Posted on 03/09/2017 7:28:42 AM PST by SeekAndFind
Peter Nelson, my colleague at Center of the American Experiment, is one of the country’s leading experts on health care policy. On the Center’s web site, he urges conservatives to take a deep breath and understand the constraints that Congressional Republicans are working under.
In particular, a full repeal of Obamacare must get through the Senate, which means it must get 60 votes. There are only 52 Republican senators. Therefore, the first bill that has been unveiled is intended to be passed under the reconciliation process, which requires only a bare majority. Only Obamacare provisions that have a budgetary impact can be repealed in the reconciliation bill. Other measures will have to follow afterward. Peter writes:
Critics do have reason to complain and demand change, but the current response recklessly sets up the expectation of a full repeal among those in the conservative base, an expectation that Congress cannot meet. Upon failing to meet this expectation, the base may become needlessly demoralized and distrustful.
***
Republicans can repeal a substantial portion of Obamacare with a simple majority through the budget reconciliation process, but this process only allows Republicans to repeal those portions with a budgetary impact.Repealing just items with a budgetary impact leaves in place the insurance regulations that are presently driving up health care costs and spinning many state insurance markets into death spirals. Specifically, the reconciliation process can’t repeal Obamacare’s essential health benefit requirements that force people to buy very generous and, therefore, very expensive health plans. Most troublesome, reconciliation cannot repeal insurance regulations that force insurers to sell coverage to everybody, regardless of whether they responsibly maintained coverage. This allows people to wait until they are sick before gaining coverage.
***
A key problem is that repealing the individual mandate without repealing the requirement on insurers to guarantee coverage increases the incentive to wait to buy coverage until you need it. That’s why the House plan imposes a 30 percent penalty on people who buy coverage who failed to maintain continuous coverage. This penalty has been panned by critics, but anyone who studies health insurance markets will tell you something like this is necessary, so long as Obamacare regulations remain in place.
The good news is that the reform process is beginning, not ending. GOP leaders say there are two more bills yet to come, and we have a Republican president whose administration can reverse those portions of the Obamacare disaster that came into being through regulations. Which is many of them.
[A]nother point too often lost in the debate is the role the Trump administration will play in complementing Congress’s work. Though certain regulations cannot be immediately repealed, the Trump administration can modify regulations through the rule-making process. For instance, the Department of Health and Human Services (DHHS) can authorize a much more affordable set of essential health benefits. DHHS has already proposed important changes to stabilize individual insurance markets.
Peter thinks that the Medicaid provisions in the current bill represent a very important set of reforms, and will address that aspect of the legislation soon. In the meantime, conservatives shouldn’t be depressed over what we have seen so far:
Much of the rest of the bill is open for reasonable debate among conservatives—such as those refundable tax credits to buy health insurance—and critics are certainly entitled to their strong opinions and encouraged to share them.
But it’s dangerous if, to foment a public outcry to force changes to the bill, critics instill within the conservative base a sense that full repeal is possible if not for those weak-kneed Republicans elected to Congress. If conservative leaders set unattainable expectations, they will create a perception of failure in Congress that will deflate the conservative base.
Read the whole thing at the link.
Just like building a house, it’s a must to have a good foundation for the house.
Do it right the first time,we don’t have to do it again.
We should never have had this P.O.S. obamacare legislation in the first place.
If you are saying the Republicans would be “just as bad as the dems” if we repealed it the same way then I don’t care ONLY because it was passed this way. It should be able to be removed the same way if needed.
Otherwise we are stuck with it forever.
OF COURSE THERE ARE ALWAYS THE UPCOMING PRIMARIES!!!
START LINING UP CANDIDATES WHO PROMISE TO REPEAL IT IN ITS ENTIRETY.
Well, that is an option with the understanding that it puts the burden on the states exclusively. 50 insurance markets with 50 different regulation systems. Grossly inefficient however, a model that needs to be retained as some insurance companies only want to compete within a limited geographic area.
Under my recommendation, insurance firms could opt to comply with the national classification system and sell to the entire nation OR they could continue, as you pointed out, to selectively choose to compete under 50 different state regulations.
I am of the opinion that by having a national market, insurance companies can compete nationally and there by, become more efficient, as competition will improve the options to the consumer and prices will be contained.
