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Bait and Switch

After claiming that there was no Plan B if they didn’t pass Obamacare repeal last Friday, it is becoming obvious that Republicans had a Plan B all along. In fact, Plan B might have been their Plan A. Let me explain.

When the ACA repeal bill failed, Paul Ryan immediately said that “Obamacare is the law of the land” and “we’re going to be living with Obamacare for the foreseeable future”. Why would he say things like that? Do you think he would give up that easily? Of course not.

My guess is that the plan all along was to pretend to try to repeal Obamacare to make the base happy, but have the repeal fail. Then (as I’ve said before) quietly sabotage the ACA so that it fails. That allows them to try to blame its failure on the Democrats.

And today, we learned more about that strategy when Secretary of Health and Human Services Tom Price testified in front of Congress, and made it clear that he has the power to kill Obamacare. He can do this partially by just refusing to enforce some of the provisions of the law, most importantly the individual mandate, which would drive up costs tremendously. And partially by taking advantage of leeway written into the law, such as eliminating most if not all of the “essential benefits” or reducing cost-sharing subsidies. Reducing the subsidies alone will bring “significant premium increases” for consumers. “Some insurers will drop out, and the remaining insurers will have to seek large rate increases.”

In fact, just by saying that he might do these things introduces uncertainty in the market, which will encourage insurance companies to drop out of the Obamacare marketplaces. The CEO of one major health insurance company said that the cost-sharing subsidies are a major uncertainty hanging over his company’s ability to participate in the marketplaces going forward. Another uncertainty is enforcement of the individual mandate.

Price claims that he will will be doing these things in order to “dramatically lower the cost of insurance for Americans”. And indeed, if Price eliminates the “essential benefits” then insurance companies will be able to offer extremely cheap insurance policies, but those policies will cover almost nothing. The essential benefits that Price can possibly eliminate include emergency room services, hospitalization, maternity and newborn care, prescription drugs, laboratory services, mental health and substance abuse services, chronic disease management, vision care, and even preventative care. What’s left?

Allowing people to buy plans that do not include (for example) maternity care means that the cost of plans that do include maternity will skyrocket, because only people who plan to have babies will buy such plans, and insurance companies are not about to just absorb those costs.

Can we do anything to prevent this from happening? Most importantly, we need to make sure that Secretary Price cannot do these things without anyone noticing, and then blame Obamacare when premiums go up or insurance markets collapse.



  1. William wrote:

    Typo midway through paragraph six: “… those policies will cover almost nothing.”

    [Thanks, fixed. –iron]

    Thursday, March 30, 2017 at 1:03 am | Permalink
  2. Jonah wrote:

    Its shameful. His own voters are likely to lose health insurance or get coverage refused. Reminds me of the movie “clear and present danger” based on a tom clancy novel. In the movie the US president sacrifices US soldiers to satisfy his personal agenda. The word complicit comes to mind for those who still support this sick SOB.

    Thursday, March 30, 2017 at 4:45 am | Permalink
  3. Michael wrote:

    This is standard operating procedure for the GOP: death by 1,000 cuts. It’s their approach to Wall Street regulation, Social Security, abortion access, etc. That’s how they get rid of popular programs that they don’t like.

    Thursday, March 30, 2017 at 9:17 am | Permalink
  4. James wrote:

    Let’s be honest, at best the ACA was only ever useful as a way to get more people to benefit from health coverage and start to expect / demand that from society, the way people in developed countries do.

    GOP efforts to sabotage the law will ultimately prevail and efforts to fight back over each and every spanner inserted into the gears will sap and fragment the energy of those of us who fight for better.

    We have one opportunity to transcend this coming mess, and that is to fight for something better. An idea that even the most simple minded Fox News addict can grasp: Open Medicare up for all.

    If we take this message to our representatives of each party and hammer away relentlessly, the way the tea party hammer away about tax cuts, we will probably succeed. If we get sucked in to fighting about the intricate details of a byzantine law with a lot of negatives, we’ll be back looking longingly at square one again.

