Friday, December 2, 2016

The GOP dog has finally caught the Obamacare car. And now, what's it going to do with it?

Republicans have spent six years telling us how terrible Obamacare is and how fast they would repeal it, given the chance.

Well, Republicans, you are the dog that has finally caught up with the car you've been chasing and barking at.   It's in your hands.   So . . . what  a-r-e  you going to do?    What does the dog do with the car when he catches it?

It's easy to boast that you would scrap the whole thing -- except that only 26% of the American people want you to do that;   and almost everyone, including the president-elect, thinks it's a good idea to keep the rule about pre-existing conditions.

Yes, but Obamacare is a lot of moving parts that all depend on being balanced by other moving parts.    No insurance company can survive by opening its doors to everyone, no matter how sick, unless something gives them a big enough revenue stream to offset it.    And that's where the mandatory requirement comes in.    That gets healthy young people to sign on to help spread the costs for the sicker patients.    And that's just one small detail in how insurance works.

But seriously, what is their plan?   Politically, they want to "repeal and replace."   But they don't have a plan to replace it with.  What they're floating today is called the "repeal-and-delay" plan.   Meaning that the next congress will vote to repeal -- but not to take effect until three years later, at which time they will have come up with a plan.   Oh, that's cute.

Six years wasn't enough, so now they'll give themselves three more years.   And what in the meantime?    This involves 22 million people and an entire health care industry just hanging and waiting.   The Huffington Post's senior national correspondent, Jonathan Cohn, calls it a "slow motion disaster."

Cohn says the Republicans have never agreed among themselves, let alone working out any compromises with Democrats, on what they want a health care plan to look like.   Yet they've done such a good job of demonizing "Obamacare," that there is an urgency to do something, even if it is a bad idea.

It will be relatively easy to pass the repeal part, because they can do that through a budgetary reconciliation bill, requiring only 51 votes.    But a new plan would likely require an ordinary bill-passing process and would be subject to filibuster, making it a 60 vote requirement -- meaning they need some Democratic allies.

Cohn explains the GOP strategy in repealing first and replacing later:  It will force Democrats into a no-win situation.   "If Democrats end up blocking all GOP efforts at crafting a replacement, they will risk taking the blame for whatever chaos ensues. If some Democrats break ranks and agree to support GOP reforms, then they will give those changes bipartisan cover ―and share responsibility for whatever transformation ensues."

House Speaker Paul Ryan has an idea but no legislation framed of any workable cost and payment options.   Congressman Tom Price (R-GA) -- incidentally my own representative and himself a physician -- came up with a plan that depended way too much on privatization and tax credits.   It never even got a committee hearing from his own caucus.   And now he's been chosen to be Trump's Secretary of Health and Human Services, which (terrible news) puts him over Social Security, Medicare, and Medicaid as well.    Needless to say, he has similar ideas about block grants to states and shifting more to the private sector.    A disaster.

[A personal note:    I used to feel proud that I resided in the Congressional district represented by civil rights icon John Lewis.    I didn't move;  but a few years ago, the Republican-controlled Georgia Legislature moved the boundary lines for District 6.   So now my representative in D.C. is this Dr. Price -- or whoever replaces him if he is confirmed as head of HHS.   At least he's not one of the crazy ones -- just a very conservative Republican.)

Current Secretary of Health and Human Services Sylvia Burwell warns about uncertainty in these programs leading insurance companies to pull out of Obamacare.   Larry Levitt, of the Henry J. Kaiser Family Foundation told Huffington Post:   “Any significant delay between repeal of the ACA and clarity over what will replace it would likely lead insurers to exit the marketplaces in droves. . . . Insurers have been sticking it out for the promise of future profits, but if the future becomes uncertain, they’ll have little reason to stay in the market.”   Others in the industry have agreed, saying that the timing is crucial.    Those companies who stick around will likely push their premiums higher and higher, knowing that only the sickest will buy any plan at all.

Levitt summed it up:  “It would be like a game of musical chairs.  When the music stops, no insurer wants to be the only one left in the market with all of the sick people.”

I think the Republicans are about to get a crash course in Governance 101.   The first lesson:    it's a lot easier to obstruct than it is to construct.

What a mess.


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