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Replacing Obamacare: The Strategies and Options

What are the possible ways out?

by
Rich Baehr

Bio

September 27, 2013 - 9:35 am
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This is the fourth and final article in a series on the rollout of Obamacare, and how the law will change our health care system. Each of the past two weeks, we have published two articles: one on the changes in medicine and medical care and one on changes in the insurance industry. We hope this series of articles will help you make better decisions when it comes to your health care and how you buy insurance.

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The Republicans in the Senate and House are now involved in the early stages of what appears to be a major internal food fight over how to leverage the GOP’s opposition to Obamacare with the need to pass a continuing resolution to keep government financed and, soon thereafter, to raise the nation’s debt ceiling. Some conservatives in Congress, encouraged by a few talk radio personalities, are supporting a strategy of seeking to defund Obamacare as their price for allowing the government to continue its business in other areas and to continue to borrow. For fiscal 2013, the federal deficit will be about $800 billion, a reduction from the trillion-dollar plus deficits of the prior Obama years due to additional tax revenues from the year-end 2012 deal on the “Bush tax cuts,” Obamacare tax increases, and some modest spending cuts due to the sequester.

Other Republicans wish to delay the implementation of Obamacare until 2014, focusing in particular on the individual mandate. Since the administration unilaterally delayed for a year the employer mandate (without asking Congress to bless this action), some Republicans seek to formally authorize the delay for both the employer and individual mandates.

Republicans in the House have passed an Obamacare repeal measure over three dozen times since they won control of the House in the 2010 midterm elections. Naturally, this effort never went anywhere in the Democratic-controlled Senate. Even if some Republican Senate candidates had not self-destructed in 2010 and 2012 in winnable races and the GOP had won control of that body, an Obamacare repeal measure that went to the president would have been vetoed.

The president is reeling from a perception that he has been a weak leader and badly mishandled the Syrian chemical weapons “red line” he had set, even if most Americans are happy that we are not engaged in a new military effort. Also, the economy is still struggling, and Obamacare is increasingly unpopular with the opening of the state exchanges now less than a week away.

A constant refrain from left-of-center supporters of the new health care law has been that the Republicans want to get rid of Obamacare, but have never offered anything substantive to replace it. Whereas Obamacare, at over 2,000 pages and with well over 10,000 pages of supporting regulatory language so far, is presumably just what the doctor ordered.

However, the Republicans have in fact offered substantive proposals, and this week House Republicans again offered a health care bill to replace Obamacare. Of course, it does not address every aspect of the legislation the Democrats rammed through in 2010, and should not be viewed as a provision-for-provision substitute.

The Affordable Care Act expanded Medicaid coverage up to 138% of the poverty level for individuals and families. Justice Roberts’ decision affirming the legality of the individual mandate also allowed states to decline to expand Medicaid without risk to their current level of federal funding for the existing Medicaid program. The other major access expansion came through employer and individual mandates. In each case, penalties would be assessed for employers of a certain size not providing health insurance to their full-time employees, and for individuals who did not purchase an individual insurance policy in the new exchanges. Given the “free shot” to enact a health care reform bill relying solely on Democrat votes, the Obamacare bill was also larded with thousands of pages and hundred of provisions regulating just about every aspect of the industry and the delivery system.

The new GOP alternative is a different animal entirely from Obamacare. It is designed to support free market competition rather than regulate private market activities. One way it does this is by allowing cross-state competition in the private insurance market. Obamacare limits the type of insurance plans that can be provided in the state exchanges in terms of the  percentages of plan cost that must be provided in coverage benefits, and mandates that all coverage in every state include a fairly comprehensive package of health care services in all plans offered on exchanges. True insurance competition in individual states would allow much greater variability in plan offerings. It has been demonstrated for many years that when individuals or employees have “skin in the game” — meaning their own dollars are at risk — they are more cautious about health care spending. They also respond to financial incentives for promoting better health (smoking cessation, exercise, weight management). High-deductible, catastrophic policies are attractive to many younger people and to those in good general health.

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All Comments   (16)
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1 year ago
1 year ago Link To Comment
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1 year ago
1 year ago Link To Comment
On the same day the House voted to defund Obamacare (PPACA), the House Republicans should have come out full force with an alternative health plan that does not have the manipulation, penalties and "taxes" (cf. USSC) of PPACA and has real insurance reform that increases competition, reduces the paperwork load on doctors and so on. But is there an alternative GOP plan or just a lot of musing out loud by GOP politicians?
1 year ago
1 year ago Link To Comment
There is an Institutional Republican plan. Try to BS the base into supporting them one more time. Then, just like the repeated promises to use budgets, Continuing Resolutions, Debt Ceilings, etc. as the basis for a real fight with the Left, they will turn and run.

