Waiting for the SCOTUS Obamacare subsidy decision: what next?
Republicans are in a pickle, and have been since the moment Obamacare was passed.
You might think they’re in a good position, because the Supreme Court is considering overturning the state Obamacare exchanges and subsidies because of wording in the statute, and this would throw the entire Obamacare system into turmoil. The case in question is King v. Burwell, and it could be decided any day now.
But there’s one catch, and it’s a biggee: if the ruling goes against Obamacare, the press and the left will rail at the Republicans for being the big bad meanies who took away a lot of people’s subsidies. That was part of the beauty of Obamacare for the left, and one of the many many reasons they were so extraordinarily eager to pass it and pass it as quickly as possible: they wanted to create a dependence and an expectation, otherwise known as an entitlement, that would be tremendously hard to reverse.
You can ridicule Republicans all you want, and rail at them for cowardice if they want to do something to replace subsidies in the event that a King ruling takes them away from many people. But Republicans run the danger of being blamed, as they always do, for any ensuing debacle as a result of the ruling.
But what do the American people actually want if SCOTUS throws out the state exchanges and therefore the state subsidies? A substantial majority appear to want Congress to fix Obamacare rather than re-establish the state exchanges, according to this poll*. But what does that mean?
Some indications here (and the whole thing is worth reading for more details):
Voters view ObamaCare as having done more harm than good. They blame Congress for a poorly written law and they expect Congress to fix it. And they want those fixes to help everyone, not just those getting subsidies. They want those changes to make sense: more choices, the ability to buy insurance any time, and subsidies that follow people, not just exchange plans.
Voters understand that setting up ObamaCare exchanges will put states on the hook for the high operating costs to run those exchanges. They recognize that doing so will put more employers and individuals at the mercy of the IRS as it enforces more ObamaCare mandates. And they’ve seen the disastrous rollouts other states have experienced in setting up those exchanges. This is a problem created by the federal government. They don’t expect or want states to bail out Congress to vote against their state lawmakers the next time they’re up for re-election if they set up a state exchange.
But why, if Congress was so bad at setting up Obamacare in the first place, would it be so good at fixing it? And that’s true even though the first feat was accomplished by Democrats and the second would be performed by Republicans, because we know that the latter aren’t necessarily so great, either (boy, do we know it). Another thing the poll indicates is that respondents still seem wedded to subsidies, they just want them to not be tied so closely to policies sold on an exchange.
Those who say Republicans have no plan are right in that they have no unified and universally agreed-on plan, but they certainly have no lack of plans, plural. A new one was recently outlined by Louisiana Senator Bill Cassidy, who is a doctor. The entire article is worth reading, but here’s an excerpt (and I think Cassidy’s statements are interesting not only for his plan itself but for the reasoning behind it):
Freshman Sen. Bill Cassidy (R., La.) wants the GOP to start thinking like the left.
In proposing the Patient Freedom Act, Cassidy believes he is doing just that””slowly chipping away at Obamacare by bringing federalism back into the health care system and getting the federal government out.
“Of course it would be wonderful [to repeal Obamacare now],” Cassidy told the Washington Free Beacon. “But as Paul Ryan says, President Obama is not going to sign a repeal of Obamacare.”
“The left was really good for decades””they were pushing, and pushing, and pushing [for health care reform],” Cassidy said. “We’re impatient. We want it all at once.”
“I think we have to be as strategic as they,” he said. “Plant those seeds, water, show people our alternative, and inch back.”
Cassidy…narrowly focused his bill to be a response to a ruling in favor of Burwell, which would take away subsidies in states that are operated by the federal exchange….
The Patient Freedom Act would give states the option of keeping Obamacare by establishing a state-based exchange, or using existing funding to provide tax credits to create Health Savings Accounts (HSAs) for the uninsured, averaging $1,500 per person.
“We are trying to give the state an option other than setting up an Obamacare exchange,” Cassidy said.
“The president, I’m sure, will make it easy [to set up a state exchange], because he wants his law to take root,” he said. “If we don’t have a better plan, it will take root.”
If states chose Cassidy’s option, they could do away with various mandates under Obamacare, including the individual and employer mandates and requirements for minimum essential coverage. The legislation would also equalize tax treatment, and require health providers to publish cash prices for services reimbursed from an HSA.
Price transparency would enable patients to know the price before booking an appointment for medical services such as a CAT scan, which Cassidy said can range between $100 and $2,500 depending on the time of day…
Cassidy’s bill borrows from other Republican alternatives to Obamacare in Congress, such as Rep. Tom Price (R., Ga.), whose replacement plan also offers tax credits. Cassidy said his is the only plan that would solve the gap in coverage if the Supreme Court does away with Obamacare subsidies.
