Posted on 03/21/2016 10:39:52 AM PDT by Kaslin
The primary component of GOP presidential candidates’ health policy proposals is to repeal Obamacare. Once GOP frontrunner Trump released his plan, the Committee for a Responsible Federal Budget took notice and did an analysis of the likely fiscal effects from Trump’s plan. Presumably, these fiscal effects would also apply to the other Republican candidates who also support repealing Obamacare.
The Committee for a Responsible Federal Budget (CRFB) is a budget watchdog group that began 35 years ago. For the past few years it has been housed with the neo-Democratic think tank, New America. The two organizations parted ways over the former’s campaign to balance the federal budget partly by cutting social programs. The CRFB is truly a bipartisan organization, with both Democrats and Republicans as members, supporters and staffers. It is mostly known for its support of a “Grand Bargain,” encouraging Democrats to cut entitlements in return for Republicans ending some tax breaks and raising taxes.
The CRFB analysis argues that repealing Obamacare in general -- and Trump’s plan in particular -- would increase the federal deficit. Although the CRFB does some great work, its analysis is wrongheaded in this case. The group correctly claims repealing Obamacare’s coverage provisions (the subsidies for exchange coverage and Medicaid expansion) would save taxpayers’ significant amounts -- about $1.1 trillion over a decade. Its dynamic scoring model even suggests doing so would boost economic growth over a 10-year period by more than $200 billion. The primary reason why the budget watchdog believe repealing Obamacare will boost the debt is due to repealing the Obamacare taxes and repealing the Obamacare cuts to Medicare.
First of all, taxes on health care raise the cost of health care. There are something like 19 different tax hikes enacted by the Affordable Care Act (ACA). There’s a tax on drugs, a tax on medical devices and taxes on insurance premiums. There’s a Cadillac Tax on high-cost health plans and a prohibition on using flexible spending accounts (FSAs) and health savings accounts (HSAs) to purchase over-the-counter drugs. There’s also a payroll tax on high-income individuals. By raising the cost of health care, consumers and taxpayers ultimately bear the higher cost.
In addition, these taxes were intended to offset the cost of Obamacare’s coverage provisions by clawing back some of the additional profit the medical industry presumably would earn from the expansion of health coverage. With Obamacare’s coverage provisions gone, there’s little excuse for these taxes to remain.
Finally, CFRB estimates repealing the ACA’s cuts to the Medicare program would save nearly $1 trillion ($880 billion) over 10 years. The problem with this estimate is: most of the cuts have not taken place and are not likely to, according to the Office of the Actuary for Medicare. Cutting Medicare in this manner would likely reduce access to care for seniors -- which is why most health policy analysts believe the cuts unlikely. Indeed, the Independent Payment Advisory Board, that was granted the power and responsibility to cut Medicare spending if expenditures breach a predetermined growth threshold, has not seated a single board member in the six years since the ACA was signed into law. Cuts to the Medicare Advantage (MA) program have been far smaller than the ACA called for mainly because MA plans are popular with low-to-moderate income seniors.
Conservatives have always believed the proponents’ estimates of the cost of Obamacare are disingenuous precisely because the cuts to Medicare are not likely to take place. Likewise, arguing that repealing Obamacare would add $880 billion to the deficit over the following 10 years (by repealing Medicare cuts that are never likely to take place) is equally disingenuous.
The CFRB estimates the Trump specific provisions -- purchasing insurance across state lines, making individual coverage tax deductible, importing prescription drugs and requiring transparency and boosting HSAs -- would cost taxpayers $70 billion over 10 years. This is primarily due to the cost of making individual coverage tax deductible.
It’s foolhardy to disagree with this assessment. Extending the tax exclusion to individual health insurance is something that many policy analysts worry will add to health care inflation and further erode the tax base. However, the tax exclusion for employer coverage (absent the Cadillac Tax) is open-ended. The employer tax exclusion causes people to purchase more insurance than they otherwise would purchase. When individuals purchase their own coverage directly, they tend to economize and select higher deductibles than are the norm in employer plans. This is even true of the self-employed who can deduct the cost of health coverage off their taxes. People with less generous coverage consume less health care.
