Kamala Harris' Health Insurance Gaffe

Kamala Harris was widely considered to have been the big winner in last night’s Democratic debate but in the midst of the evening, she committed a gaffe that she was forced to walk back this morning. The radical Democratic candidate seems to realize that she went a little too far to the left when asked about abolishing private health insurance.

At one point in the evening, moderator Lester Holt of NBC News asked the 10 candidates to raise their hands if they would “abolish their private health insurance in favor of a government-run plan.” Only Harris and Bernie Sanders raised their hands.

In the light of day, the answer must not seem as good as it did in a room full of Democratic activists because the California senator qualified her position on private health insurance this morning on MSNBC’s “Morning Joe.” On the show, Harris said that she misunderstood the question.

“Once and for all, do you believe that private insurance should be eliminated in this country?” co-host Willie Geist asked Harris.

“No,” Harris answered, adding, “But the question was, ‘Would you give up your private insurance for that option?’ And I said yes.”

“Oh, I think you heard it differently than others, then,” Geist said.

“Probably, because that's what I heard,” Harris replied.

Harris then stated, “I am a proponent of ‘Medicare for All,” adding that she would not eliminate private health insurance but  that it “will exist for supplemental coverage.”

Later in the interview, Geist pressed Harris again, asking, “So, to boil it down, Medicare for All, available to everyone if they want it, but if they have private insurance, they keep it?”

“For supplemental. For supplemental coverage,” Harris said. “Otherwise, they're in Medicare for All.”

In essence, it seems that Harris originally told the truth when she said that she supported abolishing private health insurance in exchange for Medicare for All. Even if her plan leaves private insurers intact for supplemental coverage, most Americans would lose their current health insurance, which was the gist of the question.

Harris’ position also leaves open the question of why Americans would need supplemental health insurance if Medicare for All is the be-all-end-all of health insurance and would include dental and vision coverage. Whatever the reason, under Harris’ plan, Americans would face both higher taxes for nationalized healthcare and premiums for a supplemental private plan. It doesn’t sound like a great deal.

Voters agree. While polling often shows support for single-payer plans such as Medicare for All, that support plummets when voters find out more details about the plan. Voters don’t like the idea that federal healthcare could increase wait times for care or that it would dramatically increase taxes.

Other polls cast doubt on the idea that voters are willing to blow up the healthcare system. Real Clear Politics found in May that less than a third of voters want a completely new system. A large majority, 68 percent, want to make improvements to the current system.

Even if voters are scared away from Kamala Harris by her threats to toss out the current health insurance system, healthcare does represent a weakness for Republicans. Healthcare is a top issue for voters and the GOP has been silent on the topic since its abortive attempt to repeal Obamacare in 2017. Since then Republicans have focused on tariffs and illegal immigration, issues where they are at odds with the majority of Americans.

Republicans of the Bush era failed to address Americans concerns about the high cost of healthcare. That failure led directly to the election of Barack Obama and the implementation of the Affordable Care Act. It could be that history is repeating itself as the Republican failure to present a viable alternative to Obamacare may lead to the passage of an even more radical government takeover of the healthcare industry under the next president.

Originally published on the Resurgent

Even The Hospital Doesn't Know What Your Surgery Will Cost

Last week I bought a car. I don’t know how much the car cost yet. I gave the dealership a down payment and they will send me bills for the balance. I’ll get separate bills for the engine, the body, the tires, the radio and the other separate components and send a monthly payment to each supplier until I pay it off. Until I pay all the bills, I won’t know if my new car costs $10,000 or $100,000 or somewhere in between.

If you are thinking, “That’s not how this works! That’s not how any of this works,” then you’re right. Anyone who bought a car under these terms would be an idiot. That’s not how the market for new cars works at all, but this is the way we buy health care without thinking twice.

We go to the doctor and pay our copayment or deductible, but we know that this is not the entire cost of our care. The insurance companies exclude some services from the copayment and even after paying the deductible we are responsible for a percentage of our healthcare expenses until we reach an out-of-pocket maximum. When we leave the doctor’s office or hospital, we have no idea how much money we have just spent.

It isn’t that health care providers are keeping the cost of care a secret. It turns out that they don’t know how much their services cost either. The Wall Street Journal recently cited the example of Gunderson Health System in Lacrosse, Wisc. The hospital administrators had increased the price of knee surgery by about three percent per year for a decade until the list price approached $50,000.

As with most car dealerships, only suckers pay the list price. The sticker price is a starting point for negotiations. As the car lot, the buyer negotiates directly with the seller, but in the case of health care, the haggling is done between the provider and insurance companies and Medicare.

When the insurers complained about the cost of Gunderson’s knee surgeries, the hospital conducted an 18-month review of their pricing. The review included an efficiency expert, cost of materials and a tally of the time that nurses, doctors and physical therapists spent with the patient. In the end, it turned out that Gunderson’s knee surgeries cost $10,550 at most, about one-fifth of the list price.  

A big part of the problem with American health care is lack of price transparency. If hospitals don’t know how much a procedure costs, how can patients? When you don’t know what something costs, it is impossible to compare prices and shop around. When you only see the insurance copay before the procedure, there is no incentive to compare prices.

Knee surgery, the most common procedure in the US outside of childbirth, would be a good case for price shopping if the data were available to consumers. High-priced hospitals spent about twice what lower-priced hospitals spent on the procedure, but there was little difference in the quality of the work.

“It’s a standard procedure” that doesn’t vary much between hospitals, said Professor Robert Kaplan of the Harvard Business School. “Carve out the old knee and put in a new joint.”

Gunderson went further than just finding out what its costs were. It took steps to cut them. The hospital took steps to improve efficiency while improving the quality of its care. A generic brand of bone cement was substituted for the higher-cost brand used previously. Now physical therapy is started much more quickly. This reduces pain for the patients and speeds up the recovery time, making hospital stays shorter. These and other changes lowered costs by about 18 percent to $8,700.

The American health care system is one of the best in the world when it comes to quality. The biggest problem with American health care is its high costs. Lack of transparency in pricing means that there is little competition based on price. Inefficiencies at the local level boost costs for some hospitals, but the lack of transparency prevents patients from seeking out lower cost alternatives.

The current pricing system is not working well. Even after the implementation of the Affordable Care Act, health care costs have continued to rise. Reuters reported that health care costs are projected to increase by more than five percent in 2018 while CNBC pointed out that annual health care costs already exceed $10,000 per person. Health care spending is approaching 20 percent of GDP and will go higher as Baby Boomers continue to age.

In the end, it is the consumers who are hurt most by the lack of competition and transparency. When the bills that insurance doesn’t cover start rolling in, the patient may contract a serious case of post-op sticker shock. Even those who don’t have surgery pay for the inefficiencies in the system through constantly rising insurance premiums.

Originally published on The Resurgent

Have Democrats Finally Found A Strategy For 2018 Midterms?

So far in the midterm election cycle there are indications that the Democrat blue wave may be foundering on a lack of policy prescriptions and an overreliance on Trump-hate. Generic ballots, which had shown a strong Democrat advantage, in early May showed a narrowing with one poll even showing Republicans up by five points. It seemed as though the combination of a rebounding economy and the lack of a coherent Democratic message may have spared the GOP. Now Democrats are coalescing around a few key messages that they believe will allow them to sweep away the Republican majority. Ironically, the Democratic talking points are stolen from Republican platforms of recent elections.

