This post is purely speculative.
It’s really quite remarkable that the administration is letting uncertainty about CSRs persist, increasing premiums and government costs.
— Larry Levitt (@larry_levitt) October 4, 2017
We need to think through the impact of Cost Sharing Reduction kerfluffle a bit more. I want to sketch out a couple of poorly written campaign commercials we could see in October 2018 depending on how things work out. These commercials will “air” in the district of a Republican incumbent. I am assuming that incremental voters don’t care about process nor deficits.
Scenario A: CSR not funded in 2018, appropriated in 2019
Commercial 1: “For the first time since 2014, insurance premiums are going down because of the strong leadership of Rep. Doe, re-elect him and we can get the patient-centric healthcare system that is run by you and your docs and not Washington bureaucrats….”
Commercial 2: “Rep. Doe sabotaged the exchanges that caused premiums to spike and after a bipartisan majority voted to fund cost sharing subsidies that brought the rates back down to where they should have been in the first place….Vote Smith for Congress….”
Scenario B: CSR is not funded in 2018 nor in 2019 and the state has loaded all CSR costs onto Silver plans for 2019
Commercial 3: “I voted against the unconstitutional insurance company bail-out of Obamacare. Now, more families can afford good coverage that is driven by them and their docs and not Washington bureaucrats…. Re-elect Rep. Doe ”
Commercial 4: “He is intentionally sabotaged the exchanges, costing the government more than $194 billion dollars… We can do better as Smith supports using this new revenue stream on effective re-insurance waivers to lower costs…. ”
There are three take-aways from these commercials.
First, I should never write ad-copy.
Secondly, the situation after not appropriating CSR funding is an expensive and inefficient improvement over the status quo. Many people have complained that the ACA insurance, even with subsidies, is too expensive with too much cost sharing. Not funding CSR with states loading CSR costs only into Silver plans, directly addresses this complaint for people who make between 200 percent and 400 percent of the Federal Poverty Line (FPL). And if states get aggressive about routing money into re-insurance waivers, premiums will decrease off-Exchange as well.
Finally, weird things are going to happen as the facts on the ground change.
I think health care politics are going to be much more confusing in October 2018 than now. The reality on the ground in 2018 will be very different than it is now. That changed reality will matter.
rikyrah
Everything bad in healthcare can be laid at the feet of the GOP.
THAT should not be a point of confusion.
Also, the votes for Trumpcare need to be hung around the neck of every Republican.
NotMax
“You’re paying more. This person is why.”
Simple and to the point.
Fester Addams
Seems to me most advertising copy is written using a simple two step process: (1) identify the product’s greatest weakness, and (2) lie about it.
David Anderson
@NotMax: Then you have to explain it as it is a nuanced argument as you’re dealing with a counterfactual… It gets complicated fast.
NotMax
@David Anderson
No, it’s an ad not a treatise. Get in, make the point, get out.
Balconesfault
It would be interesting to get the records from the victims being treated in Las Vegas and see how many would not have insurance right now if it wasn’t for the ACA. Imagine going into bankruptcy having to pay for bills from being shot by a mass murderer.
Just One More Canuck
@NotMax: I would just change what you said to “you’re paying more and getting less. This person is why”
NotMax
@NotMax
Case in point (from the other side) – the Harry & Louise ads.
NotMax
@Just One More Canuck
Excellent!
rikyrah
@Just One More Canuck:
TRUTH
Ragbatz
If only there really was an actual deal-maker in the White House, the high initial 2018 premium rates could serve as a pivot for early 2018 legislation restoring un-ratfucked Obamacare – in the guise of repeal and replacement “with something wonderful”. It would be easy. Believe me.
(The only confusing part would involve coverage for those forced out temporarily during the ratfucking/un-ratfucking cycle.)
john fremont
@Balconesfault: That , and along the same line, how many of the survivors would be be denied health insurance coverage in the future due to preexisting conditions from the gunshot wounds. I’m also thinking of mental health coverage being eliminated from essential benefits and the survivors’ PTSD going untreated.
Neldob
Maybe the NRA can sell health insurance?
Ohio Mom
@Neldob: They certainly need a new business model : ^ P
maryQ
It will be important to show video or still images of black people getting health care whenever the words “Obamacare” “unconstitutional subsidies” and “Washington bureaucrats” are spoken, regardless of what happens with CSR.
Mr Wu's Pigs
I’ve been calling my MOC several times a day to support CSR’s to inject stability into the insurance market. I can’t just sit by and do *nothing* even if I don’t think it will much help.