Note also Cassidy’s statement about Obama wanting his law to “take root.” That’s exactly the sort of thing that happens with entitlements—they take root, and the roots are thick, deep, and tangled. Good luck pulling them out.
[* NOTE: One thing I noticed about the poll is that the demographics are based on the voting in the 2014 election. But the 2014 election was atypically small and atypically Republican, so the poll probably skews to the right.]
Senator Ben Sasse of Nebraska has a bill to provide a fix.
A COBRA like transition solution.
But BHO will veto everything and blame the GOP. So what? Those with ACA aren’t GOP voters.
Just keep making Barry veto.
The medical industry, in partnership with federal and state governments, has created a rigged system to fix prices and stifle competion. Outside the protection of government, others conducting their affairs in such a manner would be charged under RICO. The best solution is to get rid of government regulations and force the medical industry to compete in an open, transparent market place. And yes, I know this will never happen.
Oh the GOP might get blamed. Let’s not do anything then. Shit or get off the pot.
I read somewhere today that Jeb Bush was succcesful in reforming medicaid in Florida. The last I heard was that W’s medicare part D cost less than planned. It seems that there are some Reps who may have good insights into reforms for our healthcare system. If only they would get a litttle press coverage for their ideas.
BTW, Jeb seems to have started his reform in just 2 counties in Florida to see how it would work. Then it was expanded. I wish we could get people to trust the conservative laboratories od the states approach to things instead of pushing for utopia.
Steve:
But apparently they are—or at least, some of them are—trying to do something. Time will tell—I wouldn’t put it past them to screw up or back off—but what in this post indicates to you that anyone’s saying they shouldn’t do anything?
They have already repealed Obamacare in the House, by the way (several times). But repeal is blocked in the Senate for lack of a supermajority, and of course if they could pass a repeal in the Senate Obama would veto it. Actually, though, they have been waiting for King to be decided before they go forward, which makes sense to me. They can use reconciliation after that (in a similar way to how Obamacare was passed) to get around the Senate cloture problem:
Obama will veto anything, of course, unless it has a supermajority.
Why can’t the Republicans pass a law which simply says despite any other law in effect, any citizen is free to contract for medical services with any other citizen, and the transaction will not be affected by any existing law (including revenue statutes) other than statutes intended to proscribe controlled substances?
Change the entire dynamic. Make it about freedom and government control. Let doctors, hospitals and other medical services be provided tax free for all involved.
And yes, let doctors and other medical services (like MRI manufacturers) not pay taxes on their medical income. Let’s see how fast low cost medicine becomes available to just about everyone. Not simply because of no taxes, but also because of efficiency when government compliance is eliminated.
And no one is forced to do it.
Even charitable organizations involved in medical services would be beneficially affected and far better able to provide “free” services.
“Voters understand that setting up ObamaCare exchanges will put states on the hook for the high operating costs to run those exchanges. They recognize that doing so will put more employers and individuals at the mercy of the IRS as it enforces more ObamaCare mandates…”
Although I copied a lot of that statement, I think it started off with a ridiculous assertion with the first 2 words “voters understand”. Most do not, and have not understood anything about the law from the start, and are still surprised at what they find.
The contention that voters understand any of implications and complications of socialized healthcare beyond how it affects their personal policy is false on its face. Many people affected by obamacare don’t even understand their own situation.
Republicans are not only in a pickle, getting any plan out to compete with the existing disaster will just be more background noise. It seems to me if voters understood what they were getting, or were curious enough in the first place to think about it, they wouldn’t have the pile of crap they currently have. no matter what happens, they are going to be just as confused they were before the SCOTUS makes another mess.
Starlord:
I agree that “voters understand” is an overstatement, to say the least.
But I think what the study should have said was that “the majority of respondents in this study where the sample was based on turnout in the 2014 election (which admittedly was atypical) answered as though they may have understood that…”
That’s a bit of a mouthful, though.
I second Starlord’s opinion.
The voters were sold a bill of BS. Voters will get it good and hard from the officials they have elected to take care of them, and I mean both parties.
I would favor an approach that maintained the new insurance schemes for 2 years, so insurors can resurrect their prior policies, then cancelling Obamacare. The new legislation should include portability and sales across state lines. HSAs should be favored.
Community rating is a guaranteed way to achieve single payor.