The biggest issue that Democrats hope to capitalize on is healthcare. Repeal of Obamacare has been a Republican goal since the passage of the Affordable Care Act in 2010, but after last year’s failure to pass a reform bill, the GOP has gone silent on the issue. Meanwhile health insurance premiums are increasing both for Obamacare policies and the market as a whole.

Democratic primary winners believe that the solution to the health insurance crisis is to expand Medicare to cover all Americans, a back-door plan to institute a single-payer health care system. Axios reports that Democratic candidates who support varying versions of Medicare-for-all are often winning primaries against candidates backed by the Democratic Congressional Campaign Committee.

Although it is tempting for conservatives to assume that single-payer health care would be a nonstarter for most Americans, the idea polls pretty well. A March 2018 poll from the nonpartisan Kaiser Foundation found 59 percent of Americans like the idea of Medicare-for-all. When the national health plan was made a voluntary option, the share of those in favor increased to 75 percent, including 64 percent of Republicans.

Perhaps ominously for Republicans running against the idea, 74 percent of independents favored the idea of an optional national health insurance plan. The big question is how voters in swing House and Senate districts will view the idea.

“People are increasingly happy with the Affordable Care Act, but they are increasingly unhappy with the health-care system writ large,” said Sen. Chris Murphy (D-Conn.). “I think there is a greater willingness to accept a bigger role for public programs in repairing the health-care system.”

Following the lead of Bernie Sanders, most of the potential Democrat candidates in 2020 have also endorsed some form of Medicare-for-all. A pro-single-payer Democrat running against incumbent Donald Trump, who endorsed universal health care in the 2016 Republican primary, could make for an interesting, if uninspiring, race.  

A second plan of attack for Democrats is to blame high gas prices on the Trump Administration. The high price of gasoline is caused by crude oil prices recovering after a four-year slump. Rising oil prices are caused by several factors, some of which can be blamed on the Trump Administration and some of which cannot. President Trump is not at fault for OPEC production cuts, declining oil production from Venezuela or increased demand for the summer travel season, but his policies do affect tensions in the Middle East and with China.

Donald Trump linked gas prices to presidential policy in 2012 when he tweeted, “Gas prices are at crazy levels--fire Obama!” At the time, voters rejected his advice.

Regardless of whether he is responsible, the president gets the credit for good news and the blame for the bad. High gas prices can quickly eat up the savings from last year’s tax cut for lower-income Americans as well as slow economic growth.

In early May, Patrick DeHaan of Gas Buddy told the New York Post that prices were already affected, even before Trump announced the decision to withdraw from the Obama Iran deal. “The market has already baked in that Trump is going to opt out of the Iran deal. Oil is several dollars per barrel higher because of it, DeHaan said.

“It's well known that geopolitical instability drives oil prices, and gas prices, around the world higher and higher,” said Sen. Robert Menendez (D-N.J.). “The Trump administration's chaotic approach to foreign policy not only served instability around the world, it certainly serves to drive up oil prices higher and higher.”

Neither line of attack is a sure thing for Democrats, but healthcare and gas prices finally give Democrats something other than Donald Trump to talk about. These two pocketbook issues have the potential to win independent voters over the Democratic side unless Republicans can offer a persuasive case against their ideas.

Originally published on The Resurgent

Health Care Frustrations Emerge As Election Issue

As health insurance companies set rates for 2019, the country is about to be reminded of one of President Trump’s biggest failures, the failure to repeal or reform Obamacare. Republicans made several attempts in 2017 to reform the Affordable Care Act, but failed to garner even the simple majority required to pass the measure under budget reconciliation rules. Now their inability to fix the law is coming home to roost in the form of higher insurance premiums for many Americans.

If you listened to President Trump last December, you might think that Obamacare was repealed. In reality, Republicans repealed the law’s individual mandate, but left most of the ACA intact. Repeal of the mandate might actually worsen the problem of rising premiums as young, healthy insureds flee from the expensive policies still mandated by Obamacare.

In March, the Wall Street Journal forecast that health insurance premiums would be an election issue after Congress failed to agree on a stabilization (i.e. subsidy) bill to shore up the individual health insurance markets. Now that forecast is starting to come to fruition as the first announcements of premium increases are being heard. Maryland, one of the first states for which information about the new insurance rates has become available, has insurers proposing an average increase of 32 percent. The proposed increases range from 18 to 91 percent.

Announcements of rate hikes, along with news of insurers withdrawing from Obamacare marketplaces, have become an annual tradition in the years since Obamacare was implemented, but rising health insurance costs don’t just affect those Americans on individual plans. Marketwatch recently reported on a study that showed that rising health insurance costs contribute to slower wage growth among the nation’s workers, many of whom are covered by group plans purchased by their employer. Group health insurance premiums were forecast to increase by about four percent for 2018.

Americans are getting less coverage despite paying higher premiums. Spending on deductibles and coinsurance, the patient’s share of medical bills, has increased in recent years as copayments have covered less. Whether you have an Obamacare plan or an employer-based plan, you are probably paying more out of your own pocket for health care than you were just a few years ago.

There are also hidden limitations that you only find out about when you have a claim. As an example, my wife had to go to the hospital in an ambulance last year. Six months after her hospital stay, we received a bill from the ambulance service asking us to pay more than $4,000 for a 30-minute ride. When I followed up with Blue Cross Blue Shield of Texas, our insurance company, I was told that the ambulance service was out-of-network. When I pressed further, I found that Blue Cross did not have any ambulance providers in their network in the entire state of Texas. As a result, Blue Cross paid less than $1,000 on a total claim of more than $5,000.

In the United States, the way that we buy health care is totally disconnected from markets and economic reality. If you have any idea what you will owe a doctor for something as simple as an office visit, you are in a minority of consumers. The problem is even worse if you go to the hospital for tests or surgery where several billing entities from the doctor to the anesthesiologist to pharmacies and labs and the hospital itself are involved. Prices are not known until after the service is provided. In many cases, the patient doesn’t even know what services are being provided or by whom.

In another personal experience, I went for a colonoscopy a few years ago. I discussed the cost of the procedure with the doctor and the hospital before I was admitted, but when the bills came later, it was more than three times what I had been told to expect. After months of running between the hospital, the doctor and the insurance company, I traced the problem to an error in the diagnostic code. It took many more hours on the phone to get this code corrected. Many patients probably simply pay incorrect medical bills without questioning whether they are correct or taking the time to investigate.

An accounts receivable representative for the ambulance service that we used told me that, because Blue Cross is hesitant to pay ambulance bills, they often send shockingly large bills to the patient. Part of the goal is to get the patient to put pressure on the insurance company to pay up. The provider doesn’t necessarily care where the money comes from as long as they get paid and the insurance company is happy if patients pay the bills and let them off the hook.

Because of the lack of competition in the healthcare system, Americans are left without options when health insurance companies misbehave. The majority of Americans who get their health insurance through an employer have no input into the choice of a health insurance provider. You can only decide whether to participate in or drop an employer health plan during open enrollment. If you decide to buy insurance from a company other than your group health provider, you lose the employer contribution to the premium. This means that you end up paying far more to buy your own health insurance that you would if you participated in the group plan.

