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June 22, 2017

Senate's Obamacare Bill Is Primarily Designed to "Fix," Expand Obamacare

Of course.

My anger about this is tempered by the fact that I was pretty sure this program would remain on the books forever, as soon as it went operational.

Reform of the individual market, intended to give those who do not get coverage through work or a federal program access to subsidized, regulated coverage. The law created a new federal subsidy, based on income, for lower- and middle-income households to purchase health insurance. It set up federal rules requiring insurers to sell to all comers while limiting their ability to charge based on health history. It mandated that all individuals obtain health coverage or pay a tax penalty. And it erected a system of government-run health insurance exchanges on which consumers could purchase subsidized, regulated individual market coverage.

Those exchanges have never been fully stable as either business or policy propositions. Premiums have marched steadily upwards; last year, the price of a typical plan rose by 22 percent, and early reports show large spikes coming this year as well. The non-profit health insurance organizations that Obamacare funded have mostly shut down. Large, for-profit health insurers, meanwhile, have lost money and either scaled back their participation or dropped out entirely.

Republicans have repeatedly criticized these marketplaces for being expensive and unstable. As Senate Majority Leader Mitch McConnell, who spearheaded the drafting of this bill, likes to say, "Obamacare is collapsing around us."

Yet even more than the House plan, the Senate plan retains the essential structure of Obamacare's individual market reforms. It would likely result in fewer people being covered, and it would not stop the destabilization of the market.


Like the House plan, the Senate plan retains Obamacare's major insurance regulations, including the requirement to cover pre-existing conditions, at the federal level. Unlike the House plan, it does not allow states to apply for a waiver to opt out of those rules. It also eliminates Obamacare's health insurance mandate.

Every state that has attempted this combination of coverage regulations without a mandate has seen a swift meltdown in the individual market. There is every reason to expect that the same would happen under the Senate plan, especially since Obamacare's exchanges were struggling with a too-small, too-sick enrollee pool even with the mandate in place.

The Senate bill attempts to manage this instability by buying off health insurance companies with payments that Republicans previously argued were illegal and should be stopped.

Populism, the uncouth and ill-informed belief that Your Social Betters are incompetent and are lying to you, must be stamped out due to its total divergence from reality.

Alternate Opinion: Avik Roy is a rightist health care policy expert. I tend to disagree with his assumptions, which tend to include the liberal imperatives of some kind of government-sponsored health care.

You know -- achieving Liberal Policy Imperatives Through "Conservative" Market-Based Solutions.

However, he's certainly no crank. He's very enthusiastic about the bill:


I'll read his own lengthier response once he posts it.


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posted by Ace at 04:49 PM

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