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1/27/2017 10:20 am  #1

Republicans Quietly Admit There Will Be No Obamacare Replacement

Republicans Quietly Admit There Will Be No Obamacare Replacement

The history of the development of the Republican alternative to Obamacare since the beginning of the health-care debate, in 2009, has been an endless loop of loud promises that a full plan will be announced soon, followed by quiet admissions that it will not. Seventeen days ago, Donald Trump promised a vote to repeal the law “probably some time next week” with a vote for a replacement “very quickly or simultaneously, very shortly thereafter.” At a meeting in Philadelphia yesterday, Trump and his House Republican allies produced no agreement on a plan. If there is a consensus, it is that there will be no replacement plan at all.

Representative Greg Walden, a key leader of the House Republican efforts on health care, tells Julie Rovner, “There’s no single fix. There’s no single plan.” Representative Marsha Blackburn touted bills to limit medical malpractice lawsuits and to allow the sale of state-regulated insurance across state lines. Neither of these proposals would have any significant impact on insurance coverage. If Obamacare is repealed, this would leave the individual-health-insurance market a smoldering crater.

Republicans are portraying the lack of a plan as a philosophical aversion to lengthy legislation. “If you’re waiting for another 2,700-page bill to emerge, you’re going to have to wait until the sun doesn’t come up, because that’s not how we’re going to do it,” says Walden. You may not need 2,700 pages of legislative text. But you can’t blow up the health-care system and replace it with a series of piecemeal measures. Any real plan to provide even crappy coverage — let alone the better, more affordable coverage Trump has repeatedly promised — is going to need to be paid for. Making those trade-offs means figuring out some big-picture strategy for where the money will come from.

The reason health-care reform is done by assembling a big bill with a high page count is that all the stakeholders want to know beforehand whether the final product will be acceptable to them. Hospitals or insurers or doctors or drug makers might be willing to accept provisions that hurt their bottom line if there are other provisions that help them. But they won’t support passing a bill that hurts them on the promise of getting help in a future bill, because they don’t know whether the future bill will pass. Going step by step is a talking point, not a plausible way to actually write laws.

Step-by-step changes could work if they leave the current system in place and alter it incrementally. But if you blow the market up, you need comprehensive changes to rebuild something in its place.

Several Senate Republicans have expressed severe reservations about repealing Obamacare without having a replacement. Now the House is admitting there isn’t going to be a replacement. So now the choice falls to Republicans to either defeat repeal, or allow the system to hurtle toward chaos.

We live in a time in which decent and otherwise sensible people are surrendering too easily to the hectoring of morons or extremists. 

1/27/2017 10:58 am  #2

Re: Republicans Quietly Admit There Will Be No Obamacare Replacement

Finally, the truth--what many suspected--is out in the open.  Depending on the Repubs next move this news should come as a relief to many ACA patients. 


1/27/2017 11:00 am  #3

Re: Republicans Quietly Admit There Will Be No Obamacare Replacement

Ross Douthat had athoughtful column this week about a hybrid approach put forth by Senators Cassidy and Collins as a possible solution to this whole mess and even more how the American conservative approach to health care doesn't have the holistic view it needs to be a workable for the nation. Worth a read.....

Collins has always been a solid moderate. Cassidy is the newest member of the senate meaning that he probably still has the naivety needed to think an honest proposal can defeat blind partisanship.

Perhaps half a loaf of the ACA is better than letting Trump, Ryan, and McConnell destroy it.

Modern conservatism, at least in its pre-Donald Trump incarnation, evolved to believe in a marriage of Edmund Burke and Milton Friedman, in which the wisdom of tradition and the wisdom of free markets were complementary ideas. Both, in their different ways, delivered a kind of bottom-up democratic wisdom — the first through the cumulative experiments of the human past, the second through the contemporary experiments enabled by choice and competition.

In health care policy, however, conservatives tend to simply favor Friedman over Burke. That is, the right’s best health care minds believe that markets and competition can deliver lower costs and better care, and they believe it even though there is no clear example of a modern health care system built along the lines that they desire.

The dominant systems in the developed world, whether government-run or single-payer or Obamacare-esque, are generally statist to degrees that conservatives deplore. A few of them — notably Singapore’s, the beau ideal of right-wing health care wonks — do have distinctive elements that conservatives favor. But mostly they tend to be much more heavily regulated and subsidized than the system that conservative health policy wonks and policy-literate Republicans would like to see take over from Obamacare.

Which is not to say that the conservative health policy vision lacks empirical grounding. There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow, and good reasons to think that free-market competition produces more medical innovation than more socialized systems.

But still — there is no existing system on a national scale that looks like the health care system that Paul Ryan or Tom Price would design, no wisdom of developed-economy experience that proves that such a system would actually keep overall costs low and prevent too many people from being shut out of insurance markets. So embracing even the smartest conservative Obamacare alternative requires a not-precisely-Burkean leap of faith.

And this, in a nutshell, is why Republicans should give serious consideration to the proposal that Senator Bill Cassidy of Louisiana and Senator Susan Collins of Maine have just put forward as a possible health care reform alternative.

The essence of Cassidy-Collins, and the reason that many Republicans don’t like it, is that it isn’t actually a full Obamacare replacement. Instead, it’s a federalist compromise. It lets individual state governments decide whether they want to stick with Obamacare or not, which would mean that the law would remain intact in most blue states for the time being, while redder states would have the opportunity to turn roughly the same amount of money (95 percent) to a different end.

That end would look like one of the more plausible conservative alternatives to Obamacare: a subsidy to cover the cost of a catastrophic health insurance plan, plus a directly funded health savings account to cover primary care.