Modern medicine is slowly being strangled for reasons that have nothing to do with Obamacare: Medicare and the mandate for Electronic Medical Records are the death knell. The two new systems proposed for Medicare reimbursement will go into effect later this decade and are too onerously complex to be addressed here. But they are a choice between Hell and a hot place, neither doing anything good for patients or doctors.
Doctors are becoming employees, and the employers are an insufficient absorber of Federal shocks to serve as longtime shields. Employer hospitals also have their own agendas, and those are hardly patient-centered.
Try to stay healthy.
Meanwhile, competent doctors retire earlier than they otherwise would have, and fewer of the best and brightest students go into medicine to begin with.
As long as people who are dependent on government subsidies have the same vote as people who are paying for the subsidies, there is no way out of this.
The universal franchise will doom us. The Founders were perfectly aware of that.
Given that the death spiral in premiums is getting started, it might be well better if the plaintiffs lose the Burwell case.
Yes, the media will try mightily to blame Republicans for this, but the law is quite unpopular still, so I don’t think it will work this time. Democrats own this law with all its defects.
When the takers out number the givers, it will not take too long before what can not be sustained will not be sustained. The kicking of the can will one day meet the abyss. Prepare wisely for that day.
The GOP would be fools to intervene if the subsidies collapse. Obamacare is a wholly-owned Democrat disaster, and nobody who yearns for it will vote Republican anyway.
The GOP should ignore the caterwauling, and restore the previous system. We do not reward bad behavior, or we will get more of it.
To give health insurance to 15 million people the Stalincrats imposed an unseen system on 300 million people under cover of night by lying about its coverage and effects. Since then every time a major feature of the law was set to become active Obama has deferred it until after the next election. Some rate increases and policy cancellations are being re-deferred.
It began with the betrayal of the Stupak 13 and since then the rain of high-handed, dismissive Gruberizations proceed unabated.
These Klutzocrats remind me of something a friend, an organic chemist, once said to me:
To give free health care to 15 million people the Clownocrats have done something similar to the entire American insurance business and rewrote the rules about who works and how long for everybody.
And in all of this wailing and punditry…
NO-ONE is apprehending that 0-care destroys the growth of the modern money supply — and that this pressure will grow exponentially as the months go by.
Shutting down First Time Homeownership has STAGGERING implications for the GLOBAL economy.
&&&&&
One is reminded of Captain Smith, wandering the decks of the Titanic, unable to function.
He did so for the CRITICAL first half an hour.
The lost 30-minutes triggered all of the panic action to come.
&&&&&&
The punditry is pacing the deck of the nation of state — not apprehending that the ENTIRE flow of financial events has been inverted by 0-care.
We’re not talking about 1/6th of the American economy;
nor 6/6ths of the American economy;
we’re talking the ENTIRE planet.
For the modern world is (financially) hyper-power centric.
Until 0-care is functionally destroyed — and its taxation of young marrieds is stopped — the FDR engine of money creation is OUT OF GAS.
Only for a brief, transitory, time will foreign buying paper over the epic withdrawal of the FOUNDATION of the ENTIRE American real estate market: young families in formation.
The impact on (White) demographics will also be staggering.
&&&&&&
AFTER the damage has reached a sea state of “5” on the Beafort scale will we see a horrific, violent, counter-rebellion.
The nihilist in chief will be remembered — as Hitler, Stalin, Mao, … all are remembered.
It’s what happens when you breathe your own agitprop.
Genocide without angst.
The country is in this fix because the Republicans are weak, feckless, spineless cowards. They let the Democrats run roughshod over the rules of Congress to pass Obamacare. They should have physically stopped the votes on this monstrosity.
And as feckless cowards they will do nothing sensible now, even given the opportunity a court decision may present.
And the assumption that a Roberts court would wreck Obamacare now is a great leap.
Isubmit to you the None of the Gubmint’s Damn Business Messin’ with Healthcare Act:
1. Eliminate the subsidies
2. Eliminate the mandates
3. Eliminate the penalties
4. Eliminate the excise tax on medical devices
5. Eliminate the federal exchange
6. Increase tax deduction for HSAs
7. Health insurance may be sold across state lines. (Probably the only constitutional thing Congress can actually do, commerce clause-wise.)
8. Group policies may be written for affinity groups.
9. Anybody who doesn’t have health insurance can sign up for Medicaid. It’ll cost you 8% of what you make (or the average cost of health insurance in the US, or whatever number Congress agrees on.)
That’s it. Done! Now let’s move on to the Department of Stupification, the Department of Energy? We don’t got no stinkin’ Energy! We don’t need no stinkin’ Energy, and the Department of Housing and Urban Corruption.
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