The problem is similar for workers who like their company’s group health plan, but who leave their job. Coverage may not start at a new company for several weeks. In the meantime, health insurance premiums for your old plan may from a few hundred dollars to more than thousand.

Frustration with the existing health insurance system is probably a major reason why a majority of Americans now favor a single-payer system (i.e. government-run universal healthcare). Several recent polls have shown growing support for more government involvement in health care. In April, a Washington Post – Kaiser poll found that 51 percent of Americans favored single-payer. Gallup and Pew found similar results last year. The increasing costs and decreasing value of private health insurance is undoubtedly leading many Americans to embrace this radical idea.

Republicans have damaged themselves on the issue. The Republican health bills of 2017 were so unpopular that they turned public opinion around on Obamacare. After years of favoring repeal of the ACA, more Americans now oppose repeal than support it. CNN polling from March shows Democrats with a 20-point lead over Republicans when voters are asked which party would do a better job on health care, the largest gap of any issue.

At this point, there are no signs that Republicans are interested in fixing the health insurance problem. President Trump is basking in recent foreign policy successes, but Republicans may be hurt in the midterms if attention shifts to domestic issues like healthcare. Korean détente may mean that voters focus more on pocketbook issues instead of national security. If health insurance prices spike in October and November as Obamacare exchanges and employers hold open enrollment for 2019 health plans, it could provide Democrats with a much-needed issue with which to hammer Republicans.

Originally published on The Resurgent

Is Trump's Obamacare Executive Order Constitutional?

There has been a lot of discussion about President Trump’s healthcare Executive Order. Most of the discussion centers around the likely effects of the order while little has been said about the constitutionality of Trump’s executive action. For a party that roundly condemned President Obama’s abuse of executive authority, a big question should be whether Trump has the legal authority to make the changes that he proposes.

The bottom line is that Trump’s Executive Order doesn’t actually make any changes to the Affordable Care Act. What it does do is to order cabinet secretaries to “consider proposing regulations or revising guidance, consistent with law.” In other words, Trump isn’t proposing changes to laws passed by Congress, he is considering changes to regulatory laws enacted by bureaucrats. These changes will be “considered” in three main areas.

First, the president wants to expand access to association health plans (AHPs). Health Affairs notes that these plans are more loosely regulated than traditional insurance plans. They are normally regulated by the states, but can be regulated by the federal government in the case of some national associations. The order instructs the Secretary of Labor to “consider” expanding the definition of “employer” under ERISA to allow more groups to sell AHPs and to “promote AHP formation on the basis of common geography or industry.” To purchase insurance, consumers would have to be a member of the association.

Second, the Executive Order moves to expand Short-Term, Limited-Duration Insurance (STLDI) policies. The order notes that STLDIs are “exempt from the onerous and expensive insurance mandates and regulations” of the Affordable Care Act, but that “the previous administration took steps to restrict access to this market by reducing the allowable coverage period” to less than three months. “To the extent permitted by law and supported by sound policy,” the president directs cabinet members to “consider allowing such insurance to cover longer periods and be renewed by the consumer.”

STLDIs are not considered to be individual health insurance policies and do not fall under the insurance policy requirements of the Affordable Care Act. The policies are governed by rulemaking agencies of the Department of the Treasury, Department of Labor, and Department of Health and Human Services. Therefore, these departments can amend the rules for STLDIs without going through Congress.

Third, the Executive Order instructs relevant cabinet secretaries to “consider proposing regulations or revising guidance, to the extent permitted by law and supported by sound policy, to increase the usability of HRAs, to expand employers' ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage.”

HRAs are health reimbursement accounts. They allow employers to contribute money on a pre-tax basis to reimburse employees for health insurance premiums and out-of-pocket expenses. HRAs were created by Congress, but executive branch agencies have leeway in how to regulate them.

President Trump’s decision to halt Obamacare subsidies to insurance companies is not part of the Executive Order, but is on firm legal ground. House Republicans sued the Obama Administration over the subsidies in 2014. In May 2016, a federal judge ruled that Congress had authorized the payments, but had never appropriated money for them. The Obama Administration appealed the ruling, but the decision by President Trump seems to be merely accepting the court’s initial decision.

This doesn’t mean that the Trump Administration will be able to stop making the payments. Several states ultimately joined the appeal, claiming that the Trump Administration was not adequately defending their interests. Now 18 states have filed a new lawsuit seeking an injunction against President Trump’s decision.

Because the President Trump’s Executive Order does not change existing law and only instructs cabinet members to “consider” making changes to bureaucratic regulations within the framework of the law, the order is constitutional. It remains to be seen what regulatory changes the various cabinet secretaries will propose, but the changes will probably be much less sweeping than claimed by either right or left-wing pundits.

President Trump’s Executive Order is legal in large part because it doesn’t do much. The president simply does not have much authority to change laws that have been passed by Congress. The decision to stop insurance company subsidies is a more serious threat to Obamacare, but even this is unlikely to take effect until the lawsuit by the states is settled. 

Originally published on The Resurgent

Obamacare Reform Is Looking Doubtful This Year

If you’re wondering whatever happened to the Republican health care reform bill, you are not alone. When we last heard from the American Health Care Act, House Republican leaders were waiting on the Congressional Budget Office to score the bill before submitting the legislation passed in the House to the Senate. The CBO scored the bill in late May, but the silence from the Republican ranks has been deafening. The congressional website does not show any action on the bill since it passed the House on May 4.

Readers of The Resurgent are aware that the Republican health care bill falls short of full repeal. Senate rules require 60 votes for cloture on a repeal bill and Republicans would not be able to find eight Democrats to join them in ending a Democrat filibuster. Even if Republicans eliminated the filibuster entirely, they would not have enough votes for full repeal because at least four Republicans have pledged to oppose a repeal bill that does not provide for a phase out of the Obamacare Medicaid expansion.

Now some Republicans are saying that it is doubtful that they will be able to pass even an incomplete health care reform bill. “I don’t see a comprehensive health care plan this year,” Senator Richard Burr (R-N.C.) said in Politico. “It’s unlikely that we will get a health care deal, which means that most of my time has been spent trying to figure out solutions to Iowa losing all of its insurers.” Burr serves on the Senate Heath, Education, Labor and Pensions Committee.

In the Wisconsin State Journal, Senator Ron Johnson (R-Wisc.) agreed that the first priority to would probably be to act to preserve the health insurance markets in their current form. Johnson said that a short-term “market stabilization” bill could be passed that would fund the Obamacare exchanges with billions of dollars to help prevent insurers from exiting the marketplaces. Such an approach would reduce volatility in the Obamacare markets and buy time for Republicans to agree on a reform bill.

“To me, this may be a two-part process. I would admit that’s probably a minority view in the Republican Senate right now,” Johnson said.

Senator Jeff Flake (R-Ariz.) also tried to tamp down expectations. “There are some still saying that we’ll vote before the August break,” he told the Washington Post. “I have a hard time believing that.”

