Friday, March 3, 2017

Deep in the land of never happen

"I hate the fact I am even saying this - I really do. With this issue, silence is not golden - it is telling. The Speaker has looked at his hand and can't even find a pair of sixes."

First, let me get something straight. Nobody, and I mean nobody, hates ObamaCare more than I. It was a huge mistake from the start. It was mishandled, pushed through Congress in a ram-rod fashion (in the middle of the night), and built on a set of assumptions more goofy than la-la land. It never stood a prayer of making it in its present form. Now here it sits - festering. And all of a sudden, this red headed stepchild belongs to the GOP.

I also know that in the 2010 midterms, the 2012 election, the 2014 midterms, and the 2016 election, there were legions of Republicans who won their races by promising to "pull this monster up by the roots, kill it, and replace it with something better". Now the GOP has control over just about everything, and does not know what to do with Rosemary's Baby. Our new President is smart enough to resist killing ObamaCare until the newer, better plan is ready to slide in at the same time. And that is the rub.

Here is the bottom line, as painful as it may seem. I have addressed this before. My belief is 2014 was our last best chance to kill and replace this terrible program. Even then it would have been next to impossible. When Mitt blew the election (and he did indeed blow it), he also blew our chances to remedy this issue. In other words, the roots have become so deep in 2017, the expenses are so vast, the better mousetrap might not be in the offing. We might be stuck with only one option - fixing this piece of crap.

I hate the fact I am even saying this - I really do. With this issue, silence is not golden - it is telling. The Speaker has looked at his hand and can't even find a pair of sixes. To come up with a new plan which is more cost effective than ObamaCare, bullet proof from the expected sniping from the Left, and ready to plug and play for everyone - might just be a bridge too far. In other words, the "repeal and replace" story might be living in the land of never happen. 

I might be wrong on this. I really hope I am. Maybe Secretary Price can pull a rabbit out of his hat. If anyone can do it, that would be Dr. Price. In any event, something has got to happen with this issue, and soon. Real people (who are not getting this as a freebie or subsidized) are getting toasted with the ever escalating costs of premiums. And by the way - this for those who are chanting "Medicare for all!" You have no clue what you are talking about. If we did give everyone Medicare this year, we would bankrupt that fund in less than a New York minute.

Sorry to be such a rain cloud. Nobody will be happier than I if this article is completely off base. But I believe it contains some truth.  

1 comment:

  1. You (and Congress) are overlooking the very simple. Three steps.
    1. You repeal Obamacare in toto but add two things to the repeal:
    a. "If you like your Obamacare plan, you can keep your Obamacare plan." So long as premiums are paid, the exchanges will stay open until the number served falls below 1 million people, or November 2019, whichever comes first. This obviously kills the "20 million people losing their insurance" argument.
    b. You set the effective date for the repeal as of November 2017, the start of the next Obamacare enrollment period. This means that the repeal can pass by reconciliation in the Senate because there is ZERO budgetary impact for this fiscal year.
    2. When President Trump signs the bill, he announces that he will begin enforcing the law as written. That is:
    a. Congress loses Obama's Executive Order declaring them exempt from the law requiring them to purchase Obamacare for them and their staff, rather than the deluxe plan they now enjoy, effective immediately, but with a waiver good until just before the next Obamacare enrollment period in November. As before, this will panic Democrats into accepting some alternative that allows them to keep their plan (that they like) and that their staff can actually afford.
    b. Subsidies paid through the federal exchange by Obama's unlawful Executive Order will be terminated in November 2019. Subsidies through the state exchanges will, according to law, continue to be paid so long as those exchanges are serving a significant number of people. That deadline allows plenty of time for the Republican alternative to become fully operational and available to those who cannot afford "Affordable Care."
    3. Republicans can then roll out an alternative plan that is not only better than Obamacare but as good as they can make it, because it is not a "replace" as much as it is an alternative and a choice. Some of the critical provisions should be:
    a. Permit Insurance Sales across State Lines. This is constitutional whereas Obamacare was not.
    b. PERMIT insurance companies to offer insurance for children under 26 to stay on their parents' policies, but be allowed to charge for that option.
    c. ALLOW states to establish high risk pools for those with pre-existing conditions, and let them choose the form of that, since there were many good models already existing. Also, you might restore the right of insurance companies to issue insurance with pre-existing condition waivers. That is, we give you a lower price insurance policy but we do not cover, for a certain initial period, any expense resulting from your specified pre-existing condition. Passing the tax exemption to employees would increase portability and decrease the pre-existing condition problem.
    d. Block grant Medicaid to the states, and allow them to establish eligibility and practice as they see fit.
    e. Permit unlimited HSAs or managed-care, or other innovative policies, insisting only that coverage be clearly described. Consider allowing an antitrust exemption for insurance companies to set up a nationwide exchange/marketplace. Some already exist for Medicare supplements.
    f. These things are optional: malpractice reform, transferring the tax deductibility to the employee (making health insurance portable), allowing small businesses or other organizations to cooperate to gain group rates.