The ‘Repeal and Delay’ Scam

For almost seven years, Tea-Publicans engaged in the scam of “repeal and replace” of the Affordable Care Act aka “ObamaCare.” “Almost seven years after Obamacare was enacted, Republicans haven’t offered even the broad outline of a health reform plan.” The Art of the Scam. It was always just an exercise in post-policy nihilism: opposition to ObamaCare solely for the purpose of partisan opposition.

Now that Tea-Publicans are in control of the entire federal government and their right-wing wet dreams can finally be realized, they have a new scam: “repeal and delay.”

[T]he emerging Republican health care strategy, according to news reports, is “repeal and delay” — vote to kill Obamacare, but with the effective date pushed back until after the 2018 midterm elections. By then, G.O.P. leaders promise, they’ll have come up with the replacement they haven’t been able to devise over the past seven years.

There will, of course, be no replacement. And there’s likely to be chaos in health care markets well before Obamacare’s official expiration date, as insurance companies exit markets they know will soon collapse. But the political thinking seems to be that they can find a way to blame Democrats for the debacle.

The Septuagenarian Ninja Turtle, Senate Majority Leader Mitch McConnell, the architect of the “just say no” total partisan obstruction of anything from Democrats and the Obama administration for the past 8 years, now says Repealing Obamacare to Be First on Senate Agenda in 2017:

McConnell did not say when the repeal of the Affordable Care Act, as it is officially known, would go into effect. Senator John Barrasso said it might be effective in two or three years, and that the timeframe was still being debated. [Because it is always about partisan politics, not sound public policy.]

Democrats scoffed at the Republican plans, saying they do not even know what they want to replace Obamacare with.

As Greg Sargent noted, Republicans suddenly discover that Obamacare repeal might not be so awesome, after all:

During the Obama years, congressional Republicans could rail away at the Affordable Care Act and vote endlessly to repeal it, secure in the knowledge that they would never have to deal with the consequences of repeal actually happening. At the same time, they could claim they wanted to keep the popular parts (protections for people with preexisting conditions) without explaining how that might be accomplished while jettisoning the unpopular parts (the individual mandate).

But now, repeal has suddenly become a reality. President-elect Donald Trump’s choice of GOP Rep. Tom Price as Secretary of Health and Human Services underscores that he is dead serious about going forward with repeal-and-maybe-replace. Which means congressional Republicans (who will have to vote on repeal and then later maybe on replace) now have to grapple with the consequences of repeal actually happening — and with the challenges of keeping the stuff people like while blithely tossing out the stuff they don’t.

The New York Times explains Why It Will Be Hard to Repeal Obamacare:

Republicans plan to repeal much of the Affordable Care Act, sometimes referred to as Obamacare. But the law’s parts are interdependent, and removing some aspects while keeping others will be very difficult.

These five parts of the law would be hard to remove because Republicans would need 60 votes in the Senate — they have 51.

• Pre-existing conditions
• Parents’ policies until age 26
• Essential health benefits
• Limits on age rating
• Ban on setting rates on health status

And Mr. Trump has said he actually wants to keep two of these components: Pre-existing conditions, and Parents’ policies until age 26.

But Republican leaders are considering legislation that would do away with many other provisions, e.g., cost sharing subsidies and contraception coverage.

Mr. Trump can get rid of these two things himself by ordering a regulatory change.

The Republican-controlled House and Senate can eliminate these five parts using a [budget reconciliation] process that requires only 51 votes in the Senate:

• Employer mandate
• Individual Mandate
• Premium subsidies
• Medicaid expansion

But policy experts warn that taking away the government subsidies and the mandate to buy insurance while keeping the harder-to-change provisions, like the pre-existing conditions policy, would destabilize the insurance market.

Eliminating premium subsidies would put health insurance out of the financial reach of millions of Americans who now have coverage.

Both the subsidies and the mandate are needed to keep young, healthy people in the insurance pool.

Insurance companies need young, healthy people to help pay for older, sicker customers. Without them, the companies would have to raise premiums, and millions more could be priced out of insurance.

One central component of the health law could affect millions of poorer Americans if removed: Medicaid expansion.

Rolling back the expansion, which gave more people Medicaid coverage in 31 states, would leave more than 10 million without health insurance.

In all, the Congressional Budget Office has estimated that 22 million people could lose health insurance if key parts of the law are removed.

A new study from the nonpartisan Urban Institute looks at a scenario where “repeal” goes through, but “replace” stalls. Repealing President Barack Obama’s health care law without a replacement risks making nearly 30 million people uninsured. Study: ‘Obamacare’ Repeal-Only Would Make 30M Uninsured:

The new analysis warns that repealing major parts of the health law without a clear replacement could upend the health insurance market for people buying their coverage directly, outside of the workplace. That group has grown substantially under the health care law, but also includes millions of other customers.

The study found that 22.5 million people would lose coverage directly due to repeal of the law’s subsidies, Medicaid expansion, and its individual requirement to carry health insurance.

