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“The GOP’s Obamacare Alternative; Crickets”: Now Railing Against Obamacare Without Having To Come Up With A Replacement

Now that the Supreme Court has saved the Affordable Care Act for a second time, what do Republicans do? We already know they won’t tone down their rhetoric and will continue to call for repeal because that’s what Republican primary voters want to hear. The candidates will package together vague alternative proposals that they will pledge to pass and enact as the first act of their presidency.

But they don’t have even a remote chance of repealing the ACA, even if a Republican is elected president in 2016.

“The ruling is the last gasp,” says Chris Jennings, a health policy expert who worked in both the Clinton and Carter administrations. While the presidential contenders will keep alive the hope for their base that if elected they can sweep away Obamacare, Jennings says the issue will be dead and gone by fall 2016. The voters will have moved on.

Conservatives feel betrayed yet again by Chief Justice John Roberts joining with the liberals on the Court to uphold the constitutionality of the ACA, but they should thank Roberts. He saved the GOP from having to bail out 6½ million people, the majority of them in red states, who would have lost their health insurance if the Court had ruled the other way.

Now Republicans can continue to rail against Obamacare without the responsibility of actually coming up with a law to replace it. “This decision gives them a vast canvas on which to write,” says Jack Pitney, a government professor at Claremont McKenna College in California. “There’s no need for immediate replacement, so rhetoric will fill the vacuum of legislation.”

There will be proposals, enough to satisfy the GOP faithful that the presidential candidates are doing something to end the abomination of Obamacare. But these will not be serious efforts because it is not possible to write health-care legislation that leaves in all the goodies everybody supports, like no discrimination for preexisting conditions, and leaves out what people oppose, like the mandate.

A reading of the majority opinion written by Roberts reveals that he paid close attention to the argument put forth by the health insurance industry in an amicus brief. Without the subsidies, millions could not afford coverage and only those with significant medical expenses would apply, sending the ACA into a “death spiral.”

The Roberts Court handed another lifeline to President Obama, but the decision is also a huge victory for the health industry. Asked how difficult it is for the GOP to step in with their own plan to counter Obamacare, Ceci Connolly, a Health Research Institute Leader and a former Washington Post reporter covering politics and health care, countered with some hard numbers. “The 2.9 trillion dollar health sector is exceedingly complex and changing; it takes an enormous amount of time and work,” she said. “Not only has the ACA expanded coverage, it has pumped billions of dollars in revenue to the health industry, and going back would upset a very large and important market.”

If the subsidies were removed or denied, it would have cost the health industry $36 billion in premium revenue next year alone, Connolly told The Daily Beast. Hospitals would have seen their revenue fall about $9 billion. While still a fraction in a huge market, “that’s real money to the industry,” she says. “The legislative process is cumbersome to say the least, and it would be a steep climb to replace the ACA.”

If a Republican president is elected, and the GOP retains the Senate along with the House, “that’s a new ballgame,” Connolly said. “But by 2017 the law would have been implemented for seven years. It’s very hard to take away benefits and significantly restructure a market as big as the health care market.”

Connolly noted that the executives her research group talks to around the country anticipated the decision to come down the way it did. “They could not imagine the subsidies being taken away.”

The phrase that political scientists use is “past dependency.” Once a major policy is entrenched, it’s very difficult to change in a major way. We’ve seen that with social security and Medicare, programs that President Obama invoked in his remarks in the Rose Garden about the ACA’s rite of passage into “the fabric of America.”

 

By: Eleanor Clift, The Daily Beast, June 25, 2015

June 29, 2015 Posted by | Affordable Care Act, GOP, SCOTUS | , , , , , , , | 1 Comment

“Rube Goldberg Survives”: Face It Republicans, Health Reform Has Won

Holy seven million, Batman! The Affordable Care Act, a k a Obamacare, has made a stunning comeback from its shambolic start. As the March 31 deadline for 2014 coverage approached, there was a surge in applications at the “exchanges” — the special insurance marketplaces the law set up. And the original target of seven million signups, widely dismissed as unattainable, has been surpassed.

But what does it mean? That depends on whether you ask the law’s opponents or its supporters. You see, the opponents think that it means a lot, while the law’s supporters are being very cautious. And, in this one case, the enemies of health reform are right. This is a very big deal indeed.

Of course, you don’t find many Obamacare opponents admitting outright that 7.1 million and counting signups is a huge victory for reform. But their reaction to the results — It’s a fraud! They’re cooking the books! — tells the tale. Conservative thinking and Republican political strategy were based entirely on the assumption that it would always be October, that Obamacare’s rollout would be an unremitting tale of disaster. They have no idea what to do now that it’s turning into a success story.

So why are many reform supporters being diffident, telling us not to read too much into the figures? Well, at a technical level they’re right: The precise number of signups doesn’t matter much for the functioning of the law, and there may still be many problems despite the March surge. But I’d argue that they’re missing the forest for the trees.

The crucial thing to understand about the Affordable Care Act is that it’s a Rube Goldberg device, a complicated way to do something inherently simple. The biggest risk to reform has always been that the scheme would founder on its complexity. And now we know that this won’t happen.

Remember, giving everyone health insurance doesn’t have to be hard; you can just do it with a government-run program. Not only do many other advanced countries have “single-payer,” government-provided health insurance, but we ourselves have such a program — Medicare — for older Americans. If it had been politically possible, extending Medicare to everyone would have been technically easy.

But it wasn’t politically possible, for a couple of reasons. One was the power of the insurance industry, which couldn’t be cut out of the loop if you wanted health reform this decade. Another was the fact that the 170 million Americans receiving health insurance through employers are generally satisfied with their coverage, and any plan replacing that coverage with something new and unknown was a nonstarter.

So health reform had to be run largely through private insurers, and be an add-on to the existing system rather than a complete replacement. And, as a result, it had to be somewhat complex.

Now, the complexity shouldn’t be exaggerated: The basics of reform only take a few minutes to explain. And it has to be as complicated as it is. There’s a reason Republicans keep defaulting on their promise to propose an alternative to the Affordable Care Act: All the main elements of Obamacare, including the subsidies and the much-attacked individual mandate, are essential if you want to cover the uninsured.

Nonetheless, the Obama administration created a system in which people don’t simply receive a letter from the federal government saying “Congratulations, you are now covered.” Instead, people must go online or make a phone call and choose from a number of options, in which the cost of insurance depends on a calculation that includes varying subsidies, and so on. It’s a system in which many things can go wrong; the nightmare scenario has always been that conservatives would seize on technical problems to discredit health reform as a whole. And last fall that nightmare seemed to be coming true.

But the nightmare is over. It has long been clear, to anyone willing to study the issue, that the overall structure of Obamacare made sense given the political constraints. Now we know that the technical details can be managed, too. This thing is going to work.

And, yes, it’s also a big political victory for Democrats. They can point to a system that is already providing vital aid to millions of Americans, and Republicans — who were planning to run against a debacle — have nothing to offer in response. And I mean nothing. So far, not one of the supposed Obamacare horror stories featured in attack ads has stood up to scrutiny.

So my advice to reform supporters is, go ahead and celebrate. Oh, and feel free to ridicule right-wingers who confidently predicted doom.

Clearly, there’s a lot of work ahead, and we can count on the news media to play up every hitch and glitch as if it were an existential disaster. But Rube Goldberg has survived; health reform has won.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, April 3, 2014

April 6, 2014 Posted by | Affordable Care Act, Health Reform, Republicans | , , , , , , , | Leave a comment

   

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