Repealing Obamacare

Republicans—leadership, rank and file—and Conservatives want to repeal Obamacare, and they’re right to do so. Obamacare has been an unvarnished disaster for our nation.

To this end, Republicans need to pass repeal legislation and put it on President Barack Obama’s desk, where he surely will veto it. That veto will work to Republicans’ benefit as it helps shape the 2016 elections, but things must not stop there.

The leadership also is playing small ball, working a piecemeal approach. This includes

  • a bill that would define a full-time worker under the health law as working 40 hours per week
  • repeal [of] the…2.3% tax on medical devices such as X-ray equipment and artificial joints
  • a bill that would allow Americans to opt out of the law’s individual requirement to buy insurance

Other pieces that need to be addressed, say I, include

  • repeal of the employer mandate to provide insurance
  • repeal of the contraceptive mandate

All of this will require the Republicans on the right side of the party—the Cruzes, Gohmerts, and so on—to exercise far more patience than has been their wont. Repeal’s veto won’t be overridden, we need a Republican President to sign a re-passed repeal. Most of the piecemeal approaches also will be vetoed, and most of those will be sustained by the Democrat minority in each House. But all of these votes, initial passage and veto override alike, should be by roll call. With all the Democrats—every single one of them—explicitly on the record as favoring the Obamacare disaster, those votes will very favorably shape the ’16 elections.

But that’s not enough. Even when successful, the result will be a return to the status quo ante-Obamacare. The then-existing health insurance and health provision industries badly need restructuring. Republicans need to have in place a plan to achieve that and a timetable for the plan’s execution.

House Ways and Means Committee Chairman Paul Ryan (R, WI) has been cited as saying

that Obamacare would be replaced with something that gives Americans more choices and lowers costs, improves their access to care and is “truly patient centered….”

But he says he does not have a “timeline.”

House Speaker John Boehner (R, OH) has said

Our challenge, our opportunity is to pass common-sense solutions…that repeal Obamacare and replace it with patient-centered reforms that will help our constituents have better access to high-quality health care in America….

That’s not enough: it’s time to get specific. It’s time to lay out exactly what legislation will be proposed to restructure those two industries.

There’s this critical caveat, too. Accepting arguendo Obamacare as a general solution for the restructuring, it was doomed to fail because it tried to do too much all at once. The restructuring of those two industries, even in accordance with Conservative imperatives, will see a similar doom if it attempts the restructuring all at once. These industries need to be restructured piecemeal. Pass legislation to correct (some of) the worst ills in one session, and use the year to observe how those corrections worked and where they failed. In the next year of the session, correct the corrections where necessary and pass legislation correcting the next worst ills. And so on, year by year. The industries can be favorably and successfully restructured over the course of 4-6 years (much faster than the 80 years it took to get to the point of Obamacare, but not overnight, and especially not in one fell swoop).

But that takes patience. All or nothing right damn now will only achieve nothing. With Obamacare left in place.

How’s Obamacare Working Out?

How’s Obamacare Working Out?

President Barack Obama offered this justification for the structure of his Obamacare:

My guiding principle is, and always has been, that consumers do better when there is choice and competition. That’s how the market works. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. And without competition, the price of insurance goes up and quality goes down.

How’s he doing by his own standard?

  • In 2015, 89% of total US counties will have five or fewer companies selling coverage in the exchanges. In 2014, 94% of counties had five or fewer insurers on the exchange.
  • In 2015, the exchange market in 57% of US counties will feature competition among three or fewer insurers. In 2014, 78% of all counties had three or fewer insurers.
  • In Texas, 62% of the state’s counties have only one or two insurers offering coverage in the exchange in 2015. There are 14 different insurers selling policies on the Texas exchange, but no Texas county has more than nine carriers offering coverage.
  • West Virginia still has only one insurer offering coverage on the exchange in 2015. Thus, any state resident purchasing coverage on the ACA’s exchange has no choice of insurer.

A tiny bit of improvement over last year, except in West Virginia, where 100% is controlled by just one company.

But.

