Posted on 03/11/2017 12:12:01 PM PST by Kaslin
First of all, the preferred free-market plan for health care policy should be no plan whatsoever. The idea that we need a federal top-down strategy to manage a huge chunk of the economy is at the very heart of the problem. We don't need a federal plan for health care. Yet Republicans have allowed liberals to frame the entire health insurance debate in these anti-market terms.
So the American Health Care Act, or AHCA, is obviously weak tea, falling far short of a promised free-market solution, much less a full "repeal" of Obamacare. It's a half-measure that endeavors to fix Obamacare with small doses of deregulation while failing to repeal its core. It's almost as if Republicans were trying to mollify their constituents and save Obamacare at the same time.
President Donald Trump tweeted something about a three-phase rollout, but the specifics of the other two parts have yet to be confirmed. Perhaps the full proposal will reflect better on Republicans. But considering the noise moderate senators have been making and Trump's own views on entitlement programs, it's unlikely to meet conservative expectations. So what can be done?
In a piece highly critical of the plan, the Washington Examiner's Philip Klein, who has done some of the most insightful writing on Obamacare, states, "the GOP will either be passing legislation that rests on the same philosophical premise as Obamacare, or will pass nothing at all, and thus keep Obamacare itself in place." What if this is the choice?
We know the Democratic Party's plan for health care: Constrain markets to create monopolies that can be controlled by a federal regulatory regime (this is why liberals oppose markets expanding across state lines); and rather than worrying about access, choice or cost, continue to incentivize the growth of the welfare state. When this situation becomes untenable, pass single-payer. What Democrats understand but Republicans often don't is that you can reach your goals incrementally.
Obamacare was ignored as soon as it was passed. A law that was sold as a tool to reign in rising costs quickly became a moral edifice that alleviated an imaginary humanitarian crisis (the defense of it is now almost exclusively focused on people losing Medicaid). Meanwhile, Obamacare was used as a tool for social engineering and coercion, allowing technocrats to dictate how a third of the economy functions. If you control the bureaucracy, laws become incredibly malleable. One day, Democrats will be back and, without even partial repeal, all the same mechanisms will be available to them.
So the question remains: Is something better than nothing?
Halting federal funding of the nation's largest abortion mill is a victory. Offering states more flexibility to run their own Medicaid programs is a victory. Expanded health savings accounts and the creation of real-life illustrations of successes is promising. Getting rid of the individual mandate is a victory, as is allowing consumers to purchase insurance across state lines. Repealing nearly all of Obamacare's taxes -- other than a postponement of the Cadillac tax -- is a win.
It's possible, of course, that AHCA negotiations will begin with moderate proposals and transform into something free market-oriented. With widespread opposition from conservative groups -- Heritage Action for America, FreedomWorks, etc. -- the American Health Care Act looks like a non-starter. Then again, who are we kidding? The truth is that conservatives probably find themselves in the same situation frustrated liberals did in 2009. Despite prevailing mythology, Democrats never compromised in good faith with the opposing party; they compromised with their own moderates. It only takes a few senators to hold an entire party hostage.
It's also worth pointing out that no federal entitlement program has ever been repealed or replaced, or really even weakened. This was the fight that spurred Republicans to win hundreds of seats and take the House, Senate and presidency. The fact is that many politicians who benefitted most from Obamacare's failures were lying to their constituents. Either these Republicans don't have the mettle to back a full repeal or they don't have the ideas to create a new plan. So perhaps Obamacare Lite is preferable to Obamacare because it's the best this crop of legislators is going to do. Also, as history has shown, making substantive policy changes doesn't get any easier as a term wears on. This might be the last chance to do anything.
Another infuriating aspect of this fiasco is that Democrats will treat any Obamacare "repeal" bill as if it were an assault on all that is holy and patriotic. This rhetoric shouldn't have inhibited Republicans; it should have freed them to pass bills that incorporate the ideas they supposedly believe in. Why would they let the same people who told America that Obamacare would be a political and functional success now lecture them on how unpopular a repeal bill will be?
It's just one of the many mysteries of the GOP.
Which begs the question, is Ryan better than nothing?
It is worse than nothing, it makes us own the result
Exactly. Repeal the whole thing and go back to pre-ACA health insurance.
Why replace??
It is a no win situation. If it totally fails you are left with a Govt take over of 1/5 of the economy. Another thing to say vote for me, else you will lose you health care
Nothing is better.
obamacare is about to derail. Trump should ask Schumer, Pelosi, and the democrat leaders to quickly come up with a plan to fix this train wreck. Like everything else, the democrats have nothing to offer. Then, there is a clear reason to fix the disaster because obamacare has FAILED.
