Posted on 03/07/2017 7:56:10 AM PST by SeekAndFind
The first thing to understand about the GOP healthcare bill is that it is not merely Obamacare-lite or a bad “replacement” bill. It doesn’t repeal the core of Obamacare in the first place. In fact, the few parts that it repeals or tweaks within a few years will actually intensify the death spiral of Obamacare when mixed with the core regulatory structure, exacerbated by the subsidies that they do keep. And this time, the GOP will own it politically. All of it.
The most dangerous myth about the GOP plan is that it repeals Obamacare. At least if GOP leadership would be honest and say they are too scared to repeal the ACA and are just tweaking it a few years from now (after the death spiral is made worse), then we can blame the Democrats for voting for it. Now that a bill codifying Obamacare in the worst possible form is being sold as “repeal and replace,” Republicans have bailed out Democrats from their most toxic political issue without securing a single concession.Regulations, spending, mandates, subsidies, and taxes
The basic structure of this plan is what I outlined last week after the first draft was leaked to the media. There is no discussion of lowering prices, fostering a revolution of choice, competition, portability, cost-consciousness, or breaking down the barriers between consumer and provider. That is because most of the regulatory structure and the exchanges are left in place.
There is no innovation, and no way to lower costs. While some of the regulations are tweaked with more flexibility, the 800-pound gorilla in the room — guaranteed issue mixed with community rating (which is responsible for almost all of the premium hikes) — is left in place. Nor does this bill repeal the mandated essential benefits, which require insurers to cover a specific number of people and sex change operations, maternity care for men, etc.
And even the repeal of actuarial value “metal” requirements (platinum, gold, silver, bronze) — the most positive of the outlined changes — would not take place until the 2020 plans.
Amazingly, while the “American Health Care Act” blows up the insurance market in order to mandate coverage of the sick, it still throws a whopping $100 billion at states in order to further subsidies to the poor and the sick (on top of Medicaid expansion and exchange subsidies).
… the GOP bill is actually worse than Obamacare for two reasons: 1) It will exacerbate the death spiral of fiscal insolvency; and 2) It will destroy the employer market.
Furthermore, the existence of the exchanges and the subsidies being steered to those exchanges will force insurers to continue competing for government-run health care that is actuarially insolvent. This continued structure will ensure that startup companies — which lack economies of scale to operate within this rigid (albeit slightly relaxed) structure — cannot enter the market. That is the core of what ails the health care industry.
On top of leaving the regulatory regime and the rigid exchanges, this House bill replaces the income-based subsidies with age-based subsidies – ranging from $2,000 for younger people to $4,000 a year for older enrollees, and as much as $14,000 for a family. It is a massive new entitlement for middle-income and lower-income Americans. It would apply in full for families earning up to $150,000, and then phased out $100 per thousand dollars earned over that threshold. Thus, a family could theoretically get some sort of subsidy well into the $200,000-plus income level.
As for Medicaid, the draft plan grandfathers in the entirety of the Obamacare expansion. Worse, it doesn’t freeze future enrollment for another two years, which will incentivize states to massively expand Medicaid before 2020. It also throws another $10 billion to states that never expanded Medicaid.
Between the regulatory structure, subsidies, and Medicaid expansion, this bill is Obamacare. Literally.
But, in fact, the GOP bill is actually worse than Obamacare for two reasons: 1) It will exacerbate the death spiral of fiscal insolvency; and 2) It will destroy the employer market.
The one part of the bill that does actually immediately repeal an Obamacare provision is the immediate elimination of the individual mandate and the employer mandate that requires individuals to purchase and employers to provide health insurance.
By leaving the price-hiking regulatory and subsidy structure in place, yet repealing the individual mandate, this bill will exacerbate the death spiral because people like myself — who are getting crushed with ridiculous premiums — will dump their insurance. Likewise, employers who are now forced to provide insurance will quickly dump their employees from their plans.
This is what happens when Republicans focus on coverage numbers at the expense of lowering costs through the regulatory structure. They achieve neither. While the individual mandate is replaced with a provision mandating that insurance companies charge individuals who dropped their insurance an extra 30 percent when reenrolling, that provision doesn’t take effect until 2019. The adverse selection and death spiral will be terminal by then ; the employer mandate is not replaced at all.
Also, the 40 percent Cadillac tax on more expensive health plans is delayed from 2020 until 2025, but not repealed.
Thus, House Republicans have replaced the notorious taxes, regulations, subsidies, and mandates of Obamacare with … taxes, regulations, subsidies, and mandates. Except, this time, Republicans will own it. And that is exactly what the lobbyists for the status quo wanted.
… this is one of the rare instances when it’s better to do nothing if they don’t want to do the right thing. There is no upside for a conservative to sign onto this, and only downside.
Now that Republicans will have their reputation tethered to Obamacare, they will be forced to consistently continue the hospital bailout program, otherwise known as Medicaid expansion. They will constantly be forced to re-up the individual and corporate cost-sharing subsidies to make up the gap from getting rid of the employer and individual mandates. This is not a half a loaf, it’s a poisonous loaf
House leadership will tell its members, “Look, this isn’t perfect, but isn’t it better to take a half a loaf than no loaf at all?” In reality, this is a poisonous loaf. Again: It doesn’t repeal Obamacare, will exacerbate the death spiral, dump people off employer-based insurance, and force Republicans to own it this time.
