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An Obamacare Update

It looks like Republicans are abandoning their full-on “repeal-and-delay” strategy. The new plan [1]:

“It is our goal to bring it all together concurrently,” [House Speaker Paul] Ryan said.

“We will pass as much as we can” initially, Ryan said. He said Republicans would then produce a second bill to “show you the full scope of what a real replacement effort looks like.”

Let me try to unpack this.

As I’ve noted a few times in this space, Republicans have just 52 Senate votes. They can pass budget-related provisions with 50 votes, but to repeal Obamacare’s tangle of insurance regulations, they need 60 votes to overcome a filibuster. In the old plan, they’d have set the law’s funding to expire at some point in the future (using the 50-vote process), forcing Democrats to help enact a full replacement (through the normal 60-vote process) before that point.

In the new plan, Republicans will do “as much as [they] can” in the reconciliation bill, including replacement provisions where possible—i.e., when they affect the budget. But the law’s regulations will remain intact, so Republicans will bring out another bill to handle those.

That second bill will need 60 votes. The big question is what leverage Republicans will have over Democrats at that point.

After the first bill, will the health-care market be left in a basically functional form, tempting Democrats to wait for a better political climate in which to pursue further reforms? Or is this basically a milder variant of the old repeal-and-delay strategy, where Republicans set a time bomb, threatening to destroy the market if Democrats don’t help them pass reforms? It will depend, obviously, on the exact content of the first bill.

Robert VerBruggen is managing editor of The American Conservative. Follow @RAVerBruggen [2]

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15 Comments To "An Obamacare Update"

#1 Comment By SteveM On January 10, 2017 @ 2:56 pm

I’ve said it before. Fundamentally, the Republican alternatives are Obamacare without the mandates. I.e., subsidized premiums for marginal value “catastrophic” policies with stratospheric deductibles ($6,000+ for an individual). And no doubt paper thin provider lists like with Obamacare.

And with illusory Health Savings Accounts (HSA) tacked on, even though the low wage workers stuck with the plan don’t even make enough money to contribute to an HSA.

Here is a not atypical example I posted about the Obamacare shortfalls:

Working class guy with no employer provided insurance has a painful bad knee. He does have a subsidized Obamacare policy with the standard $6,000 deductible.

He knows that if he goes to see an orthopedist, he’d need $250 for the initial consult, $400 for the x-rays and $1,400 for the MRI. In other words, he would need $2,050 in CASH just for the diagnostic. No way he can come up with that with a payday loan or by selling his beater car. So hit sits at home and suffers.

Which demonstrates Obamacare to be a cruel illusion that provides access to health insurance, but not health care.

Apart from the political machinations, perhaps Peter VerBruggen could explain how that guy would get access to care with an envisioned Republican “catastrophic” policy instead. And maybe fill us in as to whether he thinks the working poor should get any treatment at all if they don’t have the up front cash.

P.S. Scratch the surface of HHS designate Dr. Tom Price and you’ll find a Crony Social Darwinist out to protect his MD pals as the first priority.

P.P.S. Make no mistake, there are no “good guys” on the supply side of health care, (doctors, insurance companies, hospital conglomerates, Big Pharma.) It’s all about the money…

#2 Comment By EliteCommInc On January 10, 2017 @ 3:15 pm

Republicans bock — Ohh what a shock.

Not at all. As with all big government programs easier to build than dismantle or repair.

So much for the cliche’ easier to destroy than build. Especially when you lack the will, fortitude and integrity to do so.

#3 Comment By P.L. Kirst On January 10, 2017 @ 3:24 pm

“…where the Republicans set a time bomb, threatening to destroy the market if Democrats don’t help them pass reforms?”

I admit I have not thought deeply on that half sentence, but it sounds a whole lot like a person putting a gun to their own head and threatening to pull the trigger of someone else doesn’t do what they want them to do.

#4 Comment By Adam Kolasinski On January 10, 2017 @ 4:10 pm

While I did not end up voting for Hillary (I voted 3rd party), I will confess that the prospect of having Obamacare implode while Hillary was president was a potential benefit of having her win the election.

Obamacare is going to implode, and if the GOP, together with Trump, can’t replace it with something functional before that happens, they are going to get the blame.

If I were a politician, I’d much rather have the implosion happen while the other party is in power in the hopes of gaining in the next election a mandate to replace.

#5 Comment By Brandon Ruth On January 10, 2017 @ 5:33 pm

I sincerely hope that Congress is considering additional support for health-sharing ministries, or similar constructs, like Samaritans Ministries. Information about that program can be found here:

[3]

It is currently exempt from the mandate and is an excellent alternative even with ACA in place.

#6 Comment By Dakarian On January 10, 2017 @ 11:05 pm

“Adam Kolasinski says:
January 10, 2017 at 4:10 pm
While I did not end up voting for Hillary (I voted 3rd party), I will confess that the prospect of having Obamacare implode while Hillary was president was a potential benefit of having her win the election.