Then the republicans offer a common sense plan.
The democrats need to be reminded that not everything can be free in life ..... including healthcare.
Constrain markets to create monopolies that can be controlled by a federal regulatory regime
Contradicts this statement:
(this is why liberals oppose markets expanding across state lines)
The best way to guarantee that there will only be a few big players in the insurance market is to allow those markets to expand across state lines. That's what happened in banking, and it will happen in insurance as well.
I don't know that there is any real liberal opposition to expanding markets across state lines. It's probably more a case of those in favor of local control in opposition to those who want to federalize everything.
Why can't libertarians understand this? Why can't they figure out that "opening up markets" nationwide doesn't necessarily lead to freer markets. It only results in more nationalized markets which are more readily controlled by the feds rather than the states or cities.
The logical extension of this principle is to open up markets globally, which is something libertarians are for, but which ends up making our markets controlled by the feckless UN and undemocratic WTO and IMF.
So the US plays the sucker and abides by UN/WTO/IMF rulings but China, Russia, etc. do not.
How's that good for free markets and competition?
It sucks and is just as unsustainable, unworkable, unwanted and unconstitutional and insane as ObamaCare.
We don't need to follow it up with repair or replace. I can't understand republicans in congress sticking with the idea that government needs a plan to watch over us with. I wish they'd get out of the way and let us run our life with whatever options the free market offers.
No, it’s not better than nothing. Doing nothing would allow Obamacare to crash and burn on its own. Nothing is better.
No, Ryan is worse than nothing, just like his bill.
Opening up Obamacare to illegal aliens is not an improvement.
Fedzilla gained enormous power from Obamacare.
Fedzilla’s attendants in Congress are never going to take that back.
The structure of putting the federal government at the center of all healthcare will not be dismantled.
Fedzilla wants to keep all your medical records.
Nothing.
Repeal, yes. Of course.
Replace, no. Not the government’s job.
Allow insurance coverage across state lines.
Reform tort law.
Compel insurers to fix “pre existing conditions” issue.
And otherwise tell the insurance companies to shape up, and get out of their way.
Here is my plan:
Doctors take a “Hippocratic Oath,” Don’t they. If they are so virtuous then.....
If a doctor/hospital agrees to treat someone who cannot afford to pay then the doctor/hospital assumes the responsibility to pay for the uninsured one.
They will not like that. They much prefer to treat the uninsured then say to the taxpayers, “Eff you! Pay me!”
Make the doctors/hospitals pay.
Ramirez once again showing why he’s the best.
ACA is collapsing with every passing week. It cannot be fixed. Trying to "fix" it simply means that the Republicans can be held responsible and punished for the inevitable failure.
The entire thing must be scrapped. Preferably before April 15th.
But we are going to do this the hard way instead. We will have one ill-conceived "compromise" after another. Insurers will continue to exit the ACA markets. The Government will ultimately delay and default on Medicaid and Medicare payments.
We will have massive non-compliance with untenable laws, combined with a few vicious attempts to enforce the latest regulations.
After that, things will get interesting.
“It is worse than nothing, it makes us own the result”
Exactly! “Obama Care” will disappear and never be used again.
The Dems will never own anything that is bad having to do with health care again.
Now they will see to it that the burden is only on the Republicans.
Hate to be the one who has to introduce some actual facts into this debate, but here is the Congressional Research Service summary of the “Obamacare Repeal” Bill Passed by the House and Senate and vetoed by President Obama. Looks more like “Obamacare Defund” to me.
What do we have for a Health Care System is this is all that is done?
https://www.congress.gov/bill/114th-congress/house-bill/3762?r=1
Shown Here:
Passed Senate amended (12/03/2015)
TITLE I—HEALTH, EDUCATION, LABOR, AND PENSIONS
(Sec. 101) This bill amends the Patient Protection and Affordable Care Act (PPACA) to terminate the Prevention and Public Health Fund, which provides for investment in prevention and public health programs to improve health and restrain the rate of growth in health care costs. Unobligated funds are rescinded.
(Sec. 102) Funding for community health centers is increased.
(Sec. 103) Certain funding for U.S. territories that establish health insurance exchanges is no longer available after 2017.
(Sec. 104) The Department of Health and Human Services (HHS) may not collect fees or make payments under the transitional reinsurance program.
