Repeal + Replace

Is Trumpcare Dead?
Was It Ever Really Alive?

Senators Mike Lee and Jerry Moran said yesterday that they would not vote for the Better Care Reconciliation Act, effectively killing the legislation.  As anybody who has been following this story would have predicted, President Trump reacted publicly on Twitter on Tuesday morning, vowing to let the ACA marketplace collapse and then rewrite the plan later.

Senate Majority leader Mitch McConnell attempted a quick punt this morning, calling for an immediate Senate vote on the House bill, a trick card that if it worked, would give Republicans two years to work things out.

Unfortunately for McConnell, it probably won’t.

The White House sees the failure as saying more about the political establishment in Washington than itself, which shouldn’t be all that surprising. Caught up in the drama of the Watergate-Russia emails-Trump family narrative, major media outlets like the Washington Post and the New York Times see a historic defeat rather than a temporary setback. That may or may not turn out to be true. Predictably, conservative commentators and the alt-right believe the defeat says more about the mainstream media and the Deep State than it does about the Trump Presidency. For their part, Democrats clearly think they have found their issue and can be expected to continue to exploit it using legislative Viet Cong tactics (attack on social media, melt into the jungle, lob snarky public Molotov cocktails) to punish Republicans and keep the story on the front page.

One thing is clear. Instead of repealing and replacing Obamacare, the GOP now has to rewrite and replace its own plan. Doing that would be difficult under the best of circumstances, but in the current climate in Washington it is difficult to see how it would be possible without a major shift in the political landscape.

All of this is bad news for hospitals and health plans and a frightening development for consumers, although not the really bad news some had feared. The President’s threat to let the insurance marketplace die and then “figure it out” sounds good as a rallying cry to the troops on social media, but is not the kind of thing that investors and CEOs like to hear.  Realistically though, at this point everybody knew that the uncertainty would likely continue through the year (best case) or a year or longer (worst case) as the gridlock in Washington plays out. As depressing and frustrating as it is that the uncertainty will continue, by this point the industry is used to it. Insiders will continue to look for ways to minimize risk and for business opportunities to capitalize on the uncertainty.

Trump’s plan to allow the insurance exchanges to collapse is the kind of confrontational talk Trump and his advisors relish. In theory, the idea could work. There are in fact signs that it already is, as major insurers leave the marketplace and consumers hesitate before committing to expensive insurance policies.  In reality, however, the collapsing exchanges will create a political crisis that is even worse than the current one for the administration, with news cycle after news cycle dominated by stories of terminally ill cancer patients and parents with children with horrible diseases and no insurance coverage. At this point, it will be difficult for the party doing the collapsing to point at the other side and say “It was them. They did it!”

Moderates see some sort of brilliantly crafted compromise as the obvious solution. In any place and time other than Washington in the year 2017 that would probably be the case. Unfortunately, despite what you’re hearing, it probably isn’t going to happen. Extremists on both sides are unlikely to accept anything less than complete and total victory.  With the President on hand to reliably blow up negotiations with ill considered tweets and taunts, all of the pieces are in place to ensure that the  healthcare reform story continues season after season.

If you are a person with a serious pre-existing condition or somebody facing a life threatening health condition, you can be forgiven for feeling extremely unwell right about now. Will you be able to pay for your drug prescriptions next year? Will you even be able to buy insurance coverage next year?  If you are able to buy insurance, will that insurance coverage be worth the paper it is printed on? If by some miracle, you are in fact able to buy insurance coverage, will some insane person take it away from you at some later date in time?

John Irvine is the editor of the Health Care Blog. He can be followed on Twitter at @thcbstaff. He can be reached by email at john@thehealthcareblog.com

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jennkimensPetergerd-healthAllanBobbyGvegas Recent comment authors
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jennkimens
Member

President Obama gambled when he made the ACA his top priority upon entering office, and won.

President Trump gambled when he made the AHCA his top priority upon entering office, and lost bigly.