It is the only things they know how to do. Lie to their own side, and run from the enemy.

Subotai Bahadur
1 year ago
1 year ago Link To Comment
I've heard about this alternative GOP plan. There for a while it was on everybody's lips. "Yeah, we have an alternative, blah, blah, blah."
Yeah? Really? What was it? Where was it? Don't bullsh!t a bullsh!tter. If they had something they should have put it on the table. They would have talked about it on FoxNews. Even the Democrats would have talked about it if only to disparage it. Nothing! If there is a PJ reader that knows anything about it I wish he/she would speak out.
1 year ago
1 year ago Link To Comment
So why don't some high-profile Republicans go out and SELL SELL SELL this alternative!?!?!?!?!?
1 year ago
1 year ago Link To Comment
The Affordable Care Act will end up being the Awful Care Act - already its original goal of providing the same level of care for all citizens has been thwarted in that several levels of care are offered depending on one's ability to pay - bronze, silver, and gold (I suppose we can wait with bated breath for the lesser levels as the program gradually descends into insolvency - copper, nickel, lead, etc. levels).

The goal is to get to a single payer option with its attendant level of mediocre care for the middle classes on down, while the well-to-do will be able to purchase extraordinary care on the private market.

Even the Republican counter-proposals offer little significant difference in the long run. We are determined to Europeanize our system no matter the cost in money or lives. The lowliest of us are living too long as it is - the wealthiest and most influential, not long enough.
1 year ago
1 year ago Link To Comment
What happens if a conservative state balks at setting up a high-risk pool? Does the GOP health plan mandate all states to set up high-risk pools?

1 year ago
1 year ago Link To Comment
Clean slate. When government provided or mandated health care costs impossible sums without providing health care, return to laissez-faire.
1 year ago
1 year ago Link To Comment
60 years ago, before Reagan signed EMTALA into law,

hospital Emergency Rooms often refused to treat patients who had no insurance or money to pay.

Sometimes, a woman would show up at the Emergency Room about to have a baby, and they would order her to go find some other hospital because they wouldn't treat her there. (So much for the Hippocratic Oath.)

That really used to happen, back when I was a kid.

Reagan signed EMTALA into law, which forced hospital emergency rooms to treat all patients regardless of ability to pay.
1 year ago
1 year ago Link To Comment
The first free open to all hospital was supported and run by Christians in Alexandria, Egypt.* Not too many hospitals since then can afford to stay open with free care.

*cf. Palladius, Jerome, Athanasius, and the Lausaic History
1 year ago
1 year ago Link To Comment
I think most people favor hospitals treating patients who will die or suffer extreme life changing complications if not treated without worrying about payment or insurance. After the patient is treated, I'm not against the hospital taking every reasonable means to recover the money spent, including liens, wage garnishment, and such. They provided a service, they ought to be paid.
A few years back I had a little appendix problem...It didn't really hurt, it just felt very wrong. The doctor at the hospital said they didn't have time to fill out and file all my paperwork. I needed immediate surgery. As an orderly was taking my next of kin and contact information, the doctor handed me a promissory note and a pen. A nurse was also there asking me about medical allergies and any history of anesthesia problems. I joked to the doctor about not signing the promissory note. He said if I didn't sign, that they would try to keep me at the hospital and in 30 minutes to an hour they would treat me anyway, cause I would be dying. As it was, I almost died regardless. That promissory note sure put a big dent in my savings, but everyone's been paid.
1 year ago
1 year ago Link To Comment
And has been driving up the cost of healthcare ever since.

EMTALA was a huge mistake.
1 year ago
1 year ago Link To Comment
The rising costs always lead back to government action.

This is from 1994 but is still relevant:

Why Health Care Costs Too Much http://www.cato.org/pubs/pas/pa211.html
1 year ago
1 year ago Link To Comment
It might provide *some* health care, but obviously a good chunk of the money will go to pay for the underlying bureaucracy.
1 year ago
1 year ago Link To Comment
Chop it up and implement one *tiny* piece at a time - and only after each piece is studied intensively so that everyone understands what it's meant to do, what it WILL do, and what its effects will be. Anything that doesn't work or will cause negative fallout gets axed, re-written, or at least postponed.

The current approach, implementing the ACA over four years, just delays the inevitable. It shouldn't be inevitable.
1 year ago
1 year ago Link To Comment
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