Trumpcare – A disaster by all measures

This week, we have been treated to the spectacle of the house Republicans jamming their “replacement” of the ACA through their two subcommittees with astounding speed and virtually no comment or open debate.

Last week, it was the rage that the supposed plan was available to be viewed in a “secret” room, no note taking, no removal from this room, heck, the reports were that it wasn’t to be found anywhere. Amusing, funny, but tragic to our republic.

7 years of bloviating. 7 years of promising to repeal the disaster that was Obamacare – or the Patient Protection and Affordable Care Act. The complication was that the cheeto-faced Shit-Gibbon promised that they would replace the out of control Obamacare with something better, cheaper, and everybody was going to be covered.

Oops. That is a fly in the ointment. There was never a credible plan to replace it. Destroy it, shut it down, and remove all traces of its existence – sure, replace it, no credible plan. The hatred of the ACA, even though it was the brainchild of the Heritage Foundation (which has since divorced itself from the concept), and first tried with success in Massachusetts under then governor Mitt Romney, seemed boundless.

Since the Republicans do not have enough members to clear the filibuster bar in the Senate, their only real recourse is to mess around with the funding and things that they can use reconciliation for. I.e. they can remove the mandate, eliminate the tax on the high earners, as well as the medical device tax that was hugely unpopular with some of the biggest lobbyists.

Then came the outrage from their constituents. Suddenly their town hall meetings were packed with LOTS of people, all upset that the ACA is going to disappear, and surprise surprise, they realized that they were going to be tossed out in the cold. In fact, it was rather amusing to read reports of congress critters ducking out, evading, and cancelling their planned meetings. The claims that these were paid protesters, a common theme from the usual far right news sources (cough Breitbart cough, cough infowars cough), but that really doesn’t ring true. No, the protesters are taking a page from the playbook of the rise of the Tea Party, and effectively organizing.

The net-net of the proposed plan is:

  • Eliminate the mandate and replace it with a 30% uplift if someone lets coverage lapse more than 2 months. This is bad because it is a far less effective deterrent to going coverage free, and then finding an excuse to enroll outside the window (that was indeed a problem, it was far to easy to come up with an exception, and the insurers had a legitimate beef)
  • Significantly alter the subsidy for the lower income people to buy plans. Instead of weighting the subsidies to the poorer, more needful people, it will be tied to age, with older people getting a larger subsidy/tax credit (yeah, instead of a direct subsidy, it will be in the form of a tax credit, another knock on the poorer people). However, across the board, the benefit is much reduced, and will make the policies less affordable.
  • Change the formula. One of the strengths of the ACA was that older people couldn’t be charged more than 3X the cost for the younger, healthier cohort. This meant primarily that younger, healthier people paid more. Whinging about how unfair that was, misses the point. In fact the whole point of insurance is to spread the risk across a pool, and for it to not be insanely expensive for the less healthy, you need a large pool with many healthy (read: less costly to cover) people to help cover the payout. This is why the individual mandate was so important. Remove that, and the pool shrinks to the sicker cohort, and then to meet actuarial goals, the prices of the policies has to rise.
  • Increase the reliance on HSA (Health Savings Accounts). A nice idea, but the people at risk do not have enough funds to tuck away, pre-tax or not, into an HSA. And the truth be told, that is just a tax expenditure that massively benefits the wealthy, allowing them to tuck more money into a vehicle that shields it from taxes.
  • Keep the ‘popular’ items, like no denial for pre-existing conditions, unclear about lifetime caps, and the like, but those are things that it would require a full vote in the senate to remove, and frankly that isn’t going to happen.

The net is that the plan is a festering pile of shit, and it can’t seem to even get the Republicans in the house excited. Either they are feeling the pressure from their constituents (and lying about how much support for repeal has), or they view this as a sell out, or Obamacare-lite.

One interesting passage in the bill, is a significant coverage on how to exempt the winners of the lottery from getting any subsidies. As if that is common enough to make a difference. But it is in the bill because the original analysis by the CBO mentioned that as a factor in their original grading.

While this sailed through the committees, it does appear that there are headwinds on the floor of the house. And the fact that the Koch brothers are not happy with this is encouraging. Also, their ability to use reconciliation is limited to bills that have less than $1B effect on the government spending (and hence the care taken around the lottery winners), so we are seeing the pre-running trying to defang the CBO legitimacy on this.

The Republicans, and the Shit-gibbon are learning that this isn’t as much of a slam dunk as they wanted, and regardless of what they can achieve, it will leave a lot of people really pissed off. Many who were reliable voters for the Republicans and Trump. Will that anger be enough to drive turnout to flip the house in 2018?

Tellingly, the constant buzz from the administration advisors (looking at Kellyanne Conway) that this shouldn’t be called “Trumpcare” seems to me to indicate that they want nothing to do with the complete cluster fuck that this will be, should it pass. But Trumpcare it will be. And Trump was right, the Republicans will own it when it stumbles and tosses up to 20 million people back into unsinsured-land.

A man can dream, can’t he. (Sadly, I expect there to not be enough opposition to erode the solid Republican control of the house. The Senate is even less in play, with the Democrats having far more seats up for election in 2018.)

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