The fundamental problem is that conservative and moderate Republicans do not agree how to handle various aspects of the health care issue. Although Republicans have been united in their desire to repeal and replace Obamacare since the day it was passed, they disagree on the details of what should come next.

In the eight years since Obamacare became law, Republicans such as Tom Price, formerly a Georgia congressman and now Secretary of Health and Human Services, have written legislation to repeal Obamacare and reform the health insurance industry, but the party has not coalesced around any single bill. When Donald Trump eked out a squeaker of a victory in the Electoral College, Republicans were caught flat-footed and did not have a plan for how to exploit his victory. Indications were that, as late as early February, Republicans had not even started writing an Obamacare reform bill. The Senate considers the House bill dead on arrival and is writing its own version of health care reform, which may be available as early as this week.

President Trump’s antics are also hurting the possibility of passing a health care bill. The investigation into the Trump campaign’s possible connections with Russia and the firing of FBI Director James Comey are distractions that make it even more difficult to find a compromise that is acceptable to all GOP factions. The president showed leadership in the fight to pass the AHCA in the House, but has largely been missing-in-action on the issue in the month since the House vote.

Not all Republicans are pessimistic on health care. Senator John Cornyn (R-Texas) was quoted in The Hill as saying, “We do need to take care of our business, and I think you mentioned healthcare, and that's certainly front and center in the United States Senate — something we're going to have to get resolved here in the next few weeks.” Cornyn said that he thought a Senate bill would be “done by the end of July at the latest.”

Repeal of Obamacare has been the centerpiece of the Republican platform since 2010. The fact that repeal is not possible, even with Republican majorities in Congress and a Republican president, is not going to please most Republican voters. If the new Republican administration leaves Obamacare completely intact, it may well face a mutiny from the grass roots.

 Originally published on The Resurgent

Trump Administration to Continue Obamacare Subsidies to Insurers

The Trump Administration has announced that it will continue to pay subsidies to insurance companies under the Affordable Care Act says the New York Times. Separate from the subsidies paid to individuals, the subsidies to insurance companies are intended to offset losses that they incur under the Affordable Care Act and total $7 billion per year.

Without the subsidies, more insurance companies would exit the Obamacare marketplaces. Already one-third of counties have only one Obamacare insurer according to the Kaiser Foundation. Kaiser also estimated that without the subsidies, average premiums for the Obamacare silver plan would rise by 19 percent.

The failure of their health care reform bill has left the Republicans between a rock and a hard place. On one hand, disagreement between rival Republican factions makes repealing large parts of Obamacare and reforming the remainder impossible. On the other hand, if the GOP does nothing and Obamacare implodes with prices spiraling out of control, President Trump and Republican leadership would likely bear the brunt of the public displeasure.

The Trump Administration seems to have decided that the least bad option is keep the Affordable Care Act on life support for the time being. Continuing the subsidies will not be popular with the Republican base, but it might buy the president and congressional leaders time to iron out differences between the Freedom Caucus and moderates for a second attempt at reform.

Ironically, the subsidies were the subject of a lawsuit filed by House Republicans against the Obama Administration. The GOP won the case on the grounds that Congress had authorized the subsidies, but had never appropriated funds for them.

“Congress is the only source for such an appropriation, and no public money can be spent without one,” wrote US District Judge Rosemary Collyer in her decision. Ultimately the ruling against the president was stayed pending appeal, allowing the unappropriated subsidies to continue.

At least two Republican leaders say that Congress should appropriate the money. “I don’t think anybody wants to disrupt the markets more than they already are,” Rep. Tom Cole, chairman of the Appropriations subcommittee responsible for health spending told the Times. “It’s a very unstable market.”

“I will do everything I can to make sure that the cost-sharing reduction payments get made,” Rep. Greg Walden (R-Oreg.), chairman of the Energy and Commerce Committee said. Walden said the subsidies are “an obligation we have not only to the insurers,” but also to consumers, and “we cannot leave them high and dry.”

A bill appropriating money for the subsidies might make unlikely bedfellows. Moderate Republicans and those who don’t want to see upheaval in the health insurance industry might find themselves voting with Democrats to preserve the Obamacare subsidy… if only for a little while.

If the appeal continues, the Trump Administration can make the payments without an appropriation from Congress for the time being. This puts the Trump Administration in the awkward position of defending an Obama-era end run around Congress in federal court against House Republicans.

The critical nature of the subsidies on making Obamacare’s health care marketplaces work illustrates a fundamental flaw in the Affordable Care Act. The ACA did nothing to reduce the cost of health care or health insurance, it merely changed who pays. Obamacare shifted the burden of paying the bills from consumers and health insurance companies to the taxpayers. Without government subsidies paid for by taxpayers, the whole house of cards will fall.

Originally published on The Resurgent

The idiotic way we buy healthcare

Seven years ago, President Obama and the Democrats said that they had solved the healthcare crisis. Their Affordable Care Act promised universal coverage for the uninsured and lower prices for the rest of us. Their calculations were wrong and Obamacare ended up making America’s healthcare mess even worse.

While there are many problems with the current healthcare system, one seems to stand out among all the rest for its sheer stupidity. The most idiotic thing about the American healthcare system is that when we buy healthcare, we have no idea how much we are buying it for. This problem seems to have been worsened by Obamacare.

Aside from suffering from steadily rising premiums and higher deductibles since the onset of Obamacare, we are being blindsided by unexpected medical bills that come out of nowhere. When we go to the doctor for an office visit or check into a hospital, we have no idea what it will cost.

Medical care is the only commodity that we buy in such an insane fashion. Can you imagine going to your local car dealership and signing a contract to buy a new car without knowing how much it would cost or even what kind of car you’d be driving home? Not many people would be willing to take such a deal, but we do it every time we step into a doctor’s office.

When we go to the doctor, all most of us know for sure is that we’ll be paying the insurance copayment. My copay has gone from $20 for an office visit a few years ago to $35 today. In addition to higher copays, my PPO also makes me pay a share of many tests and procedures through deductibles and coinsurance. With my HMO from years past, I only had to pay the copayment for most services.

Not once, but twice in the past two years I have had large bills come from out of the blue for tests that doctors had ordered for members of my family that were denied by the insurance company. In both cases, I took the bills to the doctor to ask them to appeal the insurance company’s denial. In both cases, the doctors said that lab was only supposed to bill the insurance company, not their patients, for the tests in question.

This seems to represent something of a scam. The doctors order tests that aren’t universally recognized and approved and then the lab bills the insurance company. If the insurance company doesn’t pay for the questionable test, apparently the lab takes the loss rather than billing the patient. Occasionally, a bill for thousands of dollars for a test for a routine health condition slips through the cracks to the patient, but normally the patients never know how much money the insurance company is paying out on their behalf unless they actually look at those Explanation of Benefits forms that normally go straight from the mail to the trash.

A third of medical tests are considered unnecessary according to a paper in the Journal of American Medicine. This mountain of needless testing costs hundreds of millions of dollars. When the insurance companies are billed for these expensive tests, it translates in to higher premiums.

Even when you try to find out how much your healthcare costs, you might still be surprised. When I went in for a colonoscopy two years ago, I paid the doctor and the hospital in advance. I thought that this would eliminate any problems with the billing.