This system could be layered on top of the existing Medicaid expansion, replacing only the Obamacare subsidies and exchanges, or it could replace the Medicaid expansion as well, offering the poor and near poor the same “catastrophic insurance plus a subsidy” as everyone else in the individual market. Either way the individual mandate would disappear, but people would be auto-enrolled in a catastrophic plan (with the option to opt out), meaning that coverage would be nearly universal (thus fulfilling one of President Trump’s various promises) even though its benefits would be less comprehensive than Obamacare’s.

Taken as a whole, this approach distills both the promise and the peril of conservative health care policy. The promise is that by having people pay for more of their health care in cash and by giving them more freedom in what plans they’re allowed to buy, you would end up with less spending, lower prices and less cost inflation. (And you wouldn’t need the heavy, innovation-squashing price controls that single-payer systems use to get there.)

The peril is that there would be too wide a gap between what the money in your health savings account covers and what you need before your catastrophic coverage kicks in. In which case many people with consistent health care costs for chronic problems would rack up impossible medical bills in short order.

Conservatives who want this model to replace Obamacare nationwide believe that the promise outweighs the risk — and this is, again, a reasonable belief. But it’s also a belief that hasn’t been tested on any kind of sweeping, economywide scale. And this is the advantage of Cassidy-Collins: It encourages governors and legislators to actually put the conservative theory of health care to the test without simply reversing the ideological colors of the great Obamacare experiment and immediately turning the entire United States health care system over to the right’s technocratic vision.

Of course this would mean that Obamacare’s existing problems would persist in the states where it continues. But those problems — the rise in premiums, the fleeing insurers, the risk of a death spiral downstream — are not equally problematic in every state, and they are not fiscally dangerous, as yet, on the scale that many conservatives initially feared.

As the conservative policy thinker Yuval Levin wrote late last year, the striking thing about Obamacare to date is how much smaller than expected its effect on the overall health care system has been. Fewer people are being insured on the exchanges than liberals hoped, fewer employers are dumping high-cost employees onto the exchanges than conservatives feared, and as a result, he writes:

The extremely serious problems we are seeing now are within the one system that Obamacare created from scratch, the exchange system. That system may not survive, and its condition has a lot to teach us about the problems with liberal health economics. But it is a much smaller system than anyone thought it would be at this point, about half the size that C.B.O. projected, so that the effects of any failure it suffers are likely to be more contained than anyone might have expected.

This containment means that conservatives have room and time to be more patient, cautious and experimental than were the Obama Democrats before them. If the Obamacare exchanges aren’t ultimately going to work out, then allowing them to persist in liberal states while an alternative system gets set up in red states is a reasonable way to gradually transition from the liberal model toward the conservative one. If the right’s wonks are right about health policy, the Cassidy-Collins approach should — gradually — enable conservatives to prove it.

And if the right is wrong, if its model doesn’t match reality, if people are simply miserable as health care consumers because the system has too much of Friedman and not enough of Burke — well, in that case both the country and conservatism will be better off if we learn that via a voter rebellion in 10 right-leaning states, rather than through a much more widespread backlash against a nationwide health-insurance failure. (Which is something a president with a high self-regard and poor approval ratings might have a particular reason to avoid.)

Between this reasonable case and legislative reality, of course, falls a variety of shadows. But more than for the various repeal-and-replace alternatives? I’m not so sure.

Right now the Cassidy-Collins compromise has few enthusiastic backers. In a few months, however, it might turn into conservative health care reform’s best hope.

I think you're going to see a lot of different United States of America over the next three, four, or eight years. - President Donald J. Trump

1/27/2017 11:07 am  #4

Re: Republicans Quietly Admit There Will Be No Obamacare Replacement

Gee, they ONLY had 8 years to come up with a better plan ! 

"Do not confuse motion and progress, A rocking horse keeps moving but does not make any progress"

1/27/2017 12:30 pm  #5

Re: Republicans Quietly Admit There Will Be No Obamacare Replacement

Wait, wait, wait!  I have a solution:  Repeal 'Obamacare', replace it with the Affordable Care Act, and call it 'Trumpcare'.  His followers will eat it up and cheer.  You think I'm kidding?  Well, I'm not. 

Last edited by Just Fred (1/27/2017 12:31 pm)


1/27/2017 7:49 pm  #6

Re: Republicans Quietly Admit There Will Be No Obamacare Replacement

Another "promise" apparently down the rabbit hole ! 

"Do not confuse motion and progress, A rocking horse keeps moving but does not make any progress"

1/27/2017 10:54 pm  #7

Re: Republicans Quietly Admit There Will Be No Obamacare Replacement

The Washington Post has a tidbit of recording during the Repubs retreat in Philadelphia in which Paul Ryan is all but admitting defeat for repeal of the ACA.  The Post has set up a website for individuals who attend these meetings to record and post.  Probably everyone in attendance has their smart phone to record so we might be getting some great messages down the road.


1/28/2017 8:37 am  #8

Re: Republicans Quietly Admit There Will Be No Obamacare Replacement

The Republicans don't need to repeal it. IF they remove the mandate it becomes not fiscally viable. I believe that has been their plan anyway. The REAL problem for the R-tribe is what we have seen. They HAVE NO viable replacement that is better. The millions who ARE insured will see prices rise even farther and insurers dropping out because of the lack of mandate $$ supporting it. The R-tribe is hoping that they will not be blamed. 

What they WILL be blamed for is not really coming up with the solution that they PROMISED. 


Of ALL of the PROMISES made, this was the MOST IMPORTANT from Americans. 


"Do not confuse motion and progress, A rocking horse keeps moving but does not make any progress"

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