By another measure, this one the GAO’s, as reported at the link above,

…in 2013 the individual insurance market encompassed 1,232 insurance carriers selling full health coverage. Obamacare exchanges support just 310 insurance companies as of 2015.

Lastly, this is the trend according to the GAO since Obamacare became law; some of the data predate ObamaMart’s activation:InsurerShare

Hmm….

Crony Capitalism

Montreal-based CGI Group Inc, the company that received a $74 million contract to develop and maintain the Hawaii Health Connector web portal, will be awarded another year-long state maintenance contract despite the ongoing problems with the site.

The money comes from a $204 million federal contract the state received in 2012 to set up the Obamacare network in the islands.

This is the same crowd that had so much fun with the ObamaMart failure in 2013.

Hmm….

Obamacare and Doctoring

If you liked your doctor, you could keep your doctor. Maybe. If you were lucky, and your Obamacare Plan still had him on its cut-rate, cut-service list of acceptable (to the government) doctors.

Or, if you like the hospital that now employs him (which doesn’t guarantee you get to see him; the hospital will make that decision). After all, the government’s Obamacare

architects believe that doctors, to better bear financial risk, need to be part of larger, and presumably better-capitalized institutions.

Because, of course, these Progressive Democrats know better than doctors how to provide medical care, know better than you stupid voters how to choose doctors, and know better than either of you how to conduct the business side of any doctor-patient relationship.

In addition to that bit of Gruber-esque dishonesty and dark transparency, Scott Gottlieb, at the above link pointed out this consequence:

Local competition between providers, who vie to contract with health plans, is largely eliminated by these consolidated health systems. Since all health care is local, the lack of competition will soon make it much harder to implement a market-based alternative to ObamaCare. The resulting medical monopolies will make more regulation the most obvious solution to the inevitable cost and quality problems.

This is not at all an unintended consequence. Aside from Democrat disdain for free markets and competition, it’s long been an open goal of the Democratic Party to move our health coverage and our health provision industries into a one, linked, single-payer program—carefully run by government for our benefit, of course.

Start queueing up things to be remembered in 2016: the Democratic Party needs to be swept into history’s dustbin so this damage, among all of their other damage to our country’s weal and global standing, can be repaired.

The sweeping also should be presented as a warning to the Republican Party.

Obamacare, Take Two

…aspirin, and call your doctor in the morning. If you can find one.

Actually, this Take Two is an Obamacare second year look. I went to healthcare.gov to see what was what, after I’d done a couple of comparisons last year.

The good news is that the Web site works much more smoothly now. The bad news is that the Web site works much more smoothly now.

Taking advantage of that smoothness, I looked at some Gold plans offered in my area. As before, I selected Gold because that coverage comes closest to what I get through my wife’s employer. The failures of these plans still exist: coverages I don’t want and don’t need are forced on me (I told my doctor at my last annual that I wanted my IUD. I was paying for it, and I wanted what I was paying for. I told her that it didn’t matter where she stuck it, it was likely to fail, and I’d be back in a couple of weeks for a replacement. She chuckled over that.)

Every Gold plan offered—all seven of them—had premiums plus deductible plus out-of-pocket caps totaling in the neighborhood of $17k per year. Every year. I’d pay all of premiums and deductibles before any plan paid a single penny of my expenses, and I’d still have those caps. Certainly, that’s down from last year’s nearly 27 stacks, but still…. Those costs also are for only one person, even though I’d told ObamaMart that I was looking for coverage for two.

I can’t get a Catastrophic plan in my area anymore. Recall that last year, I could get one that—after premiums plus deductible plus out-of-pocket caps—would generously pay 60% of my costs. No more.

I looked at the down-rated Silver plans, too; there are 11 offered in my area now. Total costs ran from $19k to $23k. For coverage of one person.

There are 7 Bronze plans for me; these cost in the neighborhood of $20k. ‘Course, the folks buying these are likely to be subsidized, so they won’t be paying those 20 stacks. You and I will. In addition to the $17k-$23k (depending on our plan) we’ll pay for our own coverage.

It just doesn’t get any better than this. At least while Obamacare is in the way.