Since I had already paid for the procedure, it came as quite a surprise when I started getting more bills in the mail, again for more than a thousand dollars, a few weeks later. After spending countless hours on the phone getting the runaround between the insurance company, the hospital and the doctor’s office, I traced the problem to a diagnostic code that had been entered incorrectly. The confusion was over whether the scan was medically necessary or preventive care. Under the ACA, preventive care was covered at a higher rate than a procedure that is needed for an actual existing health reason. Go figure that one out.

Even after finding the problem, it took many more hours on the phone to get it corrected. Total time to resolve the issue was about six months. Many people probably would have simply paid these bills when they received them and couldn’t get them dismissed immediately. Alternatively, many others might have ignored the bills and suffered credit damage as a result. I have to wonder how many people are paying outlandish medical bills that they don’t really owe.

Some uncertainty in medicine is legitimate. It is possible to go into a hospital and have real, unexpected complications that make your stay more expensive. However, there shouldn’t be any fear of going in for a routine doctor visit and coming out with thousands of dollars for routine and unnecessary tests, even when you have insurance. The price of a colonoscopy shouldn’t double because you have a medical problem that requires you to get a colonoscopy.

There are many problems with the health care system and Obamacare, but one of the biggest is the lack of transparency in pricing. Patients should have an idea how much they will owe before they commit to a procedure. Too often now, cost is never considered by the doctor and never known by the patient. At least not until the bills start showing up in the mail.

To take it a step further, patients should be able to compare the rates of various doctors and hospitals. With any other commodity, if you want the best you’d better be prepared to pay a little extra. If you desperately need a procedure, but don’t have much money, you might prefer a safe, but less prestigious hospital or clinic. Before you pooh-pooh this idea, consider that medical tourism is already gaining in popularity as people travel to countries with better doctors, advanced treatments that may not be approved at home or less expensive care.

In short, health care reform needs to reintroduce real competition and markets. People can’t make intelligent decisions if they have no information about what a transaction will cost them. The illusion that their copayment is their only cost for care is leading to wasteful practices, large bills and inefficient medical care. Give patients the information to make good healthcare choices and the freedom to choose.

Obamacare repeal meets bipartisan opposition

The Republican promise to repeal Obamacare is meeting bipartisan opposition. Democrats are protesting the entire idea of repeal. Meanwhile, some Republicans are seeking to delay the repeal or protect some facets of the Affordable Care Act until a replacement can be written.

A core dispute among Republicans is whether Obamacare should be repealed before a replacement bill is ready. Obamacare can’t simply be repealed because it remade the American health care system. Not all of the healthcare eggs that Obamacare scrambled can be unbroken. Removing the law would not restore healthcare to its previous status quo, which was unpopular anyway.

The ultimate solution must take into consideration that an estimated 20 million people are insured under Obamacare. And, believe it or not, some of them even like it. To be politically viable, the Republican plan for repeal and replacement must find more coverage for these Americans.

Democrats contributed to the discussion about how to handle Obamacare with a five-hour talkathon on the Senate floor. The evening bull session among Democrats began at 6:45 p.m. on Monday and lasted into the wee hours of Tuesday morning. The Democrats boiled down their message to what The Hill calls “The Pottery Barn” rule: You break it, you buy it. Ironically, this is the same rule that gave Republicans control of Congress after Democrats passed Obamacare in 2010.

“Get real, [Republicans] don't have a clue what to do next," Sen. Elizabeth Warren (D-Mass.) said in The Hill. "Repeal and run. That's the Republican plan.”

Some Republicans agree that they don’t know what to do next. That is the essence of the debate among Republicans. One faction wants to pass a budget resolution to start the repeal and then follow up with a replacement later. The budget reconciliation is the same trick that Democrats used in passing the original Affordable Care Act to avoid a filibuster by Republicans. The resolution contains language that would direct House and Senate committees to write a bill to repeal and replace Obamacare by Jan. 27.

An amendment introduced by Sen. Bob Corker (R-Tenn.) would extend the deadline to craft a replacement law until March 3. Corker is joined by Rob Portman (R-Ohio), Lisa Murkowski (R-Alaska), Susan Collins (R-Maine) and Bill Cassidy (R-La.) in favoring more time to write the new law.

“This amendment will give the incoming administration more time to outline its priorities after its chief healthcare official assumes office and fully reviews the tools currently at his disposal,” Corker told the Washington Examiner. “By extending the deadline for budget reconciliation instructions until March, Congress and the incoming administration will each have additional time to get the policy right.

Republicans all favor a repeal of Obamacare, but they have not agreed on a replacement. The original bill allows only a few weeks to write a complex bill to restructure the health insurance industry. Corker’s amendment would extend that time to a few months.

In either case, Obamacare will probably not go away instantly. MarketWatch reports that Republicans may delay full repeal for two to four years while the replacement law is written and implemented. At the same time, they will also be working on reforming the tax code, another massive undertaking which will be passed by the same budget resolution tactic.

While the budget reconciliation to repeal Obamacare would be passed by a simple majority vote, subsequent bills to replace it would be subject to cloture votes that require 60 votes. This would allow the 48 Senate Democrats to block bills that Republicans try to pass separately from the budget resolution.

Republicans can’t count on the Democrats to pitch in. “I take (Senate Minority Leader Chuck) Schumer at his word that if we just go ahead and repeal, Democrats won't provide one vote for enacting the replacement," Sen. Ron Johnson (R-Wis.) told CNN. "So I think we need to actually have a game plan.

One sticking point among Republicans is whether Obamacare’s taxes should be repealed immediately. Bloomberg reports that some Republicans, among them Sen. Cassidy and Rep. Pete Sessions of Texas, believe that the Obamacare taxes should be repealed as part of the tax reform.

The problem, according to Cassidy, is that most Republicans have taken a pledge not to raise taxes. If the Obamacare taxes are repealed immediately, “then you’re in a hole” where Republicans politically cannot enact a new healthcare law because they can’t vote to pay for it.

“If we don’t like ’em, we can replace them,” Cassidy said. “But we can do it in a way where you overall are lowering tax rates and making the tax code more efficient. There will be enough there for people to win.”

Other Republicans say that the taxes must go immediately. “Repeal it, get rid of it, every single bit of it, don’t keep any of it,” said Rep. Jim Jordan (R-Ohio). “That’s all the taxes, all the mandates, all the things that are in this thing that the American people don’t like and that I think have driven up the cost of medicine, hurt economic growth. I think we’ve got to do what we told voters we were going to do.”

A second problem is defunding Planned Parenthood, which will also be part of the budget reconciliation. Pro-abortion Republicans Susan Collins and Lisa Murkowski may not vote for the budget bill if it defunds the abortion provider. The loss of their votes could derail the repeal effort.

Corker told CNN that it “doesn’t seem very intelligent” to repeal the law without knowing what is going to replace it. Rand Paul agreed, “I will do everything in my power to have a vote on it the day we repeal Obamacare.”

Nevertheless, the Republican leadership is still pressing for a quick repeal and eventual replacement. “We're not going to do a comprehensive bill,” said Sen. John Cornyn (R-Tex.). “We are going to do it in a step-by-step basis” with a series of smaller bills.

