Tag Archives: health care

Obamacare Replacement

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One aspect of the plan on offer in the House is this:

…whether it includes enough reform to arrest the current death spiral in the individual insurance market.

Notably, the bill includes a new 10-year $100 billion “stability fund” that allows states to start to repair their individual insurance markets. Before ObamaCare, it wasn’t inevitable that costs would increase by 25% on average this year, or that nearly a third of US counties would become single-insurer monopolies. With better policy choices, states can make coverage cheaper and more attractive for consumers and coax insurers back into the market, and the stability fund is a powerful tool.

Right idea, but it needs a tweak.  As with all Federal transfers to the States (even though nearly all of them do not have this), this transfer needs a sunset (ideally, but not as a deal breaker, on a declining balance to the sunset date) by which the transfer will cease to exist.  States need time to adjust their budgets as their addiction to Federal money is broken, but in the end the costs a State inflicts on itself must be the sole responsibility of that State.

Then there’s this:

The larger goal is to start to restore the traditional state regulatory authority over health insurance that ObamaCare supplanted for federal control. Local governments understand local needs best. With more flexibility, autonomy and accountability, the GOP hope is that reform Governors can pry open markets and help promote a larger and more dynamic business.

The larger goal still, and an even better one, should be to reduce regulation altogether to a great degree, and let the markets regulate health insurance products and costs.

In the end, too, local governments do understand local needs better than remote Federal, and State, governments.  But the greatest understanding is even more local: the patient and his doctor.  These are the participants in a free market for health insurance products—nation-wide and freely crossing State borders—whose “regulatory” activities should prevail.

Republican Gadflies

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Karl Rove talked about health care coverage prospects in a recent Wall Street Journal op-ed, and that triggered a thought in my pea brain.

Senator Tom Cotton (R, AR) has announced that the House plan on offer, a plan designed to be passable through reconciliation, with later phases of repeal and replace for completing the task, is dead on arrival, and the House shoe start over and produce a more comprehensive plan in this first phase.  But Cotton has chosen to not offer a plan of his own, or outline what a plan acceptable to him would look like other than to address taxes and to more fully repeal right damn now Obamacare, or even to offer the tactics he’d use to get the new plan—which could not be done through reconciliation—past a Progressive-Democrat filibuster.

Congressman Jim Jordan (R, OH) similarly demands a broader bill right damn now, but he, too, has chosen to offer no tactics for getting his bill past a Senate Progressive-Democrat filibuster.  He’s just using the copout excuse that that’s the Senate’s problem.  Oh, and Jordan also declines to identify the value of a bill that can’t be passed.

Senator Rand Paul (R, KY) at least has offered an actual plan, but he, too, has declined to identify how he expects to get his plan past a Progressive-Democrat filibuster.

These gadflies keep demanding that everyone else put up (these three’s demands) or shut up.  It’s time these three put up; otherwise, they’re just porch dogs, yapping from the safety of their stoops.

Tax Credits in the Obamacare Replacement Proposal

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In the main, I’m opposed to these on a couple of grounds.  One is that it’s just more welfare; we need to find a way to move folks off welfare and into the labor force and jobs rather than keeping them trapped in the welfare cage—like we did when we originally reformed the food stamps program by requiring recipients to get a job or lose the stamps.  That reform not only reduced overall unemployment, it put recipients back into jobs (and off that welfare program).  These weren’t make-work jobs, either; net prosperity for those recipient families increased.  (Then the Obama administration withdrew the work requirement, and we got record numbers of folks back on food stamps).

The (refundable) tax credits are just more of this sort of subsidy, just in the form of a tax credit rather than a direct payment, like most subsidies are.

The other is that the tax credits won’t encourage health coverage providers to lower their rates and deductible requirements.  Quite the opposite, the credits would prop up those costs by allowing the providers to put a commensurate fraction of their charges onto the taxpayer: the credits would be used by the providers to make up the difference between what the coverage purchaser pays and what the provider charges.

On the other hand, the tax credits would approach acceptability under a couple of conditions: if the credits decline year-on-year to a final value of zero over some number of years, say, two or three; or the credits are sunsetted and disappear after some number of years, say two or three.  Or a combination of the two.

