22/ This is Synthetic Repeal as I see it. No one is calling it that but that’s the plan as I see it. (Couple more tweets promise that’s it)
23/ SR is the most underhanded perversion of the law I can think of w little thought 4 the impact on ppl. But it doesn’t mean it will work.
24/ So response to SR? Working on it now. I won’t be alone. Right now let’s #GetUSCovered. One win at a time. End