Tuesday, December 6, 2016

ObamaCare Schadenfreude, Again?

I got nuttin' much going on this morning, so I might as well clean up the Obamacare Schadenfreude bin before it goes rancid.

Emerging plans for Obamacare suggest that the Republicans are adopting "Repeal and Delay" strategy. William Teach approves: BUMMER: GOP Plans Immediate Obamacare Repeal and Delay. By way of Wombat-socho's  "In The Mailbox: 12.05.16", the usually sensible Megan McArdle explains The Allure of 'Repeal and Delay' for Obamacare's Critics, and why that is not likely to be a viable option.
The idea of the moment is “repeal and delay”: pass a repeal bill now, but delay its implementation for three years to give Republicans some time to come up with a replacement bill.

The arguments for doing this are not crazy on their face. Obamacare’s implementation was delayed for almost four years, giving the Obama administration time to build the exchanges (well, almost) and make decisions about the trillion-and-one fiddling operational details that accompany any massive new policy change. Even then, they had a running head start; a national health system had been a major priority of Democratic wonks for decades. They had spent a lot of time, and cultivated a lot of expertise, mapping out what that system should look like.
 and it still sucked. Maybe because their rationale behind it was flawed.
Health-care reform has never been a similar priority for Republicans. Their stock of experts and white papers is much smaller, their consensus on what (if anything) should be done much weaker. Delay would give them time to put something coherent together.
Repealing Obamacare on a time-delay, on the other hand, ratchets regime uncertainty up to “Defcon 1.” The exchanges have so far mostly been unprofitable for insurers (although with big rate hikes in many states, that may change this year). The companies have stayed in largely because they’re hoping that the exchanges will be profitable in the future. If you announce that the law creating those exchanges will sunset in three years, to be replaced by some unspecified new program, then the companies' incentive to keep offering insurance vanishes, and the exchanges will probably completely collapse in 2018, with a replacement plan still years away.

This is a compelling argument that repeal and delay is apt to go awry. But supporters of Obamacare shouldn’t take too much comfort in that fact, because whether or not Republicans pass “repeal and delay,” insurers will be facing considerable regime uncertainty -- at a time when the exchanges were already so fragile that it’s far from clear they can withstand another blow.
Sometimes it's better to just rip the Band aid off. Delay usually just means the bureaucracy goes back to its usual games until the deadline comes again, and then they'll plead for another extension.  Ignore the New York Times when it says. Why It Will Be Hard to Repeal Obamacare, because often the hard thing is the right thing to do.

Meanwhile, Obamacare continues it's death spiral: Insurers’ Flawed Directories Leave Patients Scrambling for In-Network Doctors. Doctors are bailing out faster than the insurance companies can keep them up. But somehow, with the NYT, it's all Donald Trump's fault. Record-High Health Care Spending Hits $3.2 Trillion in 2015. A trillion here, a trillion there, and pretty soon you're talking about real money.

Federal court halts Obamacare appeal, deals setback to president
A federal appeals court put a key Obamacare case on hold Monday as judges begin to anticipate a President Trump, and move to give his administration the chance to change the Obama administration’s legal strategy on everything from immigration to health care.
. . .
The case stemmed from a challenge the House of Representatives filed against Mr. Obama’s Health and Human Services Department, which made Obamacare payments to insurance companies despite Congress zeroing the funding out in its appropriations bills.

A lower court sided with the House, ruling both that lawyers had standing to sue and that the spending was illegal.

Mr. Obama had fought to keep the case on track, with his lawyers arguing insurance companies who are counting on the money could be confused, and might be scared away from participating in Obamacare.

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