Another 7.3 million would become uninsured because of the ripple effects of market upheavals. That could happen if insurers lose confidence in the Republican promise of a replacement and abandon the individual market. A key industry worry is that a repeal law would get rid of subsidies and mandates but still leave insurers on the hook for covering people with health problems.

The number of uninsured people would rise to nearly 59 million in 2019, since the ACA did not completely eliminate the problem of people without coverage. As a result, the nation would have a higher uninsured rate than when the ACA passed in 2010, the study found.

* * *

The concerns raised by the Urban Institute study were underscored Wednesday in a letter to congressional leaders from the American Academy of Actuaries. The group represents professionals who advise corporations and government on how to design and maintain benefit programs like pension and health care plans.

The actuaries said even if Congress delays the date of repeal, the uncertainty could prompt insurers to stop offering individual plans for people not covered by employers.

“Delaying the effective date of repeal while a replacement is worked out likely won’t be enough to assure the stability and sustainability of the individual market,” wrote Shari Westerfield, the group’s vice president for health care practice.

Hospitals also have warned that they would suffer heavy financial losses if Congress repeals coverage for millions of new paying customers. Those would be magnified if lawmakers leave in place cuts that hospitals accepted as part of the deal to pass the Obama health law. Hospitals warn Trump, Congress of massive losses with Affordable Care Act repeal:

The nation’s hospital industry warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”

The nation’s health insurers have publicly outlined what the industry wants to stay in the state marketplaces, which have provided millions of Americans with insurance under the law. Health Insurers List Demands if Affordable Care Act Is Killed:

[The insurers] say they need a clear commitment from the Trump administration and congressional leaders that the government will continue offsetting some costs for low-income people. They also want to keep in place rules that encourage young and healthy people to sign up, which the insurers say are crucial to a stable market for individual buyers.

The demands are a sort of warning shot to Republicans. While the party is eager to repeal the law as quickly as possible, and many have promised a replacement, its members are sharply divided over what shape any new plan should take. If they do not come up with an alternative, more than 22 million people would be left uninsured, including the more than 10 million who have bought individual plans on state marketplaces.

* * *

Ms. Tavenner did not give many details about her group’s positions, but she said its top priority was to stop the immediate threat of eliminating the subsidies for plans sold to low-income people. House Republicans have already sued to block these payments, and the lawsuit is now delayed. If the new administration chose not to defend the lawsuit, the money would disappear, and insurers would probably rush to the exits because fewer potential customers would be available.

Another of the industry’s concerns is ensuring that enough young and healthy people sign up to stabilize the market. Republicans have discussed eliminating one of the law’s main tools, the so-called individual mandate, a tax levied on those who do not enroll.

Margot Sanger-Katz writes, An Obamacare ‘Delay’ Plan Could Backfire:

The nickname for the [GOP] plan is “repeal and delay,” and the assumption underlying it is that the current system will be sustainable for as long as it takes Congress to pass and the White House to install a new health plan.

The plan might be better described as “zombification.” It is not at all clear that Republicans can easily time the expiration date of the Obamacare markets. Insurance experts say the resulting zombie market — not dead, but not alive either — would suffer from many of the maladies of the existing system, and quite a few more. The result on the books might look like the status quo, but millions of Americans could lose their insurance and others could pay much higher prices to keep their coverage.

* * *

Obamacare was devised as a market system rather than a government program like Medicare . . . There’s nothing in the health law that forces insurance companies to sell insurance if they don’t want to — as we learned this year, when several major carriers exited the market. And there’s good reason to think that, with the death of Obamacare looming, many more companies would rethink their decision to sell Obamacare policies in the zombie interval.

“Why go through the hassle for something that’s going away anyway?” said Jon Kingsdale, who teaches at Boston University and is a director at the actuarial firm Wakely Consulting Group. Mr. Kingsdale, a former insurance executive, said that insurance companies had tended to weigh the short-term pain of remaining in the Obamacare markets against their long-term hope that markets would stabilize, grow and prove profitable. That calculus would change in an instant if the law were repealed, he said. “This is the perfect excuse to get out,” he said.

* * *

The result could be bare patches around the country — places where no company is selling insurance, and where no one can get access to tax credits to buy it. That might look a lot more like a quick repeal plan than a carefully planned “delay.”

* * *

Christopher Condeluci, who was a G.O.P. finance committee counsel when Obamacare passed and now runs a policy consulting business, said he had spoken with current staffers considering such options. Over the last few years, Republicans have resisted changes that would make Obamacare work better, but Mr. Condeluci said that the election had shifted the outlook.

“If there’s disruption, even in a wait for repeal and replace, Republicans are going to look terrible,” he said. “And the Democrats are going to rightly blame them.”

Finally, Steven Pearlstein wryly notes, Under Trump, red states are finally going to be able to turn themselves into poor, unhealthy paradises, as does Greg Sargent, Obamacare is probably toast. And a lot of poor, white Trump voters will get hurt by it.

If only we could limit the harm to those people who foolishly voted for the Tea-Publicans and their con game on ObamaCare. Unfortunately, their foolishness will affect us one and all.