Horsecrap. The bill does NOTHING to eliminate the insurance industry’s Federally-sponsored franchise to mark down reimbursed healthcare costs as submitted on providers’ bills by 90% or more. In other words, the insurance industry has an apparent right to argue a $1237. hospital bill down to $75. or $128. or whatever ridiculous number they end up paying. This is the precise point where the rubber meets the road. If I can go into McDonalds and order a Big Mac for $4.75 yet offer the clerk 71 cents and the deal goes thru, there is a market distortion of such magnitude that nothing of any reasonableness can occur. With such a perma-distortion in place, docs and hospitals HAVE TO submit giant bills for services rendered if they know that an insurance claim will be the source of payment. It HAS TO BE this way, the doctor or hospital cannot bill for a service, perform the burden of ins claim submittal and then accept a dime on the dollar for his service. Until this horrific distortion of market forces is removed from the system, enormous cost-shifting MUST occur.
Secondly, the very idea that no-limit pre-existing condition “insurance” coverage is shoved into the same portfolio of insurance risk to the ins co that routine claims are is completely absurd. If I am an ins company in the business of insuring houses against fire and I have a book of 500 houses, I cannot now go out and seek super-tanker-run-aground policies to sell. The one time the supertanker runs aground obliterates my risk profile. This cannot be done. Insurance risks must be properly matched to insurance premia and vice versa otherwise we are just perpetuating a massively distorted system.
Until these factors are fixed and/or changed, there is nothing but squeezing the balloon of gross HC costs and trying to shift the costs from here to there.
What a bunch of Horsecrap! Repeal it with a majority vote. That was how it was passed or deemed passed.
RE: START LINING UP CANDIDATES WHO PROMISE TO REPEAL IT IN ITS ENTIRETY.
1) You’ll have to wait another almost 2 years for that.
2) If you repeal it entirely, are you saying that we don’t have to care what happens to those who are already enrolled under the law as it is now?
There is the INTENT and there is the REALITY of having to work with what we have.
RE: Repeal it with a majority vote. That was how it was passed or deemed passed.
OK, let’s say we did that. We pass a bill using the same chicanery that the Dems did in a one liner that says : OBAMACARE IS HEREBY REPEALED IN ITS ENTIRETY.
What effect will it have on those who are enrolled in it now? Do we simply tell them, you’re on your own?
President Trump needs to do a prime time address to the nation on this. Otherwise, both Democrats and GOPe will spin this not in his favor.
Let's take a step back and make sure we understand one of the primary flaws of ObamaCare: It was a Federal law that forced everyone in the U.S. to pay New York, D.C. and Los Angeles prices for their insurance coverage even if they lived in Mississippi or Arkansas or North Dakota. This is why the insurance industry absolutely loves ObamaCare, and will love RyanCare even more.
“Specifically, the reconciliation process can’t repeal Obamacare’s essential health benefit requirements that force people to buy very generous and, therefore, very expensive health plans.”
This provision was created under the reconciliation process. Why are we to believe it can not be ended the same way?
Is this a tacit admission that the original bill was, in fact, illegal?
Maybe Republicans ought to do the repeal through reconciliation and duke it out in court. Either it IS LEGAL to do so, or the original bill was ILLEGAL.
Rep. Gohmert: Don't let Robert Byrd's 'KKK rule' stop Obamacare repeal
We need to separate pre-existing pool & high risk pool. Not all pre-existing are high risk.
Agree. I listened to Congressman David Schweikert, a Freedom Caucus member who is on the Ways and Means Committee. He is on board with this bill as the first step because of reconciliation. Democrats will not vote for this, and they will need 60 votes to do anything further.
Repeal the whole bill,and pass a clean & simple Bill for many years to come. We don’t want to keep all the bad provisions which we have to reform the bill every election year.
Another exercise in turd polishing.
Yes they did: 60 to 39. One not voting.
Yes it was: 60 dem to 39 repub
They gutted an unrelated House bill, filled in Obamacare, and passed it like it was the Obamacare House bill.
It did not originate in the House. That was skullduggery.
“Agree. I listened to Congressman David Schweikert, a Freedom Caucus member who is on the Ways and Means Committee.”
I’m not a big fan of Ryan, but I do have some trust for House republicans, (a lot less for Senate GOP).
When I heard this passed Ways and Means, I’m more confident they’re getting it done.
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