reconciliation allows the GOP to further undermine the stability of the ACA’s insurance market, but not to remedy its fundamental structural flaws.
.. Instead of straining with reconciliation to patch the fissures in the insurance market, the GOP should employ the regulatory powers of the Department of Health and Human Services to fix it. By repealing an October 2016 regulation that was used to prevent the sale of actuarially priced “short-term” insurance, Secretary Tom Price could reestablish a market in which health insurance is competitively priced in proportion to most individuals’ health-care needs. This would relieve the exchanges and their subsidies of much of the burden placed on them, repurposing them as a targeted safety net for the chronically ill.
The health care bill could be Donald Trump’s Iraq War
Sold on lies, poorly planned, deadly to thousands, and a catastrophe for its authors.
Conservatives believe it is not the government’s responsibility to ensure the poor can afford decent health insurance. They argue that if taxpayers are pitching in for someone’s coverage, that coverage should be lean; a high-deductible plan that protects against catastrophic medical expenses is plenty for charity care.
Under this view, the basic structure of Obamacare — which taxes the rich to purchase reasonably generous coverage for the poor — is ill-conceived and should be reversed.
.. Much as Americans were told the Iraq War was about removing the threat of Saddam Hussein’s weapons of mass destruction, they have been told that the GOP’s health care effort is about replacing Obamacare with “something terrific” — a plan that covers everyone with good health insurance that they can actually afford to use. In both cases, they were lied to.
.. But Republicans have taken everything they said they didn’t like about the process behind Obamacare and supercharged it — it’s as if they’re using their critique of the ACA process as a playbook for retribution. They are moving faster than Democrats did, and they are doing so with less stakeholder support, with a smaller congressional majority, with less bipartisan input, with an unpopular bill backed by an unpopular president, with less information about what their bill would do, and while providing fewer opportunities for members of Congress to amend and improve the underlying ideas.
.. The 2003 “shock and awe” campaign to topple Saddam Hussein reflected a misconception that the hard part of the Iraq War would be fighting through to Baghdad — but once we were there, and once Hussein was gone, it would all work out. It didn’t. The hard part was after Hussein fell, and the United States was responsible for the future of a country it didn’t understand and faced with chaos it hadn’t planned for.
.. President George W. Bush famously called the invasion of Iraq a “catastrophic success” — it was a military victory that left America embroiled in a catastrophe.
.. This is the heath care version of Dick Cheney’s promise that American troops “will, in fact, be greeted as liberators.”
.. A cautious estimate, based off the best available evidence, suggests coverage losses on the scale Republicans envision will lead to more than 24,000 deaths annually.
.. Democrats could, within a matter of weeks, pass a short, clear law restoring and expanding the Medicaid expansion, restoring and expanding Obamacare’s tax credits, allowing Americans to buy into Medicare as an option on the exchanges, and paying for the whole thing by levying hefty taxes on the rich. The bill would be easy to write and easier to explain.
.. If Republicans upend Obamacare, their replacement plan is unlikely to survive the aftermath — it’s simply too different from what voters want, too vulnerable to future change, too loathed by existing interest groups, and too shoddily constructed to build support on its own merits. Rather, their plan will create chaos in insurance markets, anger among voters, and radicalization among their opponents; the policy that eventually fills the vacuum they create will not be one they like.
The Republican Plan Is Even Worse Than Obamacare
There is no big political constituency for the GOP’s endgame. Democrats could offer a flawed bill as a first step toward doing more. Republicans don’t really have that option.
I suspect the Republican leadership shares my concerns, given how long they kept the thing in the kind of secret reading room usually used for sensitive intelligence briefings. They were not the first to classify our nation’s health care policy “Top Secret,” of course; that had hilarious echoes of the Obama administration’s decision not to tell states what the exchanges would look like, lest Republicans somehow find out, and make fun of them.
.. they’re resorting to all the same tricks: the secrecy, the opacity, the long implementation delays (the better to get a good score from the Congressional Budget Office, and oh, yes, also, get them past the next election before voters meet their program).
Republicans plan health-care vote on Thursday, capping weeks of fits and starts
Under the GOP plan, states could opt out of parts of the ACA, meaning people with preexisting conditions could be denied coverage or charged more. Such states would have to set up “high-risk pools” to absorb some of the costs
.. Some experts doubted that $8 billion was enough to aggressively address those costs over a five-year period.
.. “For subsidies to cover 68 percent of enrollees’ premium costs, as ACA tax credits do now in the individual market exchanges, the government would have to put up $32.7 billion annually,” Emily Gee, a health economist at the progressive Center for American Progress, wrote in an analysis of the plan. “Even after applying that subsidy, high-cost consumers would still owe $10,000 annually toward premiums.”