The direction that the GOP will take will soon be evident. The Senate plans to vote on the budget reconciliation authorizing the repeal of Obamacare this week. 

Originally published on The Resurgent

Bill Clinton bashes Obamacare - then asks for more

In a rare Democratic moment of truth, Bill Clinton almost sounded like a conservative for a few minutes in Flint, Mich. on Monday. In his remarks, which were covered by CNN, Clinton called Obamacare the “craziest thing in the world.” On Tuesday, Mr. Clinton tried to walk back his comments and may have inadvertently provided insight into Hillary Clinton’s new healthcare strategy if the she wins the election.

"So you've got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It's the craziest thing in the world," Clinton said on Monday according to CNN.

He tried to rebut criticism from the left on Tuesday, telling an Ohio crowd, “Look, the Affordable Health Care Act [sic] did a world of good, and the 50-something efforts to repeal it that the Republicans have staged were a terrible mistake. We, for the first time in our history, at least are providing insurance to more than 90% of our people.”

“But there is a group of people -- mostly small business owners and employees -- who make just a little too much money to qualify for Medicaid expansion or for the tax incentives who can't get affordable health insurance premiums in a lot of places,” Clinton continued. “And the reason is they're not in big pools. So they have no bargaining power.”

Clinton’s criticisms of the Affordable Care Act mirror concerns of conservatives before the law was passed. Adverse selection, in which people who are already sick sign up for health insurance while the healthy pay the fine instead, played a large role in driving up prices. Obamacare depended on enlisting young, healthy people to pay the costs for people were older and unhealthy. That has not happened. The problem is so bad that many health insurance companies are choosing to leave the market completely, rather than continue to absorb losses.

As prices increase, companies are passing more costs along to their employees or dropping health insurance coverage altogether. If you still have an employer health insurance plan, you’re probably paying a higher monthly premium as well as higher deductibles and copayments. Many companies, particularly small businesses, are opting out of providing health insurance altogether.

Those who still have insurance may not be able to go to the doctor. As Clinton pointed out, 25 million more people now have insurance, but there are just as many doctors as there were before Obamacare. This increased demand has caused a doctor shortage in many areas. The Fiscal Times estimates that “demand for physicians will grow by 11 percent to 17 percent through 2025, while the number of doctors will increase only by 4 percent to 12 percent.”  It’s going to get hard to get an appointment.

The original goal of the Affordable Care Act was to insure everyone in the United States. Has it been successful? The Kaiser Foundation estimates that the uninsured rate declined from a high of 18.2 percent in 2010 to 10.5 percent in 2015. Even after the devastation wrought by the ACA, more than 28 million Americans remain uninsured. The most common reason for not having insurance according to Kaiser is that it costs too much.

What is the Clinton solution to the continuing healthcare crisis? Last January, Hillary Clinton told a crowd in Iowa, “It was called Hillarycare before it was called Obamacare. I don't want to start over.”

Bill hints that she won’t start over. Slate has a quote that many articles covering the story didn’t include that hints at where the Clintons want to go. “So here’s the simplest thing,” Bill Clinton said, “Figure out an affordable rate and let people use that, something that won’t undermine your quality of life, won’t interfere with your ability to make expenses, wont’ interfere with your ability to save for your kids’ college education, and let people buy into Medicare or Medicaid.”

So the Clintonian answer to the health insurance crisis is more government. Bill would let people buy into a Medicare and Medicaid at “an affordable rate” that probably has no relationship to the market rate for insurance. This can be understood as price controls and a public option.

Voters should know that a third of doctors are already not accepting new Medicare patients according to Investor’s Business Daily. Both programs are also in financial trouble already. Medicare’s trust fund is projected to be insolvent in 15 years. Medicaid, whose cost is split by the states and the federal government, already represents 20 percent of state budgets even before the costs of the Obamacare Medicaid expansion kick in.

Bill’s idea does not address the economic problems of Obamacare at all. It just changes the insurance provider from private companies to the government. In other words, Hillarycare would impoverish the government the way Obamacare has broken the insurance companies.

Originally published on The Resurgent

High premiums and cancellations - not website problems–are real Obamacare scandals

The continuing revelations of the meltdown of the Obamacare website have obscured news of a problem that is much more difficult and perhaps impossible to fix with President Obama’s namesake health care plan. New information suggests that there are at least three separate problems that threaten the viability of the entire Obamacare premise. In fact, early signs point to the possibility that more Americans will be uninsured under Obamacare than before. As Rep. John Barasso (R-Wy.) said on the Sunday, Oct. 27 edition of ABC’s “This Week, the problems with Healthcare.gov are “the tip of the iceberg.”

First and most obvious, health insurance premiums have not decreased due to the Affordable Care Act as Barack Obama promised. Instead, an analysis of HHS data by Forbes found that few Americans will see decreases in average premiums. The HHS data, which detailed premiums for 27-year-olds and the average-age exchange participant for each state, found that premiums for the younger group would increase by an average 97 percent for men and 55 percent for women. Forty-year-olds, which were used to approximate the average participant, saw an increase of 99 percent for men and 62 percent for women.

For the majority, the higher premiums are not offset by subsidies according to the Forbes data. Twenty-seven and forty-year-olds would have to earn almost 60 percent less than the median income of their age group (around $40,000) to qualify. Members of the middle class, who do not qualify for subsidies, face a combination of higher insurance premiums as well as higher taxes built into the law to pay for subsidies for the poor.

The website Obamacarefacts.com, which says in its Facebook page that it is “a group of private citizens with no funding from any party,” doesn’t dispute that premiums have increased, which it says is “a sore subject with many readers.” Instead, Obamacarefacts acknowledges that the requirements “to cover high-risk consumers,” cover “Americans with pre-existing conditions” and community rating to prevent “higher rates based on health status or gender” have caused premiums to increase. Other factors, such as eliminating benefit caps and requiring plans to cover children up to age 26 also serve to increase premiums.

Obamacare’s high premiums contribute directly to the second problem, the fact that more than half of the enrollees on the health insurance exchanges are signing up for Medicaid and not private insurance. CNN reported on Oct. 27 that government data showed that, of the 700,000 applications on the health insurance exchanges so far, most have enrolled in Medicare. The report raises the prospect that not enough healthy, younger Americans are signing up to pay the high prices that will theoretically support the premiums of older and unhealthy Americans. CBS News confirmed that in Washington, of the more than 35,000 people newly enrolled, 87 percent signed up for Medicaid. In Kentucky, out of 26,000 new enrollments, 82 percent are in Medicaid. In New York, Medicaid accounts for 64 percent of 37,000 enrollments.

The combination of high premiums and difficulties with the web site may explain why young, healthy consumers aren’t opting in. Older Americans and those with health problems have more of an incentive to invest the time required to successfully apply for an Obamacare policy.

Gail Wilensky, a former Medicaid director, told CBS News, “Either the private insurance enrollments come up somewhere around the expected amount or there's going to be a problem. ... You need a volume and you need a mix of people that are healthy as well as high users in private insurance, in order to have it be sustainable.”

