A Bit More on Health Care Coverage

Senator Susan Collins (R, ME) is worried about health care plan availability to our poor, which she thinks would be endangered were President Donald Trump to act on his thoughts regarding cutting off the funds the Feds pay to health coverage plan providers to get them to charge (artificially) lower deductibles and copays from the poor.

It really would be detrimental to some of the most vulnerable citizens if those payments were cut off. They’re paid to the insurance companies, but the people that they benefit are people who make between 100% and 250% of the poverty rate.

Couple things about this. One is that folks making more than the poverty rate…aren’t poverty-stricken.

The other is that, if the money really is intended to help folks pay for health care coverage plans, the money should go directly to those folks and not to the insurance companies. That way there would be no loss to internal friction in the middlemen of health care plan providers—a friction loss extant even in the most honest and well-intended of providers.

And one more: these aren’t insurance companies selling insurance policies.  It isn’t insurance when risks are transferred by Government fiat and at fees that bear no relation to the risks being transferred.

Collins knows these things full well.

Obamacare and Choice

There are 3,142 counties and equivalents (Louisiana has parishes, Alaska has boroughs, three States each have an independent city, Virginia has 38 of them, and State of Rhode Island and Providence Plantations does things entirely differently) in the US.

The Centers for Medicare and Medicaid Services expects that 40 of those counties will have no health care coverage plan providers at all in 2018, and 1,332 of those counties—over 40% of them—will have only one such provider.

Not to put too fine a point on the matter, but this is not choice.  This also drives home the lie of “If you like your doctor, you can keep your doctor; if you like your insurance plan, you can keep your insurance plan.”

Obamacare’s implosion is in full swing, it’s happening rapidly, and Republicans are fiddling.  They can bleat that it’s all Progressive-Democrats’ fault, that the Progressive-Democratic Party owns Obamacare to their heart’s content.  It’s irrelevant.  The Republican Party has been running on repeal and replace for the last four election cycles, and they now have majorities in both houses of Congress, and they have the White House.  The Republicans own repeal and replace—and they own the failure to make even the first syllable of progress toward that worthy end.

Timid Republicans need to find their courage and get on with the business.  Along these lines, others who demand that it all be done at once—both right damn now and in a single bill—need to recall the lessons of Obamacare as a single, all-at-once, almost right damn now bill, and they need to keep in mind political realities: Republicans in the Senate don’t have the filibuster-proof majority the Progressive-Democrats had for most of the time they were putting together their bill.

Repeal and replace can’t, won’t, and shouldn’t happen in a single bill.  It’ll need to occur as a series of bills, although those bills need to be passed in quick succession as politics go: over the course of a couple of Congressional sessions, or at most over two Congresses.

Senators Susan Collins (R, ME) and John McCain (R, AZ) are desperate to return to “regular order,” to negotiate with Progressive-Democrats and to hold hearings.  Fine.  Do that.  Those hearings need not take longer than a couple of weeks—especially if the Senate (read: Republicans) get rid of the ridiculous 2-hour per day limit on hearings—and the negotiations can be done similarly quickly, particularly since the Progressive-Democrats have shown they won’t seriously negotiate.

But get after it.  Republicans need to stop dithering, stop playing with their…fiddles…and get on with the business.  They have their own choice to make regarding their place in Government and in the nation.

Republicans and Obamacare

In a Wall Street Journal editorial about Republican Senators’ timorous attitude toward actual repeal and replace of Obamacare now that what they do matters, the editors had this remark toward the end of their piece:

One vote to watch would repeal ObamaCare with a two-year window to replace it, which is similar to a bill that 51 Senate Republicans voted for in 2015. We’ll see how many have changed their minds.

We’ll see how many have changed their minds.  The rest of that sentence is this: …now that their vote has actual consequences, and they can’t hide behind their virtue signaling.

Questions for Susan Collins

Susan Collins is the Republican Senator from Maine whose refusal to vote for the health care reform bill on offer (and any of the prior efforts) is centered on her insistence that the bill’s cuts to reductions to growth in Medicaid payments to the States—Maine in particular—are too great.  Collins needs to be asked, and required to give straight, substantive answers to, a number of questions.

What is Maine’s government doing to reduce the costs to its citizens of health care and of health coverage?

What is Maine’s government doing to make health care available to its citizens in the absence of health coverage?

On what is Maine’s government spending its citizens’ tax money on instead of Medicaid?  What does the Maine government consider to be more important than the health of its citizens?

On what basis does she insist that the citizens of New York, Illinois, California, Texas—any of the other 49 States—must be required to pay into Maine’s Medicaid program?

The Cruz Amendment

Senator Ted Cruz (R, TX) has a provision in the latest Senate health bill that’s on offer, one that would allow sellers of actual health insurance to sell non-Obamacare compliant policies on the condition that they also sold Obamacare compliant plans on the ObamaMart.  The idea, and it’s a sound one, is that those plans, better tailored their customers’ needs, would soon have commensurately lower premiums, deductibles, and copays and thereby be more affordable.

Health plan sellers don’t like it, though.

While this setup could offer healthy people less expensive policies, insurers and actuaries say it would likely prove dysfunctional over time, pushing up rates and reducing offerings for people buying the compliant plans.

That’s a market decision, though; nothing in the provision or in the overall bill would require the plan sellers offer fewer compliant plans or at higher premiums.

Aside from that, those non-compliant plans would be better tailored—market forces would require it—have fewer items covered that a plan purchaser doesn’t want or need—market forces would push plan sellers to stop forcing contraceptive coverage on men and geriatrics or prostate cancer coverage onto women—and they would, as advertised, have much lower premiums, smaller deductibles, and lower copays.

They would also attract customers, low income and others, from those ObamaMart plans into the non-compliant market because those better tailored and cheaper plans would better suit their needs, too.

Maybe the health care coverage welfare plan providers—sorry, the health insurance companies—don’t want the noise of competition; maybe they prefer the steady, safe income of government subsidies in the form of customers trapped in their protected monopoly in the health “insurance” industry.  Maybe that’s why so many of these companies are leaving ObamaMarts, leaving folks with few plan choices or no plans to buy at all—because the industry as Obamacare has changed it is so sound.

On the other hand, the Progressive-Democrats in Congress should jump on this provision with both feet.  Obamacare plans are terrific, they insist.  Surely, in their wonderfulness, these plans would win resoundingly in the competition of the market place.  Especially with so many of those plans still subsidized through other provisions in the bill.  Wouldn’t they?