If nothing else, repealing Obamacare with its costly coverage provisions -- including massive open-ended subsidies and abled-bodied adults added to Medicaid -- would be a symbolic gesture that the welfare state is being corralled. Furthermore, the cost of Obamacare’s coverage provisions will rise over time. A truly responsible federal budget should repeal the most recent entitlement added to the welfare state.
Drug coverage should be separated out.
Drug coverage is best done on a national scale.
Without having to buy drugs, hospitals and hospital companies could sell care coverage, cutting out the middlemen and cutting costs greatly.
People should be able to import a year’s personal supply of drugs, with foreign doctor’s prescriptions being allowed entry through US Customs for FDA, Health Canada or EU approved drugs that are not addictive.
Deductibility makes coverage cheaper for more affluent people than for low income people.
Here in Florida, people with high incomes can get mortgages and pay about 50% less for an equivalent house than lower income people - that is crazy.
Perhaps a monthly subsidy of up to your age*$2, but not for more than 60% of the cost of a plan would be better.
I’m low-income. I need cheap plans.
As for coverage mandates, if any government thinks a plan should include X, then that government should pay for X for all people with incomes below $20,000/year and partially for those with incomes below $40,000/year.
Obama is an incompetent liar - on every possible subject. Everything about Obamacare was and is a lie. I was a US Army combat infantryman for several years fighting our enemies overseas and left the service to spend more time with my family. Since I’ve been out, my health insurance (Blue Cross) has been cancelled twice, I have no idea who my doctor is now, and my premiums in three years have gone from $450 per month to over $1200 per month (family of four).
No one should even gives this liar the time of day. Shame on all those who voted for such a godless, unqualified, juvenile delinquent to our highest elected office. Mark my words, Obama will go down in history as the worst, most corrupt US President of all time.
A more sensible Cadillac tax might kick in at say 130% of cost of the silver plan subsidy base amount for the employee’s area.
That would eliminate federal tax discrimination against highly unionized areas such as New York State.
Equivalent Cadillac cars cost about the same nationwide.
Equivalent coverage varies a lot nationwide, being very expensive in New York State and much less expensive in Salt Lake City.
Strange Bedfellows Defending ObamacareYou mean like so called, self-proclaimed conservatives that fall all over themselves in a rush to continue funding it?
Patriots, as mentioned in related threads, please bear in mind that the states have never delegated to the feds, expressly via the Constitution, the specific power to regulate, tax and spend for INTRAstate healthcare purposes. This is evidenced by the excerpts from Supreme Court case opinions below.
With respect to the constitutionality of the Obamacare insurance mandate for example, note the fourth entry in the list below from Paul v. Virginia. In that case, state sovereignty-respecting justices had clarified that regulating insurance is not within the scope of Congress’s Commerce Clause powers (1.8.3), regardless if the parties negotiating the insurance policy are domiciled in different states.
”State inspection laws, health laws, and laws for regulating the internal commerce of a State, and those which respect turnpike roads, ferries, &c. are not within the power granted to Congress. [emphases added]” - Gibbons v. Ogden, 1824.
”Congress is not empowered to tax for those purposes which are within the exclusive province of the States.” - Justice John Marshall, Gibbons v. Ogden, 1824.
”Inspection laws, quarantine laws, health laws of every description [emphasis added], as well as laws for regulating the internal commerce of a state and those which respect turnpike roads, ferries, &c., are component parts of this mass.” -Justice Barbour, New York v. Miln., 1837.
” 4. The issuing of a policy of insurance is not a transaction of commerce within the meaning of the latter of the two clauses, even though the parties be domiciled in different States, but is a simple contract [emphasis added] of indemnity against loss.” - Paul v. Virginia, 1869. (The corrupt feds have no Commerce Clause (1.8.3) power to regulate insurance.)