The third problem is that the Affordable Care Act actively works to decrease the number of people in private insurance. Because Obamacare mandates a list of essential health benefits for insurance plans, many existing policies do not meet the new standard in spite of President Obama’s promise that “If you like your health care plan, you can keep your health care plan.” As a result, hundreds of thousands of Americans are receiving cancellation notices from their insurance companies. In California, Kaiser Permanente is canceling 160,000 policies. Florida Blue is canceling 300,000 policies. As many as 16 million Americans may lose their coverage according to an estimate in the New American. Forbes notes that the cancellations in three states – Florida, California, and Pennsylvania - are more than the total number of Americans who have applied for coverage under Obamacare.

When policies are canceled, people have the choice of paying higher premiums through Obamacare or being uninsured. One such American is Kirsten Powers, a liberal columnist and Obamacare supporter. The 44-year-old Democrat’s policy with a $2,500 deductible was canceled, she noted on Fox News, adding that she can get a similar policy, but the premium will increase from $160 to $300 per month.

Democrats have responded to the premium increases by noting that the new and improved policies are much better than the ones being canceled and that part of the increase will go to help the uninsurable. To voters who relied on President Obama’s promises of lower rates and keeping their old policy, that may not be much of a consolation.

As Kirsten Powers lamented on Fox News, “I don’t think that’s quite the way they sold it.”

Originally published on Examiner.com

Millions of poorest Americans get no Obamacare subsidies

Lost among reports of the difficulties of the Affordable Care Act’s health insurance exchanges is the news that President Obama’s health insurance reform law is actually making it harder for the very poor to get insurance coverage. The architecture of the law and the Supreme Court’s 2012 decision that struck down a portion of the Affordable Care Act have combined to create a gap for low income Americans that deprives them of Obamacare’s health insurance subsidies as well as no-cost coverage under Medicaid.

Danielle Morgan, the 23-year-old married mother of four in North Carolina, is one of those affected. Danielle’s husband is a full-time Bible college student with no income. Danielle told Examiner that she works to support their family, but her employer does not offer health insurance. The family has not had health insurance in the past, but Danielle was hopeful that the new health insurance marketplaces would allow her to purchase an affordable policy for her family and avoid Obamacare’s fine.

Even though Danielle is employed, President Obama unilaterally delayed the portion of Obamacare that requires employers to provide their employees with health insurance. The employer mandate will only apply to companies with more than 50 employees when it goes into effect in 2015.

The problem of insuring low income workers is made worse because Obamacare bans the “mini-med” policies that cover an estimated 1.4 million Americans according to an estimate by Politico. These plans were used by many employers, such as McDonald’s, to provide low-cost health coverage for low-income workers who cannot afford to pay their share of a traditional health insurance plan. Because the plans have annual limits for payouts and do not provide the federal minimum essential coverage, they do not qualify as health insurance under the Affordable Care Act. Many workers formerly insured by “mini-med” plans will likely become uninsured unless new “skinny” plans can be designed that meet the requirements of the law.

After several attempts at logging on the exchange, Danielle finally went to Kaiser’s online premium and subsidy calculator. What she found shocked and dismayed her. The premium for her family would be $5,711 per month for a Bronze plan. She also found out that her family would not qualify for a subsidy even though they are below the poverty line.

Danielle and her family fell into a gap created when the Supreme Court struck down Obamacare’s mandatory Medicaid expansion. In the 2012 ruling, the Court held that the federal government could not force the states to expand Medicaid to low income families. If states voluntarily expanded their Medicaid programs, the federal government promised to pay the full cost for three years and 90 percent thereafter. Twenty-five states, including North Carolina and Georgia, chose not to join the Medicare expansion. .

The Winston-Salem Journal estimated on Oct. 19 that as many as 300,000 North Carolinians under the poverty line may be affected by this Medicaid gap. Bloomberg, also on Oct. 19, noted that the number of Americans affected by the gap is estimated at 5.2 million nationwide.

According to the News Observer, North Carolina officials cited the cost of Medicare as well as systemic problems such as cost overruns and billing delays in rejecting the growth of the program. North Carolina’s Medicaid program cost $14 billion last year. The state’s portion was $3 billion, which represented about 15 percent of the state’s budget according to the North Carolina Department of Health and Human Services. In Georgia, Medicaid spending also makes up 15 percent of the state budget according to Georgia Health News.

“So much of our state revenue has been eaten away by the Medicaid budget,” said Justin Burr, a Republican member of North Carolina’s House health care committee. “I certainly don’t think we need to expand an entitlement program.”

The ability of the federal government to honor its promise to pay its share of new Medicaid costs is also in question. The federal government has been operating at a budget deficit for years. As the federal debt mounted during Barack Obama’s administration, congressional battles over spending have become increasingly frequent and acrimonious. In the final analysis, increased spending for the Medicaid expansion may force tax increases at both the state and federal level.

Since the unveiling of the Affordable Care Act’s health insurance exchanges on Oct. 1, many Americans have experienced cases of sticker shock. Even many Americans who qualify for federal subsidies have found that premiums are much higher than expected. Both CNN and the Fiscal Times list high prices among the top complains about Obamacare. In many cases, deductibles and out-of-pocket expenses are higher as well.

Danielle, who has a minor heart problem, says that she has not had health insurance in her adult life. She was worried about having to choose between paying the Obamacare fine and finding money for the health insurance premium for her family. There at least, there is some relief. Due to her family’s low income, she is exempt from the fine even though she will remain uninsured.

“It would be great to get coverage for just basic family doctor care at a reasonable price, Danielle said. “It just doesn’t make since to pay almost six grand for one or two visits a year with the cash price being a fraction of that.”

 

Originally published on Atlanta Conservative Examiner

A path forward for Republicans

As the government shutdown goes through its third week, poll after poll indicates that Republicans are taking the brunt of the blame. As Examiner noted last week, an NBC News/Wall St. Journal poll found approval of the Republican Party at a historic low. Generic congressional polls (summarized on Real Clear Politics), which have been in a dead heat all year, have turned against Republicans since the shutdown. Recent polling shows a consistent advantage for Democratic candidates.

Through it all, Republicans have made no headway in defunding the Affordable Care Act. In fact, the negotiations to reopen the government have shifted toward a new Democratic demand to undo the sequester cuts from last January. The sequester represented a rare GOP victory during the Obama era. It also worked. As Stephen Moore pointed out in the Wall St. Journal, the sequester law actually reduced spending and cut the deficit by about half. Removing the sequester’s spending limits would represent a major defeat for Republicans.

The government shutdown also tarnishes the Republican reputation for fiscal responsibility, an area where Republicans polled well before the shutdown. The shutdown is costing an estimated $160 million per day on the conservative side. Higher estimates rise to more than $1 billion per day in lost growth and other factors. To add insult to injury, the House voted last week to give furloughed federal workers their back pay, which means that federal workers will be paid for doing nothing if the Senate passes the bill.

Defunding Obamacare, which, as noted in Examiner last month, would require the votes of a minimum of five Democrats in the Senate (overturning President Obama’s certain veto would require the votes of 54 Democrats in the House and 21 in the Senate), is beyond the reach of the GOP and the party is taking heavy damage from its stand. Since the original goal of defunding Obamacare is clearly unattainable, where should Republicans go from here?

