The Sure Fire Failure Republican Health Plan

One would think that last week’s passage of the Republican version of the American Healthcare Act, the bill to “repeal and replace” Obamacare, would be met with jubilation on the right.  Instead it’s been met with a mostly “meh” attitude.  Unlike Obamacare, which Democratic activists enthusiastically defended every step of the way, Republican activists aren’t happy with this bill. When the bill is taken up in the Senate, they are likely to be even less happy. Probably the only positive feature that Republicans will agree on is that it’s likely to be better than Obamacare.

Some of the features of the Republican bill include:

  • Ends the mandates and tax penalties of Obamacare.
  • Changes the subsidy system to a system of tax credits
  • Allows states to get waivers to the old Obamacare coverage requirements
  • Blocks Planned Parenthood payments for one (?) year.
  • Stops and begins the rollback of the Medicaid expansion.
  • Changes Medicaid from an entitlement to a block grant.

If, through some miracle, this bill were to sail through the senate unscathed, and become law as currently written, it would destroy healthcare in this country and do to Republicans what Obamacare did to Democrats; Reduce their numbers to a shrill minority in the House and Senate and forfeit the Presidency to the Democrats for the foreseeable future.

Why am I so glum about the results of the bill?  Changing the subsidy to a tax credit is a positive step, one that Republicans have supported for years, but the range of tax credits, $2,000 to $4,000, and the method of doling them out, is a disaster.  First, the tax credit amounts are ridiculously low.  John McCain’s 2008 health reform plan was better than that, and I thought that was a bit low at the time; $5000 for families and $2,500 for individuals. Also, the amounts are more based on age rather than income. There may be a rationale for that, but the Republicans in the House have not attempted to explain why basing tax credits on age will be more helpful to people than basing them on income. The average family employer insurance plan cost for 2015 was $ 17,322.00. To buy an equivalent plan on the individual insurance market, the tax credit should be anywhere from a third to half of that (to provide somewhat equal equivalence to the employee cost that employer plans have); way more than the Republican bill is offering.

The other issue is Medicaid.  Changing Medicaid from an entitlement to a block grant is probably the single most important long term feature of this bill, and one that does the longest term good. However, depending on where you get your estimates, more than 84% of the increase in health insurance coverage is due to Obamacare’s increase in Medicaid expansion coverage.  That’s coverage that, to the recipient, is free, with no premiums or co-pays.  Almost 12 million people will lose the Medicaid Expansion coverage over time. To offer them a replacement of a $2, 000 tax credit (with no mandate to force coverage) will leave a result that almost all of those people will lose coverage and not get a replacement plan.

However in terms of media coverage, the GOP elephant in the room has been pre-existing conditions.  The way the House bill handles pre-existing conditions is described in Time this way:

“The American Health Care Act stipulates that states can allow insurers to charge people with pre-existing conditions more for health insurance (which is banned under the ACA) if the states meet certain conditions, such as setting up high-risk insurance pools. Insurers still cannot deny people coverage outright, as was a common practice before the ACA’s passage, but they can hike up premiums to an unaffordable amount, effectively pricing people out of the market.”

So if you have a pre-existing condition, your health care costs are likely to go up, even though you’ll still be able to purchase insurance.  We are currently in an Obamacare death spiral; a death spiral which probably represents a good portion of the Obamacare exchange market. Next year it will be worse. So in this way at least, things are likely to continue under the House bill the same way they are currently under Obamacare-higher prices and fewer choices.

Of course there is an answer to the Pre-existing conditions conundrum, one I touched on back in 2012 during the Obamacare discussions. But I think that’s probably an entire post on its own, so stay tuned…

So to summarize, the House bill is an unworkable mess as currently written and is less a repeal and replace than an optional opt out of Obamacare, while taking away the features of Obamacare.  So Congress is keeping the Obamacare rules and regulations, but taking away the features that made them workable. States can opt out of those requirements, but Medicaid Expansion is going away anyway.  If you have a pre-existing condition, you may be no worse off, but certainly no better, than if we do nothing and let Obamacare death spiral into the ground.

Some reform.

Ultimately, none of this will probably matter. The Senate is likely to so alter the bill that it will be unrecognizable.  But the struggle and fight over the House bill is a precursor to the fight in the Senate.

Ryan Care taught me one thing…

The collapse of Ryan Care was probably the first big failure of the young Trump administration (not counting the tweets-4D chess and all that). And to that, as on many things, I’m of two minds.  For all of its flaws, being able to block grant Medicaid funds to the states and capping its growth would be a major victory; a major reform of a major entitlement program.  Just that would have been a major administration accomplishment.