Yes, this is one of the rare instances when it’s better to do nothing if they don’t want to do the right thing. There is no upside for a conservative to sign onto this, and only downside. Also, remember that the Senate GOP is even more liberal than the House GOP, so this is the opening bid that will invariably get worse.
Big picture: The result of this bill is that insurance companies will continue to look to government to regulate and subsidize. Thus, insurers will continue to run health care based on government and lobbyists to keep the gravy train rolling, and box out competitors instead of being forced to compete directly with new insurers for consumer business.
Under the guise of promoting expanded coverage rather than decreasing costs, this plan will exacerbate both. Well done, Republicans.
If nothing else, this is a vindication of those who warned during the primaries that Republicans were lying to us all along.
It’s time for President Trump to lead, or this is over.
That last part is critical.
Till now the Democrats owned this piece of sh**, lock, stock and barrel.
Now Republicans have their fingerprints on it.
True
Trump needs to veto this and tell Ryan piss up a rope until they come up with something real.
It’s almost like some wealthy billionaire New York liberal planned it.. question is, which one?
I want to be on record against this atrocity. We didn’t kick the Dems out of power for this.
P.S. - There was a lot made of the the fact that not a single GOP vote was cast for Obamacare. This bill proves they might as well have done so.
The RINO’s are not interested in a Conservative Gooberment at all. Boot them out!!
The Freedom Caucus will oppose this RINOcare bill.
The only way it passes is with Democrat and RINO votes, like they tried to do with Rubio’s Gang of Amnesty bill that caused Eric Cantor to be Cantorized.
If your Congressman signs onto this, Cantorize him in the next primary.
We will now see the real test. Will President Trump see this is garbage, veto it for what it is and offer a far more conservative policy? Will he stand up to moaning from the RINO house and Senate and remain firm?
This will be the first legislative test
Call it Establishment Care!
No House RAT should vote for this so the RINOs own it.
Then the House Conservatives should vote it down.
If it makes it to the Senate, maybe they’ll have the good sense to say, “are we nuts” asnd vote it down.
I'll post a more detailed review of this later, but this line caught my eye.
I think the author has this all wrong. Destroying the employer market will do more to "fix" health care in this country than anything else that has been discussed.
Think about just how idiotic our employer-based health care system has become. Expecting my employer to cover the cost of my medical insurance is just as ludicrous as expecting my employer to do my grocery shopping for me. This link between employment and health coverage should be severed ASAP. The best way to do this is by treating employer-paid health insurance as a taxable benefit just like anything else.
When my employer purchased a disability insurance policy for me and paid the premium every year, I had to report that premium as taxable income on my tax return. And guess what -- the premium was so low that it hardly even mattered.
Now Republicans have their fingerprints on it.”
And that can be avoided very easily and the President can FORCE A BIPARTISAN BILL to Repeal Obamacare.
I will say it again, OBAMACARE WILL NEVER BE REPEALED in any way, shape or fashion. I watched COUNTLESS Government Unions proudly marching and advocating for OBAMACARE on TV all across this Country.
There is ONLY ONE WAY to make it happen:
Executive Orders
1. All waivers to the Affordable Care act are hereby repealed.
2. There shall be NO funds drawn from the treasury to pay for Health Insurance for ANY Federal Employee except Members of the Armed Services.
3. ALL Federal Employees except members of the US Armed Services, SHALL purchase their own personal and Family Health Insurance from the Affordable Care Exchange in the state they legally reside.
And to make sure it is Bipartisan, President Trump should VETO it every Time and FORCE them to Override his Veto to Repeal this Monstrosity.
Sign these 3 orders and it will be FULLY REPEALED in Less than 30 days.
NOT UNTIL, Anyone want to make a BET???
I would also consider another Executive Order Withholding All Transportation Funds from All States that do Not have Their Public Employees enrolled in Obamacare, just to Prove a Point.
When and ONLY WHEN Government Lives under the Same Laws as us will anything substantial happen
I AM TAKING BETS that the Rino Party Will NEVER REPEAL OBAMACARE!
No House RAT should vote for this so the RINOs own it.
Then the House Conservatives should vote it down.
If it makes it to the Senate, maybe they’ll have the good sense to say, “are we nuts” and vote it down.
And what about the other provisions of the law that will be left in place for a future democrat administration to abuse?
2600 pages worth!
GOP is worthless! They let a paid for group protesting town halls scare them into going back on their voters!!
So F’ing sick of these cowards.
Uh....it’s a starting point for negotiations. People are supposed to come to the table and fight for what they want included and excluded.
This is in stark contract to the Dems where no one got a chance for input
May the best ideas win!
Donald Trump has been on the record many times calling for a single-payer health care system in the U.S., so the idea that he would veto a garbage RINO-sponsored variation of ObamaCare seems pretty outlandish.
Ryan is such a weasel. He never ever thought Trump would win so he had NO replacement plan.
His grand plan was to send phony repeal bills to Hillary for 4 years and when it finally imploded on its own, he’d run for president in 2020.
Exactly...It isn’t in effect yet...Trump has a big say in this....It’s called veto...
Back when I was supporting Cruz and watched 2ndDiv get roasted for being a big time Ted supporter I would occasionally try to defend Cruz and point out Trump is no conservative. The conservatives in the UK are essentially a party that appeals to voters saying we can run the big govt programs better.
And that is what the republicans have turned into here. Trump said nice things about this bill. All those attempts to repeal were phony as sh1t. They could have just took the last repeal bill Obama vetoed
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