The Republicans should look to the Hippocratic Oath for guidance: “First, do no harm.” The government shutdown must be ended to avoid irreparable harm to the Republican Party, but, by the same token, the Republicans cannot accept a deal that ends the sequester while offering nothing in return. A return to the status quo would be acceptable, if humiliating. Writing in the Guardian, Grover Norquist proposed a deal in which the sequester is lifted temporarily in exchange for entitlement reform. Republicans should get what they concessions they can, but they must end the shutdown before it leads to a default.

After the government is reopened, Republicans need to make some strategic changes. Railing against Obamacare and just saying no don’t work. If they did, Mitt Romney would be in the White House.

First and most important, the Republicans need to start listening to the American people. The American people oppose Obamacare, but they opposed a government shutdown by even larger margins. As Examiner reported in September, 54 percent opposed Obamacare, but 71 percent opposed the shutdown. Republicans have traditionally criticized the Democrats for their attitude that “we know what’s best for you,” but the GOP has fallen into the same trap and is paying the price for it.

Second, Republicans need to change the focus of their argument. Arthur Brooks points out that Republicans cede the moral argument to Democrats and focus on materialistic concerns such as debt or abstractions such as free markets and capitalism. To the contrary, the left uses emotional arguments, caring for the poor, to advance policy agendas that actually hurt the poor. Brooks’ concern is borne out by CNN exit polls that show a staggering 81 percent of the voters who thought caring about people was a candidate’s most important quality voted for Barack Obama.

In Brooks’ view, the answer is to focus on how conservative policies help people. This does not require changing conservative principles; instead it means reframing arguments to say, “We will fight for you and your family” rather than fighting against things, such as Obamacare.

When the government shutdown is ended, Republicans will be able to return the focus to why Obamacare is bad for the American people. This should be an easy task given Obamacare’s disastrous debut. The much-vaunted health care exchanges are plagued with glitches that make it difficult for consumers to log on and purchase insurance. Consumers who are actually able to navigate the exchanges often find that their insurance premiums have gone up due to the new law. As the Chicago Tribune notes, deductibles, the share of medical bills that the consumer must pay before insurance kicks in, are also increasing. This means that not only are Americans paying more up front for health insurance, they are paying more when they go to the doctor as well.

The Republicans should be talking about how these premium increases affect families across the country who are still reeling from the Great Recession and its lackluster recovery. They should be standing with Americans like Adam Weldzius, the 33-year-old single father in the Chicago Tribune article who has to choose between an insurance premium that doubles or a deductible that triples.

Finally, Republicans must go beyond saying “no” and communicate a positive vision for the future. It isn’t enough to want to repeal Obamacare, for example. Rising health care costs will still be an issue if and when the Affordable Care Act goes away. Karl Rove presented some ideas for conservative health care reform in August and Examiner covered the topic last year, but these have been the exceptions. For the most part, the Republican message on health care has been negative.

Finally, Republicans need to remember who the real adversary is and focus their attention on President Obama and the Democrats rather than bashing each other. To defeat the Democrats and repeal Obamacare, the Republicans must unite and find a common voice. Interparty bickering and squabbles drown out any positive message that the Republicans try to convey to voters.

As President Reagan was fond of saying, “The person who agrees with you 80 percent of the time is a friend and an ally — not a 20 percent traitor.” Nevertheless, Republicans like John McCain, Lindsey Graham, and John Cornyn have had their reputations trashed and been the victims of vicious personal attacks. Yet, when their records are examined, the American Conservative Union gives them lifetime ratings of 82 percent, 89 percent, and 93 percent respectively. All three have consistently voted against Obamacare.

The shortsightedness of the Republican Party threatens not only the possibility of GOP control of the Senate after the 2014 elections, but continued control of the House as well. A few simple midcourse corrections might persuade Americans that the Republican Party is a viable alternative to the Democratic habit of taking money from Americans to fund programs that harm them.

 

Originally published as Atlanta Conservative Examiner

Oklahoma lawsuit may deal Obamacare ‘fatal blow’

The Supreme Court upheld the constitutionality of the individual mandate in 2012, but now another lawsuit is challenging the Affordable Care Act on different grounds. The new lawsuit, brought by the State of Oklahoma, has its roots in a legal paper by Jonathan Adler, a professor at Case Western Reserve University, and Michael Cannon, director of health policy studies at the Cato Institute. The paper, “Taxation Without Representation: The Illegal IRS Rule to Expand Tax Credits Under the PPACA,” argues that, according to the language in the law, Obamacare’s health insurance subsidies can only be applied to state exchanges, not exchanges set up by the federal government.

As Dick Morris explained in The Hill on Oct. 8, Section 1311 of the ACA establishes state health insurance exchanges. Section 1401 stipulates that refundable tax credits, the subsidies, are available only for health insurance purchased in Section 1311 exchanges, those set up by the states. Morris argues that the intent of Congress was to establish subsidies as an incentive for states to set up their own exchanges.

Only 16 states and the District of Columbia elected to form state health exchanges in spite of the promise of subsidies. One of these states, Oklahoma, filed suit in Pruitt v. Sebelius, challenging an IRS ruling that extended both the individual and employer mandates to all states according to lawyers.com. The suit claims that the employer mandate to provide health insurance to employees or pay a fine should not apply to states that did not set up their own health insurance exchanges. It also challenges the subsidies.

Although filed in 2011, a stay was issued until the Supreme Court ruled on the constitutionality of the Affordable Care Act. The federal government moved to dismiss the lawsuit after the stay was lifted, but a federal judge let stand the complaints against the employer mandate and subsidy. The court also ruled that the State of Oklahoma has standing in the suit as a large employer. The case is currently pending before the Eastern District United States Court of Oklahoma.

If the court eventually sides with Oklahoma, John Goodman of the National Center for Policy Analysis argues that it would be a “fatal blow” to Obamacare. “With so many states declining to set up exchanges,” he says, “Obamacare will be a disastrous failure if the courts agree with them.”

A victory for Oklahoma would also likely apply to other states, such as Georgia, that decided not to set up their own health exchange. As reported by Examiner, Governor Nathan Deal announced Georgia’s decision not to create an exchange in November 2012.

If the courts rule that the employer mandate and insurance subsidies do not apply in states with federal exchanges, it would destroy the delicate balance of the law in those states. Employers would not be fined if they declined to provide coverage for their employees. While the mandates for Obamacare’s “essential health benefits” would still apply in all states, subsidies would not be allowed in states with federal exchanges, making the cost of insurance prohibitively expensive.

While a court decision would not strike down the Affordable Care Act immediately, it would render the health law virtually nonexistent for employers in a majority of the country. While the individual mandate and fines would still apply, the lack of subsidies would mean that more people and companies would choose to opt out of purchasing insurance and the risk pool would shrink. Obamacare depends on young people buying expensive insurance to subsidize older and less healthy people.

If young, healthy people opt to pay the fine and employers choose not to provide health insurance, Obamacare will likely collapse under its own weight in short order. With Republicans controlling the House of Representatives, a new health care fix would require a bipartisan agreement, unlike when Obamacare was passed in 2010 with Democratic majorities in both houses and no Republican votes.

It seems as though Congress should have actually read the bill before they passed it.

Originally published on Elections Examiner