Obamacare repeal and replace begins – Read the GOP’s new health care plan
Explore the Republican plan to repeal and replace Obamacare and deliver on President Trump’s proposed health care reforms.
I haven’t had time to read the bill yet, but the link above summarizes some high points. I liked this particular feature:
During the transition, Americans will continue to have access to their existing health care options.
We even take steps to immediately provide more flexibility and choice for the people who purchase insurance through the individual marketplace. For example, individuals and families will be able to use their existing subsidy to purchase insurance—including the catastrophic coverage that’s currently prohibited—off of the exchanges. (emphasis added)
This very simple feature is an attack on the exchange system. At the present time, if you have a tax credit, or intend to claim one on your tax return, you must purchase the plan from the exchange. No longer (once the bill is passed). Also, Catastrophic plans, available to those under the age of 30 are not currently eligible for a tax credit
Both hands clapping.
Perhaps you’re not of this persuasion, but thought you might want to consider this perspective:
https://www.conservativereview.com/commentary/2017/03/rino-care-a-more-insolvent-version-of-obamacare-except-this-time-gop-owns-it
Mark, I haven’t been able to keep up with developments as much as I would have liked in the last few days.
First, there is an error in the above post, in that if you want the tax credit advanced, you still must go through the exchanges. However, if you simply want to claim it on your taxes, you can purchase either from the exchange or directly from the insurance companies.
Addressing the article you linked to, after only skimming it, I think there is a great danger that the GOP ends up owning a very bad health plan. On the other hand, it appears the main goal is to repeal (a squishy definition) Obamacare through reconciliation, which means they can only address mostly the financial aspects. Then they will come behind that with additional legislative changes that will require 60 votes. I’m skeptical that this strategy will work. The political atmosphere is so polarized that it may be impossible to get 60 votes, not to mention Republican infighting.
Other options I guess are simply letting it fail, which it will, or changing Senate rules.
My own philosophy is to get insurance out of day to day non-trivial stuff. Does you car insurance come with oil changes and tune ups? There are a myriad of ways to get lower medical costs if you’re incentivized to search for them and the system knows it needs to provide them. Getting insurance companies involved in day to day stuff simply drives up the cost of care. In fact, whenever there’s a sugar daddy with a perceived “bag of money”paying the bills, I believe the cost of the care or service gets driven up.
Changing the subject just slightly, there was a very interesting article in the WSJ a week or two ago that addresses the “race to the bottom” for ACA plans. If one particular plan or series of plans offers the best drug for a chronic conditions (MS was the example), then it attracts all the MS patients. That doesn’t happen in the group market, NOT because the drug isn’t offered, but because the company is selecting the plans. Thus MS patients (or pick your expensive to treat chronic illness) get spread out across insurance companies. I can’t find the link at the moment, I’ll add a comment when I find it.
I think catastrophic coverage is the only real medical insurance. That goes along with what you’re saying. The rest just call themselves insurance, but are really redistribution schemes to make medical payments. The better forms of these, I believe, were the HMOs, before they became regulated/standardized by government policy. They were a mutual agreement between participants and doctors and hospitals/doctor’s offices to give preferential network treatment (you could call it a cartel). It wasn’t insurance, but a mutual medical payments system, and it was still market-based.
What the article I cited is talking about is the AHCA reconfigures the system, but does not fundamentally end it. Sec. of DHHS Tom Price talked about changing Obamacare in phases. The first phase, as you said, is reconciliation, and all that’s needed is 51 votes in the Senate. The 2nd phase, he said, was going to be dealing with the thousands of pages of regulations, and stripping that down to “what’s needed,” and phase 3 was going to be opening up competition across state lines “so long as insurance complies with state standards.” The thing is, what he described for phase 3 is what we have right now. Perhaps insurers have to be certified to enter state markets, but basically the reason we have monopolies in state markets is because the states configure their medical insurance regulations to favor certain providers, and exclude others. I don’t see how this proposed standard changes that dynamic that much. If you want more competition, you need to get rid of most of the state restrictions, and the federal government has the constitutional power to do that, but it’s not using it in this case.
Another problem the article cites is what the GOP is doing is not going to get rid of the adverse selection death spiral in private insurance that’s been going on with the ACA, because they still require insurers to cover pre-existing conditions, which means you can wait until you get sick to get coverage for your illness. That’s not a matter of reconciliation vs. 60 votes. That’s been the Republicans’ game plan for revision of the ACA since 2010, since that’s one of its provisions that’s popular with a lot of voters, including Republicans. It’s the Tea Party that’s opposed that, but they have not been given a seat at the table, and they just got routed in the 2016 primaries.
Price said that full repeal is not possible, because “the governors would not allow that to happen.” He said something about how they need support for their poor populations, which sounds like Medicaid expansion to me. The thing is, when the Establishment wants something, it gets right on it, and fights for it, and fiercely opposes anything they think is unacceptable. You can see that in how Ryan says, “This is the only option for repeal.” This mealy “well, it’s the best we can get” is not what they’re really thinking. This is what they want. “Repeal and replace” was a mirage to get votes.