With those conditions, and with the understanding that both individual and State budgets need time to adjust, a disappearing tax credit, by providing that adjustment time, could become acceptable.

Call Them on Their Obstructionism

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Heather Higgins, CEO of Independent Women’s Voice, says go big or go home regarding Obamacare.  Republicans in Congress should quit dithering, should not play reconciliation games, and should simply put an Obamacare repeal and replace package up for vote.  This would force the Democrat obstructionists—especially those #NeverTrumpNoHow and #NeverRepublicanNotEver Progressive-Democrats in the Senate on the record as by-name blocking reform of the Obama program that is in its death spiral, the endpoint of which will leave millions of Americans without health coverage and without even coverage providers to which to appeal.  Especially put those 10 Progressive-Democrats pretending to moderacy in order to protect their precarious reelection chances in 2018 on the spot.

Now that insurers are acknowledging the death spiral, there’s an opportunity for bolder action. The House could use regular order, not reconciliation, to pass a bill that not only fully repeals ObamaCare—returning control of the private market to the states—but simultaneously puts into effect at least the core components of reform while including grandfathering and other provisions to smooth the transition to lower-priced options on the free market.

Such a bill could easily pass the House, putting pressure on the Senate. Would Minority Leader Chuck Schumer allow proper consideration of much-needed health-care reform? And with all the evidence that ObamaCare has been a disaster and—untouched by Republicans—is quickly unraveling, would Democrats, 25 of whom are up for re-election next year, vote to defend the status quo?

And

There would be two Senate filibuster points—the first, to allow consideration; the second, to allow a vote. Thinking through what would happen, the American public and Trump administration would be well served by this exercise of transparent democracy.
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If Democrats blocked consideration of the bill, they would do President Trump a favor by showing the public the parliamentary shenanigans of the anti-deliberation filibuster—call it the “Senatorial Full Employment Through Avoiding Tough Votes” maneuver.

And

If Democrats refuse to allow debate, Republicans should kill the filibuster against deliberation (as distinct from the filibuster to end debate and hold a vote). They can do so by simple majority vote, as Harry Reid showed when he ended the filibuster against most nominations in 2013. Either way, the Senate can actually have a vote on repealing the Affordable Care Act and reforming health care.

Republicans should heed this advice, and go for it.  If it fails, Republicans can always go the reconciliation route.

What Should a Health Plan Cover?

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Anna Wilde Mathews wondered about that in her piece in The Wall Street Journal.  First, a couple of asides.  Notice the tacit acknowledgment that we have no health insurance plans available.  That industry was eliminated in toto by Obamacare, which replaced the industry with a Federally mandated, publicly/privately funded health coverage welfare program.  Next, notice the tacit assumption in the piece’s subhead: that the law should mandate business decisions.

To the piece itself:

The 2010 health law created a new set of federal requirements for plans sold to individuals and small businesses, including a list of 10 benefits, among them prescription drugs, mental-health services and laboratory tests. It also mandated that plans cover preventive services such as vaccinations at no cost to enrollees.

Along with women’s contraceptives (but not men’s…) at no cost to enrollees or the businesses providing the plans.

Trimming certain benefit categories from the required list could sharply raise the cost of those benefits for consumers who opt to have them.

That’s Mathews’ claim, anyway.  What she’s chosen to ignore is that a competitive, free market would sharply reduce the cost of most of those “benefits.”  What she’s also chosen to ignore is that eliminating the mandatory nature of the coverages would sharply lower the cost to millions of others who don’t need those “benefits,” but who must pay for them anyway—even if they’re included in a plan at “no cost to enrollees,” a fiction cynically foisted onto us by the Obama administration.  Enrollees certainly are paying for them; the added cost is simply hidden in a higher overall price.  And the rest of us are paying for them, too, in premiums similarly elevated to pay for that required coverage and/or in the taxes we must pay to pay for the subsidy.

It’s certainly true that other, rarer or more expensive to treat problems would have higher prices, but there’s never been a case made for why Government should pay for these ahead of family, friends, charity, church, local community—the usual suspects.

Plans with skinnier coverage can carry lower premiums, actuaries say. But as with everything in health care, that comes with a trade-off.

NSS.  But those trade-off decisions belong to the individual, not to Government.