    Thursday, March 30, 2017 at 9:25 am | Permalink
  5. Ed Alexander wrote:

    After 43 years with the same doctor here in Canada, he retired. I very quickly found another doctor, a very excellent female who is also a runner. I had to drop a $50 check off to the former doctor to pay for the transfer of the file to the new doctor. THIS WAS THE FIRST AND ONLY FEE I EVER PAID FOR MEDICAL SERVICE IN CANADA, which included among other things the birth of my daughter, a major appendectomy (9 days in hospital), specialist services for DVT, and specialist services for my right knee which I injured 8 years ago. Nananabooboo from Canada where I moved to in 1970 from the States. Ever going back? Are you nuts? Because we have a parliamentary form of government here, the lobbyists don’t run the show.

    Thursday, March 30, 2017 at 9:28 am | Permalink
  6. Ed Alexander wrote:

    Oh, yeah, I should also mention that when I was in the hospital following the appendectomy, one of the patients I shared the room with for a few days was a young homeless man. I remember him because he thought the food was great!

    Thursday, March 30, 2017 at 9:34 am | Permalink
  7. Rod Dale-Johnson wrote:

    The US is the only first world/developed country WITHOUT universal health care. As well US pays a higher percentage of GDP for healthcare than does any other first world country. Fix the goofy tort laws and fix the 3rd world healthcare system. Both go hand-in-hand. I am a former US resident now living in Canada. Our system is not perfect but I will not go broke over health care costs.

    Thursday, March 30, 2017 at 1:55 pm | Permalink
  8. Ralph wrote:

    As I’ve said before in a previous post, single-payer/UHC and taking profiteering out of the healthcare market is the only way we’re ever going to get out from under this rock and, on that score, the GOP will have to be dragged kicking and screaming into the 21st Century.

    So lo and behold, I’m scrolling through today’s WaPo and see an opinion piece by none other than staunch conservative, Charles Krauthammer, America’s foremost authority on all things anti-Obama, conceding that gov’t sponsored, single-payer healthcare may be an inevitable eventuality following last week’s AHCA crash and burn. Not that he likes the idea, by any means, but suspects the momentum is headed that way. As he solemnly puts it, after a brief analysis of the political landscape and emerging public sentiment, “…there is an ideological consideration that could ultimately determine the fate of any Obamacare replacement. Obamacare may turn out to be unworkable, indeed doomed, but it is having a profound effect on the zeitgeist: It is universalizing the idea of universal coverage.

    Acceptance of its major premise — that no one be denied health care — is more widespread than ever. Even House Speaker Paul Ryan avers that “our goal is to give every American access to quality, affordable health care,” making universality an essential premise of his own reform. And look at how sensitive and defensive Republicans have been about the possibility of people losing coverage in any Obamacare repeal.

    A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system. It’s what Barack Obama once admitted he would have preferred but didn’t think the country was ready for. It may be ready now.”

    Let’s hope (and change)!

    Friday, March 31, 2017 at 12:41 pm | Permalink
  9. btn wrote:

    The Republican base (and many of their leaders) have now accepted that their should be no lifetime caps and no upcharges for pre-existing conditions (several Republcian Representatives even praised their Democratic colleagues in committe hearings because of this). Many governors have already accepted expanding Medicaid to non-families.

    However, these benefits came with a cost that Obama and the Democrats did not explain to the American people: those new beneficiaries (the sick and the poor) would be subsidized by higher premiums on the rest. The problem is that many of the healthy members of middle class can’t afford to subsidize the beneficiaries of these three provisions. The Democrats are in denial that Obamacare would lower rates for almost everyone, and the “Repeal Obamacare!” chant that the Republicans rode to power over 7 years should have been a big clue.

    Also, Republicans keep talking about giving people more choices so that they don’t have to pay for services they don’t want. Of course, the reason for the mandates is the subsidy effects. Everytime somebodies chooses a cheaper plan, somebody else will pay more. Unfortunately, the ones that pay more will be the sickest, so an unavoidable consequence is that people **will** die as a result, which is a politically un-tenable position (regardless of the moral issues).

    So now it’s just a matter of time before Republican politicians figure out the math and the traditional choice it encompasses:
    1) abandon one or more of these three provisions, leading to a certain loss of voter support or
    2) make the federal government pay for it.

    It’s almost unheard of for politicians to choose Option 1.

    Friday, March 31, 2017 at 1:40 pm | Permalink