Obamacare is going to implode, and if the GOP, together with Trump, can’t replace it with something functional before that happens, they are going to get the blame.

If I were a politician, I’d much rather have the implosion happen while the other party is in power in the hopes of gaining in the next election a mandate to replace.”

I voted for Hillary and I had a small inkling that this was going to be the Republican gameplan before Trump won. Use Trump’s loss to get the more ‘crazier’ elements of their party more in line, use the tarnish put on hillary combined with her low approval rating and falling out of Obamacare as leveraging tools not unlike what happened with Bill.

For myself, part of why I wanted Hillary over Trump was because I expected her to be put under hot coals by a VERY angry Trump coalition and the Bernie democrats forcing her to compromise or get eaten alive by a country that don’t trust her like they did Obama.

But we get Trump. And in that I hope that those that voted for him aren’t giving him a blank check. We already had that with Bush Jr and you see how well that turned out.

#7 Comment By Roger Elliott On January 11, 2017 @ 12:12 am

Republicans have the business acumen to fix Obamacare. If they don’t or won’t, it will be the least possible statesmanship imaginable. Repealing takes no brains. Replacing does. Simply said, it requires the party in power to care more about doing the right thing than seeing Democrats go down with their ship. Except there’s only one ship. That ship is America. And all Americans are on board it. The GOP sounds like it’s not interested in being a statesman and would rather run us all aground, rather than fix the hull.

#8 Comment By paradoctor On January 11, 2017 @ 12:50 am

I see three options:
* Damage Obamacare slightly, and call it Trumpcare.
* Full repeal, market chaos, de facto death panels.
* Medicare For All.

Option 2 would result in option 3 after enormous public suffering. Option 1 would require cooperation between establishment Republicans and Trump.

#9 Comment By Mz On January 11, 2017 @ 1:43 am

Honestly the GOP has been wanting to remove Obamacare for years, and yet they do not even have a complete plan of action as to how they will keep those who are now insured. While im no fan of Obamacare, i will say millions are now insured, and although it is flawed it can be fixed. This is where the GOP should come in and instead of getting rid of all of it,they should reform it. If not, then the GOP will be hitting a dead end, and the ones to pay will be all those who are now insured,and could be at risk of being unisured.

#10 Comment By SteveM On January 11, 2017 @ 10:34 am

Re: “While im no fan of Obamacare, i will say millions are now insured, and although it is flawed it can be fixed.”

Obamacare can’t be fixed. American per capita health costs are $10,000 a year per person! The Republican plans merely move the “who pays” food around the plate. There are no effective mechanisms proposed to effectively contain costs. None. The Republican cronies are lying out their collective wazoo.

The combined crony-saturated pathologies of health care and the hyper-metastasized National Security State are systemically busting the American economy.

German per capita health care costs are 47% lower than the U.S. There are other health care models to consider. But the crony parasites that control the massive health care apparatus will never allow those transformational models to be considered.

To say nothing of containing the war-mongers and fear-mongers that pull the levers for the Security State to hoover up a TRILLION bucks a year wrecking other countries by playing Global Cop.

What can’t go on forever – won’t…

Stick a huge, lethal, penetrating fork in America – because it is way over-cooked.

#11 Comment By Bruce On January 11, 2017 @ 4:19 pm

Why do we need the Federal government to write a bill for the health insurance market. The market can and will exist without any direction from the Feds. Why does Congress think it is necessary, or even can, define a health insurance market?

#12 Comment By Dennis J. Tuchler On January 11, 2017 @ 5:31 pm

What will we end up with? Maybe what we would have NOW were the Republicans willing to participate in framing the national health policy THEN during Obama’s first term?

#13 Comment By John On January 12, 2017 @ 7:44 pm

Although it may no longer be on the table, at one point the Republican plan was ‘universal access.’ Translated, that seems to mean ‘If you want to buy whatever health insurance the market has to offer at whatever price, no one will stop you.’

Trump promised better care at lower cost for all Americans. Single payer would get there. But the rest of his party has no interest in meeting those goals, certainly not via single payer. The main goal is to reduce federal spending on medical services across the board, freeing up a substantial sum for the promised corporate and 1% tax cut.

#14 Comment By Nelson On January 15, 2017 @ 12:32 pm

Medicare for all seems like the sensible option. Democrats would back it too!

#15 Comment By Greg On January 18, 2017 @ 3:44 pm

If medical care didn’t cost so much this whole thing would be a non-issue. They can start by passing a bill that limits a person’s meds at $1000 per year max for a course of treatment. Or something similar. And limit facility and doctors’ bills to no more than 150% of Medicare rates. Dump the mandate. Ta dah, Trumpcare!