”Direct control of medical practice in the states is obviously [emphases added] beyond the power of Congress.” - Linder v. United States, 1925.
In fact, regardless that federal Democrats, RINOs, activist judges and indoctrinated attorneys will argue that if the Constitution doesn’t say that the feds cannot do something then they can do it, note that the Supreme Court has condemned that foolish idea. More specifically, the Supreme Court has clarified in broad terms that powers not expressly delegated to the feds via the Constitution, the specific power to regulate intrastate healthcare in this case, are prohibited to the feds.
”From the accepted doctrine that the United States is a government of delegated powers, it follows that those not expressly granted, or reasonably to be implied from such as are conferred, are reserved to the states, or to the people. To forestall any suggestion to the contrary, the Tenth Amendment was adopted. The same proposition, otherwise stated, is that powers not granted are prohibited [emphasis added].” —United States v. Butler, 1936.
Remember in November !
When patriots elect Trump, Cruz, or whatever conservative they elect, they also need to elect a new, state sovereignty-respecting Congress that will not only work within its constitutional Article I, Section 8-limited powers to support the president, but also protect the states from unconstitutional federal government overreach as evidenced by unconstitutional federal funding for intrastate schooling, likewise for Obamacare and possibly Trumpcare.
Also, consider that such a Congress would probably be willing to fire state sovereignty-ignoring activist justices.
“The Congress shall have Power
....
To regulate Commerce with foreign Nation, and among the several States
....
To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;
....
—And
To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers”
Congress has the power to grant patents. Yes?
Even on drugs?
What if the drugs are life-saving and people can’t afford them?
Can Congress indirectly subsidize the purchase of these drugs under the “necessary and proper” power?
There are prudential reasons for wanting longer-term supplies at hand than most drug insurance plans are willing to pay for, viz., emergency scenarios. Tight control of drug supplies means patients will start running out of maintenance drugs like BP and blood-sugar drugs within days, weeks at most, of a regional or national emergency -- like a major war.
Are you ready for the bad news now?
It's deliberate. The guy is an enemy.
Regarding the Supreme Court case excerpts in previous post, if corrupt Congress wasn't stealing dollars from taxpayers' wallets by means of trillions of dollars of unconstitutonal federal taxes, consider that citizens might be able to afford the life-saving drugs that they need.
Can Congress indirectly subsidize the purchase of these drugs under the “necessary and proper” power?"
Since the corrupt feds are effectively stealing trillions of dollars in state revenues by means of unconstitutional federal taxes, the states, not the feds, can subsidize such drugs.
Regarding the necessary and proper clause, again, previous generations of state sovereignty-respecting justices had clarified that the states have never delegated to the feds, expressly via the Constitution, the specific power to regulate, tax and spend for INTRAstate healthcare purposes.
But also consider that there is nothing stopping the states from amending the Constitution to give the feds the specific power to regulate, tax and spend in the name of intrastate healthcare.
In fact, former Rep. Jessie Jackson Jr. had repeatedly proposed a healthcare amendement to the Constitution long before Obamacare was wrongly established outside the framework of the Constitution.
"Proposing an amendment to the Constitution of the United States regarding the right of citizens of the United States to health care of equal high quality." —H. J. Res. 30.
So former Speaker Pelosi blatantly ignored Sen. Jackson’s proposal for a constitutional healthcare amendment before ramming Obamacare through the House. If Congress had successfully petitioned the states for a healthcare amendment to the Constitution before establishing unconstitutional Obamacare, then we wouldn’t be having this discussion.
In fact, while I will gladly vote for Trump for president, while I don’t know the details about Trumpcare, he should probably be promoting a healthcare amendment on the campaign trail so that he can establish Trumpcare. Trumpcare is possibly justifiable under the Commerce Clause (1.8.3) but I don’t know.
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