Tuesday, November 29, 2016

Returning to Obamacare Schadenfreude

With the demise of the Clinton.com line of posts, along with the demise of Hillary Clinton at the pols (to be revived only if the recount actually goes somewhere, only Obamacare Schadenfreude remains as a long standing political series. The Obamacare digital fridge isn't exactly overflowing the way it has in the past, but the election has changed the trajectory, and it's time to get some of these out before they become too stale:

Obamacare still not looking like a bargain to many Americans. Especially, the young and healthy, the dedicated victims of this legislation.

Donald Trump has named Congressman Tom Price to be his Secretary of Health and Human Services, the department that oversees Obamacare. Larry O'Connor at Hot Air thinks Trump’s pick for HHS Secretary suggests he’s very serious about dismantling Obamacare.  Althouse asks "Who is this Obamacare critic that Donald Trump has picked as Secretary of Health and Human Services?" before going on to answer her own question:
Tom Price is an orthopedic surgeon who has been a member of Congress for 6 terms. He isn't just a critic of Obamacare. He's been offering detailed alternative bills going back to 2009, when Democrats got to work on Obamacare.
“Congressional Democrats and the Obama administration blatantly ignored the voices of the American people and rammed through a hyperpartisan piece of legislation that will have a disastrous effect on our nation’s health care system,” Mr. Price said shortly after Mr. Obama signed the bill in 2010....
The legislation Mr. Price has proposed, the Empowering Patients First Act, would repeal the Affordable Care Act and offer age-adjusted tax credits for the purchase of individual and family health insurance policies. The bill would create incentives for people to contribute to health savings accounts; offer grants to states to subsidize insurance for “high-risk populations”; allow insurers licensed in one state to sell policies to residents of others; and authorize business and professional groups to provide coverage to members through “association health plans.”...
My link goes to a NYT article that warns us that Price has the vantage point of a doctor and needs "a broader perspective" that looks after the "needs of Medicare beneficiaries, Medicaid patients and taxpayers who finance those programs." We're also told that Price is "a strong conservative," "a member of the Tea Party Caucus," but "no bomb thrower": "He works within the system and has led two groups that promote conservative policies in the House."
I can live with all of that. Trump administration’s first big decision on Obamacare coming in February
“The Trump administration could immediately turn off the tap for making cost-sharing payments,” said Mark Regan, legal director of the Disability Law Center of Alaska in Anchorage, and a defender of the law. “Turning the payments off would come close to destroying the market.”

Insurers could be stuck with massive losses because they would still have a legal obligation to cover patients’ out-of-pocket costs, but would get no reimbursement from the government.

Another approach might involve setting a deadline.

“What Trump should do is on Day 1 say, ‘We are not going to fight that lawsuit — those payments end at the end of calendar year 2017’,” said Michael Cannon, health policy director at the libertarian Cato Institute think tank. Cannon was one of the main proponents of an earlier legal challenge to the law’s premium subsidies in certain states. That case was decided by the Supreme Court in favor of the administration.
Oooh, "sue and settle". I like using the enemies toys against them.

GOP Eyes Lightning Strike on Obamacare to Kick Off Trump Era
The Republican plan would take advantage of reconciliation, a budget-related mechanism to circumvent the 60-vote threshold in the Senate and prevent Democrats from being able to block legislation on their own. By striking early, the GOP could set itself up to invoke the same procedure again later in the year on a broader range of targets, including tax cuts.

The quick-strike bill, like one vetoed earlier this year by President Barack Obama, H.R. 3762, would likely set what amounts to an expiration date for the law’s financial underpinnings, leaving Congress to act at a later date on any replacement plan. That’s because more than six years after the law’s passage, Republicans still don’t have a consensus on how to replace Obamacare.
What, stop and think about what to do do? It's such a novel idea, it just might work!

Who said Trump can’t repeal ObamaCare? Leftist, who mostly say you can't possibly take away the insurance from the 20 million people we gave it to,
Here’s the real deal about repeal.

Will 20 million lose coverage?

Not even close: 16 million of those who gained coverage are enrolled in Medicaid, the public program for low-income residents. ObamaCare allowed states to expand the category of those eligible to sign up for Medicaid, with the federal government covering the tab.

Repeal could result in less federal funding. But no one is pushing to abolish the nation’s health-safety net. And states that just expanded Medicaid are unlikely to do a 180 and shrink it. The 16 million are likely safe.
President-elect Trump is proposing giving states more flexibility in how Medicaid is managed. That’s urgently needed. Federal Medicaid spending has shot up 40 percent in the last three years. And research shows that extra spending isn’t improving patients’ health.

What about the other nearly 5 million newly insured? They’re in ObamaCare plans, along with another 6 million who already had insurance, and all of them are having a tough time. Technically, they’re “covered,” but many can’t come up with the cash to see a doctor. They’re struggling with exorbitant deductibles — $6,000 per person for the typical bronze plan.

In short, about 5 million previously uninsured people — not the bogus 20 million — may need help after repeal. Trump is proposing market reforms to lower costs and increase choices for consumers stuck in the individual market.
By way of Wombat-socho's  "In The Mailbox: 11.28.16", the usually sensible Megan McArdle digs into those numbers further, in The Enrollees Who Actually Didn't Even Need Obamacare.
Molly Frean, Jonathan Gruber and Benjamin D. Sommers provide a detailed look, not just at the amount of coverage expansion but also the sources of it. According to the authors' analysis, they can explain about 70 percent of the decline in the number of uninsured people through three factors: the subsidies for buying insurance; the law’s more generous criteria for Medicaid eligibility; and the “woodwork effect,” in which people who were previously eligible for Medicaid “came out of the woodwork” and signed up for the program in 2014.

But here’s the surprising thing: Of the change that they can explain, they find that the largest effect comes, not from the subsidies, nor from the mandate, nor even from the Medicaid expansion. The largest effect was due to that woodwork effect -- about 44 percent of the effect they can explain, or roughly 30 percent of the overall reduction in the number of uninsured in 2014. Call it 3.3 million people, out of the 11.6 million who gained insurance that year.

We’ve always known that there was some “woodwork effect,” in which people who were already eligible signed up because of some combination of easier signup procedures and the heightened publicity that surrounded Obamacare’s passage and implementation. But these are huge numbers; the woodwork effect is more than twice as large as the number of people who became eligible for Medicaid thanks to Obamacare’s more generous criteria. This suggests the possibility that the plurality of people who gained insurance thanks to the law technically didn’t need a new program to become insured; all they needed to do was to sign up for public insurance they already qualified for.
. . .
This 44 percent figure also has implications for repeal. If that many of the people who gained coverage under the law already qualified for Medicaid under the old criteria, those people will probably stay on Medicaid even if the entire law is junked. That means that repeal will not save as much money as Obamacare's detractors might hope -- but it also means that Obamacare's supporters have less to fear, because fewer people would lose coverage.
Like the little girl who killed her parents and threw herself on the mercy of the court, pleading her orphanhood, the next argument of ObamaCare advocates is that  Repeal might cause collapse of individual-plan markets, you know, now that they've pretty well collapsed anyway in large numbers of states:
In four short years, ObamaCare has blown up the individual markets and driven insurers out of them (and providers, too). Those remaining in them in 2017 had already warned before the election that they wouldn’t stick around much longer than that, either. Claiming that repeal would create a death spiral that has been forming for the past four years sounds less like ignorance and more like an attempt to create a blame-shifting narrative that lets ObamaCare advocates off the hook for their own massive — and utterly predictable — failure at running a command economy. Perhaps we’re seeing a credibility death spiral at the same time.

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