Steven Findlay
Member
Steven Findlay

The chance of a pivot to a bipartisan effort to stabilize the exchanges is increasing, though perhaps still low. Depends on how votes go this week and next. Below is a slightly modified portion of a THCB post by me from earlier this month, with what ought to be considered in any bipartisan approach: (1) An 5% or so increase for 2018 in premium tax credits (via the formula) for low-income people (2) A commitment to enforce the individual mandate while a comprehensive study is conducted of viable alternatives over the next year. (3) Inducements to insurers to expand into,… Read more »

Peter
Member
Peter

“The chance of a pivot to a bipartisan effort to stabilize the exchanges is increasing, though perhaps still low.”

Yes, so low it’s impossible. Any Republican who attempts to do bipartisanship will get killed in their primary where they’re rewarded for behaving badly. The center for Republicans no longer exists as it’s been purged over the years.

BobbyGvegas
Member

PRESIDENTIAL LEADERSHIP: “President Donald Trump’s interview with The New York Times generated plenty of headline-making comments. But his remarks on health insurance, the biggest topic of the week, suggested he didn’t know how it works or how much it costs. He said: “So pre-existing conditions are a tough deal. Because you are basically saying from the moment the insurance, you’re 21 years old, you start working and you’re paying $12 a year for insurance, and by the time you’re 70, you get a nice plan.” The notion of paying $12 a year for health insurance is even less than the… Read more »

Peter
Member
Peter

I haven’t found Trump knows anything of value on any policy he’s wants. He certainly has nothing to offer.

I hope the ACA is repealed without replacement. Then we’ll see who regrets voting for Trump.

BobbyGvegas
Member

The smarmy HHS Secretary Tom Price the other day cracked that we should just do “Repeal” and go back to the good old days pre-Obamacare — insurance denials, rescissions, lifetime caps, no regulation of costs.

BUT, he’ll keep his 70% taxpayer-subsidized FEHB coverage, thank you very much.

Steven Findlay
Member
Steven Findlay

Indeed, there should now be no doubt that DT does not understand much about the health insurance market and has made no effort to be come fully informed. Maybe Putin can explain it to him next dinner they have

Peter
Member
Peter

Many Americans who will loose coverage if the ACA is repealed may want what members of congress and their staff get.

http://www.snopes.com/members-congress-health-care/

Maybe this push for ACA repeal is so MOC can go back to the 70% premium subsidy they were getting when on FEHBP.

gerd-health
Member

Hi JOHN IRVINE,
Insurance feeds the pay off of Ponzi scheme with high cost marginal care. Fascinating system but little to do – or at least less than it could do- for helping sick people while feeding frenzy for well people. It is nuts to think of system as fixable; need new not old thoughts

BobbyGvegas
Member

CBO on Zombie McConnellCare / “Trumpcare”: “The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Obamacare Repeal Reconciliation Act of 2017, an amendment in the nature of a substitute to H.R. 1628, which would repeal many provisions of the Affordable Care Act (ACA). According to the agencies’ analysis, enacting the legislation would decrease deficits by $473 billion over the 2017-2026 period (see Figure 1). CBO and JCT estimate that enacting the legislation would affect insurance coverage and premiums primarily in these ways:… Read more »

BobbyGvegas
Member

Trump’s latest to Dean Heller: “Nice little Senate seat ya got there. Be a shame if something bad happened to it.”

Allan
Member
Allan

What we are learning is, it is easier to give than to take away even when the gift is only perceived in the mind and is not a reality.

The only solution is to figure out a way to lower costs so that we would be giving to all and not taking anything away. That means lower costs which means less government control, not more. It means cost constraint with subtle charity. It means less rent seekers. . …And finally it means that individuals learn to take charge of their own lives.

retinaldoctor
Member
retinaldoctor

No it was never really alive. The GOP Congress has zero interest in repealing Obamacare. For two reasons. One is that they don’t want to displease their donors, those who support the primary job of any member of Congress, reelection. They fear their big donors (insurance, pharma, hospitals, chamber of commerce, etc) far more than they fear their constituents. Donor class wants Obamacare, so it stays. Two is that many member of Congress hate Trump and want to see him and his agenda fail. Trump is a threat to the establishment, the status quo. Anything to discredit him. Just observe… Read more »