On the other hand…the bill was seriously flawed in virtually every other way and didn’t meet the President’s goal of providing coverage for everyone.  And even worse than the flaws of the bill, it revealed how amateurish the Republican House was.  It was like they had not even considered the idea of writing a health care bill until a few weeks ago.  And when they did, they repeated every bad Democratic mistake in doing it by keeping the bill writing secret to exclude… not Democrats but the real enemy; other Republicans.  And in fact, it was Republicans that ultimately killed their own reform plan.  Democrats just had to sit by and eat popcorn.

This of course, is yet another example of why the GOP has the amply deserved moniker of the stupid party.  Democrats usually have a handy bill just sitting on the hard drive of Democratic Congressional servers just waiting for a crisis.  You know, so they cannot waste it.  School shooting?  Just hit print and run out to the House floor waving a fully written Gun Control bill, “for the children.”

With Republicans, after passing multiple repeal bills during the Obama years, including having a full replacement bill in committee in 2013, the Options Act, suddenly became the proverbial deer in the headlights; “Wait we won?  That wasn’t supposed to happen!”

So after thinking that the GOP had at least a draft of a consensus plan tucked away waiting for its own opportunity, it soon became obvious that there had probably been not a single meeting or discussion on it until recently.  So after crafting a bill in secret with zero input from any effected groups, it turned out there was no constituency for the bill.  Even the late lamented Options Act had buy in from several conservative think tanks, and Tea Party groups.  No conservative groups even had a peek at it until it was unveiled.

Sorry, but that’s not how you do things.

But…none of that was the “one thing” that Ryan Care taught me.

Have you ever noticed that you never hear the left clamoring for Medicaid for all? Since Medicaid has no premiums, co pays, or deductibles, it’s truly free healthcare (from the consumer point of view). Meanwhile regular Medicare has an 80/20 cost share. Medicaid has lower provider reimbursement rates than Medicare so in theory it should be cheaper. Why shouldn’t the left/liberals/Democrats like Medicaid as the basis of a national healthcare plan over Medicare?

The other day I was on a forum discussing the late, unlamented Ryan plan, and how it weans off Medicaid funds to the states with a different formula over the years. Some left leaning poster complained that means the states would have to raise taxes to make up the difference!  Well duh, but if you’re liberal, shouldn’t that be a feature rather than a bug?  Don’t those guys love taxes, the higher the better?  How could increasing taxes be a flaw in a health care reform plan if you’re liberal?

Epiphany time. Unlike Medicare, which is fully federally funded, states have to pitch in for the cost (not counting the expanded Obamacare version) for Medicaid. Medicare, or any fully federal plan is paid for by deficit spending, so no one is really paying for it (yet) but the states have to tax real money to pay for things like expanding healthcare for people in their own state.  That’s why even the bluest states don’t have their own universal healthcare plans. Vermont tried to do it and spent three years trying to make it work before abandoning it because of taxes.  California is attempting to do it now, and the lessons of its attempt on this regard will be instructive.  I’m not sure any state can afford both a 50 billion dollar bullet train to nowhere and single payer health insurance.

So the lesson?  That’s how you defang the left: Make them pay for it.  A Balanced Budget Amendment would do more to rein in the Democratic Party than any comparative cluster of policy reforms that will be undone by the next Democratic administration.  The basic tools in the Congress and in statehouses across the country are all there to make it happen. Democrats love the rhetoric of raising taxes on the rich but the reality is that the rich are much of their constituency, and it’s not clear how far that constituency is willing to go if every single thing the Democrats want they had to pay for up front.

I’d like to find out.

Predictions for 2017

Given how well I did with my 2016 Predictions I thought I would give it another go and see what I thought would be likely for 2017.

At least 3 terrorist attacks in Western Europe resulting in double digit casualties.  Why?  Because Muslims will continue to be Muslim.

Angela Merkel wins the Nobel Peace Prize.  Because that is exactly the kind of retarded thing the Nobel Prize Committee would do.

Most of the ObamaCare (ACA) legislation will be repealed.  I say most because there are a few items that may be either too politically popular (keeping kids on their parent’s plan until 26) or were already part of Republican replacement plans (pre-existing conditions).

The FED will raise interest rates by at least three-quarters of a point.  The FED just recently raised the short term interest rates by a quarter of a point, the first increase in 2016.  This strikes me as a totally political decision, since Janet Yellen was a target of Trump and I’ve no doubt she’ll raise rates at least another ¾ of a point in 2017 in hopes of stalling the economy to punish Trump for his impertinence.

