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You are here: Home / Anderson On Health Insurance / Reminder: The unpopular stuff was needed

Reminder: The unpopular stuff was needed

by David Anderson|  December 7, 20166:00 am| 18 Comments

This post is in: Anderson On Health Insurance, All we want is life beyond the thunderdome, I Can't Believe We're Losing to These People, I Reject Your Reality and Substitute My Own

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Via TPM, Senator Corker (R-TN) is stating an impossibility:

“You really do have to have 60 votes to replace and you know reconciliation can create some hangover effects as we’ve seen with the health care bill itself and with the Bush tax cuts and all of that so are you better off going ahead and attempting to put something in place that will work that does away with all the negatives that exist in ACA, but builds on some of the positives?” Corker asked. “Again, President-elect Trump mentioned, I thought wisely during the campaign, that replacement and repeal should be done simultaneously.”

The negatives (mandates, reinsurance, risk adjustment, risk corridors) and the annoying (narrow networks, HMO’s, high cost sharing) were needed to make the popular stuff work (guarantee issue, community rating) work.  Definitions as to what counted as a qualified plan were needed.  Definitions as to what counts as an essential health benefit were needed.  All of the negatives were needed .  They can be tweaked and twisted.  The continual enrollment concept changes the form of a mandate but performs the same function of making going without coverage too expensive to be attractive.  The negative stuff was not put into the bill for shits and giggles.

About the only major things in the medical coverage expansion sections of the ACA that don’t need the negatives of the ACA are Medicaid expansion and the Under-26 coverage expansions.  Those are easy things that are severable from the core of the three legged stool.  One is state by state single payer and the other is an expansion of multi-payer community rated/guaranteed issue coverage.

We’ll see this refrain at least four times a week for the next four years.  Health policy is hard even if the objective is to present a patina of coverage in order to loot.  Actually providing a usable coverage expansion is harder.

 

Update 1: Victor in comments makes a very good point:

I think it is also fair to point out that most of the stuff on the revenue side was also unnecessary. The ACA can work without the employer mandate or the cadillac tax although the Cadillac tax is a good economic policy. The employer mandate was a fine rule from a fairness issue but can easily cause labor market distortions.

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Reader Interactions

18Comments

  1. 1.

    Zinsky

    December 7, 2016 at 6:19 am

    As I have posted many times, these Republican reptiles are not interested in responsible governance or in ensuring that all Americans have access to affordable health care (is that really such a horrible goal?). What is sad and frustrating are the millions of rubes out there who believe they are!

  2. 2.

    OzarkHillbilly

    December 7, 2016 at 6:41 am

    Wahhhh, I want my magic pony.

  3. 3.

    Pseudonymous Bosch

    December 7, 2016 at 6:52 am

    Health policy is hard even if the objective is to present a patina of coverage in order to loot.

    And that is exactly the objective.

  4. 4.

    Patricia Kayden

    December 7, 2016 at 6:54 am

    All of the negatives were needed .

    Yep. And I’m sure Republicans will figure that out pretty soon when their repeal fever breaks. Are they really prepared to take away healthcare access to the 20 million who benefited under the ACA? I doubt it.

  5. 5.

    OzarkHillbilly

    December 7, 2016 at 6:59 am

    @Patricia Kayden: Sure they are, they’re itching to do it, fucking over poor people is what they live for, they just haven’t found a way to blame the DEMs for it yet.

  6. 6.

    rikyrah

    December 7, 2016 at 7:15 am

    Keep on telling the truth, Mayhew.

  7. 7.

    rikyrah

    December 7, 2016 at 7:17 am

    Everytime I think about the 20 million who gained healthcare because of Obamacare, the blues come.???

  8. 8.

    Patricia Kayden

    December 7, 2016 at 7:38 am

    @OzarkHillbilly: I’m hoping Dems stick together to oppose any changes to the ACA which don’t strengthen it. That way Repubs cannot blame Dems for taking away healthcare access to 20 million of their fellow Americans. We’ll see how the so-called blue dog Dems handle this.

  9. 9.

    OzarkHillbilly

    December 7, 2016 at 7:50 am

    @Patricia Kayden: So am I, for the same reasons, but that won’t stop Repubs from blaming DEMs, they’ll just say it was broke from the beginning and they’re being forced to “fix it”. As to Blue Dogs, are there more than a half dozen or so left?

  10. 10.

    sunny raines

    December 7, 2016 at 7:56 am

    if repealing ACA eff’s over the the ignorant garbage that voted for trump, and blue states implement their own ACA’s to cover the vulnerable in their states – have at it.

    republican voters NEED to bear the full weight of the effluent they have sown. There is no solution to stupid other than the stupidee wising up to the source of the pain that stupid invokes.

  11. 11.

    satby

    December 7, 2016 at 8:02 am

    @rikyrah: I’m one of them, and debating if I should pay the premium for January next year since I renewed or just skip it. I won’t be able to schedule any doctor visits in that month, and I’m not in a position to pay that much (even with a subsidy) if it’s only going down the drain. Yeah, I could get hit by a bus, so it’s worth it that way, but I have more pressing needs for the small amount of money I earn.
    Same calculation all is poor make about everything all the time.

  12. 12.

    Lurking Canadian

    December 7, 2016 at 8:29 am

    @Patricia Kayden: Yes. That is what they want. They also want to take it away from the millions who currently rely on Medicare.

    They’re going to try to spin it that the US could never afford Obamacare, but that rat bastard Obama was stealing from the Medicare trust fund for eight years to pay for all the gay abortions, and now the cupboard is bare. Thus, with a heavy heart, they must do what is difficult but necessary and take away grandma’s pills.

    CNN and NYTimes will publish, “Some left-leaning economists dispute this narrative, but here’s Snidely Whiplash from the AEI with his view…”

  13. 13.

    OzarkHillbilly

    December 7, 2016 at 8:33 am

    @satby: Pay it. Last I heard was a 3 year time line to shut it down.

  14. 14.

    Victor Matheson

    December 7, 2016 at 8:59 am

    Richard,

    I think it is also fair to point out that most of the stuff on the revenue side was also unnecessary. The ACA can work without the employer mandate or the cadillac tax although the Cadillac tax is a good economic policy. The employer mandate was a fine rule from a fairness issue but can easily cause labor market distortions.

  15. 15.

    MattMinus

    December 7, 2016 at 9:18 am

    @satby:

    Even in the event of a repeal, nothing is going away for 2-3 years.

  16. 16.

    mai naem mobile

    December 7, 2016 at 9:58 am

    @Patricia Kayden: I wonder if the bluedogs need to go along with the gop since Lumpy won their states and most if not all their governors didn’t accept the medicaid expansion.

  17. 17.

    Richard Mayhew

    December 7, 2016 at 11:02 am

    @Victor Matheson: Agreed — the revenue side stuff was only “neccessary” as long as the marginal votes to pass the bill demanded at least budget neutrality if not actual cost savings.

  18. 18.

    Applejinx

    December 7, 2016 at 4:21 pm

    Reminder: the unpopular stuff was necessary to protect the American healthcare system as it’s currently constituted, rather than outright destroying it.

    I don’t concede that protecting it, as it is, must be the only correct answer. Trouble is, wrecking it may well cause more problems than it fixes, because the system’s so entrenched: it’s a huge chunk of the economy. And that alone is inexpressibly troubling and wrong. That is WRONG.

    I don’t see any good way out of this. Maybe we’ll end up seeing some of the bad ways, then.

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