(Sec. 105) This bill makes appropriations for FY2016 and FY2017 for HHS to award grants to states to address substance abuse or to respond to urgent mental health needs.
TITLE II—FINANCE
(Sec. 201) This bill amends the Internal Revenue Code to require individuals to pay back the full amount of advance payments in excess of their premium assistance tax credit. (Currently, there is a limit on the amount of excess an individual must pay back.)
(Sec. 202) Provisions relating to the premium assistance tax credit, reduced cost-sharing, and eligibility determinations for these subsidies are repealed on December 31, 2017.
(Sec. 203) The small employer health insurance tax credit does not apply after 2017. (This credit is for certain employers who make contributions toward employee health coverage purchased through a health insurance exchange.)
(Sec. 204) The penalty for individuals who do not maintain minimum essential health care coverage is eliminated.
(Sec. 205) Large employers are no longer required to make shared responsibility payments.
(Sec. 206) For one year, this bill restricts the availability of federal funding to a state for payments to an entity (e.g., Planned Parenthood Federation of America) that:
is a 501(c)(3) tax-exempt organization;
is an essential community provider primarily engaged in family planning services and reproductive health;
provides for abortions other than abortions in cases of rape or incest, or where a physical condition endangers a woman’s life unless an abortion is performed; and
received a total of more than $350 million under Medicaid in FY2014, including payments to affiliates, subsidiaries, successors, or clinics.
(Sec. 207) This bill amends part A (General Provisions) of title XI of the Social Security Act (SSAct) to require the additional payments to U.S. territories for Medicaid under the Health Care and Education Reconciliation Act of 2010 to be made by the end of FY2017 instead of the end of FY2019.
This bill amends title XIX (Medicaid) of the SSAct to end the expansion of Medicaid under PPACA on December 31, 2017.
After 2017, hospitals may no longer elect to provide Medicaid services to individuals during a presumptive eligibility period.
States must maintain Medicaid eligibility standards for individuals under 19 years old through FY2017 instead of through FY2019.
The federal medical assistance percentage (FMAP, the federal matching rate for Medicaid expenditures) for U.S. territories is 50% after 2017 (currently, the FMAP is 55%).
The increased FMAP for childless adults and home and community-based attendant services under PPACA ends December 31, 2017.
After 2017, states may no longer elect to provide certain individuals with a presumptive eligibility period for Medicaid.
Medicaid benchmark plans are no longer required to provide minimum essential health benefits after 2017.
After 2017, states are no longer required to operate a website for Medicaid enrollment that is linked to the state’s health benefit exchange and Children’s Health Insurance program (CHIP).
(Sec. 208) Medicaid allotments for disproportionate share hospitals are increased.
(Sec. 209) The excise tax on high cost employer-sponsored health coverage (popularly known as the “Cadillac tax”) does not apply after 2017.
(Sec. 210) Health savings accounts (HSAs), Archer medical savings accounts (MSAs), health flexible spending arrangements (HFSAs), and health reimbursement arrangements may be used to pay for over-the-counter medications.
(Sec. 211) This bill lowers the tax on distributions from HSAs and Archer MSAs that are not used for medical expenses.
(Sec. 212) Salary reduction contributions to an HFSA under a cafeteria plan are no longer limited.
(Sec. 213) The annual fee on manufacturers and importers of brand name prescription drugs is eliminated.
(Sec. 214) The excise tax on medical devices is eliminated.
(Sec. 215) The annual fee on health insurers is eliminated.
(Sec. 216) Medical costs are allowed as a tax deduction regardless of whether the costs are taken into account when determining the amount of the subsidy for an employer-sponsored retiree prescription drug plan under Medicare part D (Voluntary Prescription Drug Benefit Program).
(Sec. 217) A tax deduction is allowed for medical expenses in excess of 7.5% (currently, 10%) of adjusted gross income.
(Sec. 218) The additional Medicare tax on income above a certain threshold is eliminated.
(Sec. 219) The indoor tanning services tax is eliminated.
(Sec. 220) The net investment income tax is eliminated.
(Sec. 221) A health insurer is allowed a tax deduction for the full amount of an employee’s compensation. (Currently, there is a limit on the amount of an employee’s compensation that a health insurer may deduct.)
(Sec. 222) Provisions relating to the economic substance doctrine are repealed. (The economic substance doctrine treats a transaction as having economic substance if it has a purpose other than reducing income taxes. Currently, there are penalties for claiming tax benefits for transactions without economic substance.)
(Sec. 223) Funds are transferred from the Department of the Treasury to the Federal Hospital Insurance Trust Fund.
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