Articles of Impeachment against Donald Trump will be introduced in the House.  Why?  Because the Democrats are already talking about that now.  Waiting until Trump is President is merely a formality.

There will be at least one assassination attempt against Donald Trump this year. When the media has been promoting the “literally Hitler” meme for the past year, would it be surprising that some earnest liberals take the Dead Zone option and try to take Greg Stillson out?

Marine Le Pen will be elected President of France.  Although Michel Houellebecq’s novel Submission predicted an establishment deal to elect a Muslim political party winning the Presidency of France, in real life the current populist uprising may hit the French shores quicker than you can say The Camp of the Saints. Brexit, Trump, and the constant Islamic terrorist attacks may cause a public revulsion where people will just say, “enough.”  In some ways, that would be a bigger deal than Trump winning the Presidency.  The French establishment has been fighting populist nationalism a lot longer than the American GOP-Democratic-Media alliance.  So if that goes, dominos will fall all over Europe with dismal prospects for the EU.  That would slide in nicely with another prediction of mine, that the EU will be mostly undone by 2020.

Not really a prediction, more of a certainty, but every foreign policy decision made by the Trump White House will be called either idiotic or ignorant.

#NeverTrumpers and the Drive for Irrelevancy

As crazy as National Review has gotten over the past few months, I’ll still occasionally follow a link to it to see the current grim state of Acela Corridor conservatism. This week, Jonah Goldberg doesn’t disappoint, staking out a position as the last Japanese soldier hold out on a remote island in the DC suburbs, living out his version of never give up, never surrender.

I honestly believe that a President Trump would do enormous, perhaps fatal, damage to the conservative movement as we know it. I also believe that without the conservative movement, this country is toast. But I further believe that Hillary Clinton would do obvious and enormous damage to the country. That’s why I’m not voting for either of them. That’s why this election sucks. But I don’t write in the voting booth. I don’t get paid to offer my opinions at the ballot box. And I don’t work for the G-d damn GOP.

It’s a snooty drawing room politics.  If Goldberg believes that the country is toast without the conservative movement (an arguable point I concede) then prepare the toast.  Why Romney, McCain, Dole or Bush(s) didn’t do fatal damage to the conservative movement is never explained, although I could argue that each of those Republican Presidents and candidate wannabes collectively did enough damage to the conservative movement that by the time you get to Trump, the collective knife wounds were already enough to put the patient into a medically induced coma.  Trump didn’t do anything.  He just grabbed the mic while no one was using it.

The idea that a President Trump would kill the conservative movement is, as I’ve argued elsewhere; ludicrous.  Political position-wise, Trump is a moderate Republican in the Romney mode.  How Trump kills conservatism, while Romney, the author of Romneycare, who wouldn’t criticize Obamacare, didn’t; is left unexplained.  And it will always be left unexplained since it upends the argument that Trump poses some particular danger to conservatism that the Republican Party didn’t already inflict on it.

What Goldberg and the other #NeverTrumpers don’t get is that William F. Buckley’s dictum, to support the most electable conservative candidate, is a sliding scale, not a scientific constant.  Demographics, the media, and academia have all worked their magic each and every election cycle to make conservatism in general more and more irrelevant.  Sadly the reaction of Goldberg and the #NeverTrump movement is to double down on that irrelevancy.

Goldberg and the other #NeverTrump survivors are perfectly happy to lose elections as long as the ideology remains intact.  But the ideology never remains intact.  What is conservatism now, which apparently means unlimited trade and unlimited borders, has no relation to the conservatism of most of the 20th Century.  When did mass immigration of Muslims become a conservative issue? But that appears to be Paul Ryan’s major sticking point with Trump.  We are heading towards a vanishing point where “Conservatism,” as Goldberg and others define it, becomes a rarified ideology like Libertarianism, which has no mass support, and no hope of changing actual real politics.  It’s like politics as Fantasy Football; fun to play maybe, but no relation to actual football and totally irrelevant to what’s happening on the field.

 

On My Burwell Bet: I Win!

In a totally unsurprising turn of events, I was proven right once again.  The Supreme Court upheld, not the actual text of the law, but the IRS and HHS interpretation of the law that allows subsidies paid out through the federal exchange rather than just through the State exchanges, as the actual law requires.

All is as I’ve foreseen.  As I wrote back in March:

 So in spite of the actual text of the law limiting subsidies to State exchanges, I predict that the Court will find against the plaintiffs and rule that the subsidies can pass through the Federal exchange.

I did think that Justice Roberts would, if given enough cover to keep the subsidies might vote against it to show his “independence” however even with a court majority, he either wanted to be counted with the free stuff gang, or he just wanted to shoot a bird at conservatives who criticized him for his last Obamacare decision.

