I mean, I sure do like those budget numbers. On the other hand, 24 million is a whole lot of folks. Republicans are going to stand accused of taking insurance away from a lot of needy people in order to cut nearly a trillion dollars worth of taxes. And in fairness, that is kind of what this bill does.
.. According to the CBO, under Obamacare, a 64-year-old making 450 percent of the federal poverty line, or about $53,000 a year, can expect to pay $15,300 a year for a plan that covers 65% of their expected medical expenses.
You can easily see why someone in that situation would be reluctant to pay that much for insurance.
.. Moreover, many of the folks who will see their insurance options shrink are those older white voters in rural districts who helped put Trump over the top. The merely middle aged won’t get hurt too badly, though they, too, will see their premiums go up. But the older, not-poor-but-sure-not-rich folks? They get creamed.
.. We do not rely on CBO scores because they are particularly accurate, but because they are consistent, allowing us to compare bills to each other — and because they provide an exceptionally useful check on the wildly overoptimistic estimates that politicians would produce on their own.
.. We could argue about whether the insurance markets are going to stabilize with a younger, healthier pool, as the CBO suggests, or whether I’m right that there’s a substantial risk they won’t stabilize and will instead start spiraling towards death.
Deconstructing Frank Luntz’s Obstructionist Health Care Reform Memo
Luntz warns that “if the dynamic becomes ‘President Obama is on the side of reform and Republicans are against it,’ then the battle is lost and every word in this document is useless.’”
.. Luntz establishes a straw man argument against a non-existent health plan.
.. “Humanize your approach,” but argue that health care reform “will result in delayed and potentially even denied treatment, procedures and/or medications.” “Acknowledge the crisis” but ask your constituents “would you rather… ‘pay the costs you pay today for the quality of care you currently receive,’ OR ‘Pay less for your care, but potentially have to wait weeks for tests and months for treatments you need.”
.. “This plays into more favorable Republican territory by protecting individual care while downplays the need for a comprehensive national plan,” the memo states.
.. Readers are also instructed to conflate Obama’s fairly moderate hybrid approach to reform (i.e. building on the current private/public system of delivering health care) with “denial horror stories from Canada & Co.”
.. Republicans will provide “in a word, more: ‘more access to more treatments and more doctors…with less interference from insurance companies and Washington politicians and special interests.’”
.. pretending that the Republicans actually have some kind of health care solution (the memo instructs Republicans to focus on targeting waste, fraud and abuse).
Republicans Should Kill Obamacare or Let It Die
That very inflexibility is probably one reason that buildings like the Pantheon survived for us to admire them. Other ancient treasures were torn apart by the locals looking for building materials, but concrete buildings could not be repurposed stone by stone.
.. By the time Obamacare came on the scene, America already had government programs that were propping up health care for almost everyone in the country: tax-subsidized employer-sponsored health insurance, Medicare, Medicaid, the VA. No one was willing to shoulder the cost of knocking those things down and designing a rational, well-built structure to take their place
.. The base may rejoice when they hear that Obamacare has been “repealed” (sort of). But their cries of glee will be drowned out by their wailing when they find that they cannot buy individual insurance at all.
.. What do they think will happen after they proudly proclaim that they’ve repealed Obamacare—followed in short order by the complete implosion of the individual market? Do they really imagine that they will be allowed to leave the rubble-filled lot there and proclaim that they’ve undone President Obama’s mistake?
.. But insurers will start to submit their proposed rates for 2018 in a few months. That is likely to become the effective deadline for any further tweaks, because if insurers think the collapse of the individual market is imminent, they will decline to sell into that market, and then the collapse will no longer be a forecast, but a historical fact.
.. they should do nothing, and start preparing their rebuilding strategy while they wait for the flaws in Obamacare’s structure to bring down the individual market on its own.
Best Health-Care Plan for Republicans? Wait
Speaker of the House Paul Ryan gave Thursday, you’ll see that he understands the problems. His argument is, basically: Democrats screwed up the health-care system. They won’t let us fix it cleanly, so if we’re going to do something, these half-measures are the best we can do. Let’s get this passed, address what we can through regulatory changes, then force Democrats to come to the table to negotiate the rest.
- .. One, the exchanges where individuals buy policies could fail, leaving people unable to buy insurance.
- Or two, the exchanges don’t fail, and we’re left with an unsatisfactory but still operational system.
.. In either case, the Republicans’ best option is to wait. Why? Because what they can do now — hastily, without touching the underlying regulations that have destabilized the individual market — is worse than either of those outcomes.
.. Stop the funding games the Democrats were using to prop up the exchanges. And if the exchanges collapse, say to the public: “Hey, look, we didn’t touch the individual market.
.. The only possible way to shore up Obamacare’s flawed design is through a big increase in subsidies for individual plans and bigger tax penalties for those who don’t participate. Democrats didn’t have the guts to do this, and they liked Obamacare.
.. Whatever it is, they’d better be prepared to do it fast, because if the individual market does collapse, there’s going to be a political crisis. They need to think about this now and have a bill ready to go as soon as it happens.
.. have the government pick up 100 percent of the tab for medical expenses that exceed 15 or 20 percent of a family’s adjusted gross income: basically, a single-payer catastrophic-care system for expenses that no one can realistically save for. Let people buy insurance for expenses below that, or, if it’s not too expensive taxwise, let people set aside more money tax-free in Health Savings Accounts. And make some more generous provisions for people closer to the poverty line, such as prefunding Health Savings Accounts for them.
.. voters don’t want genuine insurance, by which I mean a pool that provides financial assistance for genuinely unforeseeable and unmanageable expenses. Voters want comprehensive coverage that kicks in at close to the first dollar of spending, no restrictions on treatments or their ability to see a doctor
.. nor do they want their taxes to go up, or to pay 10 percent of their annual income in premiums.
- Old people hate paying more, of course. But the effect of the current system is to drive young people out of the market — which means that premiums are set to cover an old population, which means high. It’s not clear that this actually benefits old people in the long run.
.. There are too many Republican governors and senators among the 32 states that expanded Medicaid for total repeal to be politically feasible
.. The current financing structure, in which the federal government matches whatever states spend, encourages states to use the program as a piggy bank to reward favored interest groups in the health-care sector, without necessarily providing very good care to the poor. As Brian Blase of the Mercatus Center recently put it, “Because Medicaid spreads the burden of state spending decisions in this way, many states grow inefficiently large programs and create numerous accounting gimmicks to access as much federal money as possible.
.. A plan based on these ideas may, to be sure, end up covering fewer people than Obamacare currently does. But then Obamacare may end up covering fewer people than Obamacare currently does, because it seems to be slowly strangling the individual market
.. What they can’t afford to do is try to get it done in stages, or do half of it because that’s what can pass. That kind of thinking is what got us into this mess in the first place.