Thread by @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" 😂😂😂😂😂😂

(Apologies for the length-- 5 or 6 more)

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.👇

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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.

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