Screw you guys!

Message received Roberts.

This was a simple case.  The text of the law was pretty specific; there were multiple Gruber statements and statements by others involved in the law that that it was specifically written that way to force States to start their exchanges, and it didn’t matter.  Politics trumped law.

And now; on to gay marriage, when we’ll learn that the founders, when they wrote the constitution in 1787, really intended gay marriage…

My Burwell Bet

Supreme Court

 

The Supreme Court is hearing oral arguments today for yet another Obamacare case, this time, it’s King v. Burwell.  What’s the case about?  In short, from the text of the ACA:

“…the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311…”

The key phrase is “an Exchange established by the State.”  So since most States didn’t set up an exchange forcing people into the Federal exchange, none of the subsidies given for health plans through the Federal exchange are legal.  The ACA plainly stated that subsides could only go through State exchanges and the IRS, which crafted a rule allowing subsides through the Federal exchange, overstepped its boundaries outside of the text of the law and is in error.  This should be an open and shut case.  The IRS violated the text of the law, it was wrong, and subsidies should be halted from going through the Federal exchange, right?

Heh!

I don’t believe the law has anything to do with how the Supreme Court arrives at decisions.  If there were any questions to that, the way the Court handled the individual mandate should settle them.  The Court is a political animal.  If it were ever truly interested in a just and reasoned weighing of law and the Constitution, those days are long passed. Of course that makes it easier for me to predict the Court’s behavior.

That’s how I was able to predict the Court’s decision over the individual mandate.  As I wrote then:

“My gut feeling is that the odds are better than even that the court will uphold the mandate.  I base that on the fact that the mandate has 4 automatic votes for.  So that means that only one vote is needed to be swayed among the other five Justices who actually have to study this case (unlike Ginsberg and Breyer, who will be windsurfing instead of reading law books). “

I was right because the Court decision (Robert’s changing his vote) was purely political.  So since I’m feeling cocky, I’ll go ahead and lay my marker down now.  So in spite of the actual text of the law limiting subsidies to State exchanges, I predict that the Court will find against the plaintiffs and rule that the subsidies can pass through the Federal exchange.  The 4 liberal judges will of course vote to uphold the subsidies because…Obama.  The magical swing vote will either be Kennedy or Roberts.  If Kennedy votes against the plaintiffs, then Roberts, to save the law, will vote for.  But if Kennedy votes for the plaintiffs; abolishing the Federal subsidies, then Roberts will vote against, since he will then have a free vote to show his independence; as long as it means nothing.

Of course, I could be totally wrong and the Court could surprise me.  But no breath holding on my part.

 

 

 

 

Obamacare Math

I’m no mathematician, but I’ve come to some interesting conclusions from “running the numbers” on the Obamacare debacle.

First, about 14 million people are covered under the individual health insurance market.

Of those, in 2013, 13% were covered by grandfathered plans; or plans that could be renewed for 2014.  So that’s 1.82 million who for sure can “keep their plans;” at least for 2014.

That means as many as 87% of individual health plans could be cancelled.

We know for sure that as of last week (this is a week by week changing number) 4.8 million people have already gotten cancellation notices.  These are people who were covered this year, and if they want to continue to be covered, need to choose and purchase new insurance plans by January 1st.

The CBO estimated that 7 million people would be covered in the health insurance exchanges in 2014, but that was an estimate based on a fully functional Obamacare website.  I’ve no doubt that that the Obamacare site will eventually be fixed, but how long will that take?  I’m pretty comfortable guessing that the problems will not be fixed by the end of November, as promised by the administration.

The administration estimates that 200,000 people have signed up for coverage with the exchanges by mid-November.  That means as of right now, of the people who had coverage under the individual health insurance market this year, 4.6 million of them still don’t have coverage for 2014.   Although I’m sure that the number of enrolled people will steadily increase over the next few weeks, does anyone think that the remaining people who lost their coverage because of the Obamacare requirements will have coverage by the start of the New Year?

Even the Obama administration isn’t that optimistic.

That means that thanks to Obamacare, more people will start off the year without health insurance coverage than had it this year.  Congratulations President Obama!  You’ve successfully wrecked the nation’s health insurance market!   I think the administration should have applied the lessons learned from the Hypocratic Oath: First, do no harm.  Instead, the administration burned down the house, only to learn that their plans for the new house were incomplete.

If the percentage of uninsured in this country is greater this time next year than it is now, it will be pretty clear who will be responsible for it.  I hope someone is smart enough to remind people of that for the elections.

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