Category: Howard J. Warner

How Republicans Gain Seats This Year


Daily reports by the media express the likelihood that the Republicans will lose seats in both Houses of Congress.  They point to loses in Alabama, Virginia, and Wisconsin by Republicans as proof that Donald Trump is dragging down the party.  Trump’s poll numbers are offered to demonstrate his unpopularity.  These numbers are questionable, to be sure, as Democrats are often over-represented. 

Clearly, these polls demonstrate how Trump’s personal style rattles many.  They reflect the constant negative press reports, which do not recognize his impact upon our national economy.   Routinely, the off-year elections will cost the party that occupies the White House seats in the Congress.  Yet there is a way to ensure that this effect is minimized or reversed.

The Republicans must draw a stark contrast with the Democrats.  The best way to do this is to put together legislation that makes the reduction in the personal tax rates (just enacted at the end of 2017) permanent.  Bringing this legislation forward will draw a direct line that any Republican can support and run on.  The public will gladly support this in most states.  The few exceptions, such as New York and California, are already a lost cause for gaining any seats.

Many Republicans from these states are planning on retiring (so far, a total of 30 have indicated this desire), which will likely put pressure on Republicans to hold their numbers.  They need good and thoughtful candidates to run for office.

In the Senate, it is possible to gain seats, as more Democrats are up for re-election.  Many are in states that supported Trump.

The best way for Republican candidates to gain victories is to align themselves with Trump’s economic policies.  The economy is booming, and with sustained growth due to the new tax law, this benefit will accrue to the administration.  If the primaries give candidates like Judge Moore, then the outcome is problematic. 

Further, the Republicans must place long-term funding for the military within the continuing resolutions, taking this issue off the table.  Let the Democrats decide if they want to stop funding national priorities over ensuring that the military is funded sufficiently.  Today, most voters will not support this, as the military is now viewed positively.  As the economy improves, the pressure to support social welfare programs diminishes among most citizens.

If the House were to bring forth an immigration bill that the White House could support, then that would also put the Senate Democrats on the line to decide which priorities are critical for them.  The compromise offered by the Gang of Six senators gave a clear negotiated victory to the Democrats on chain migration, the wall, and the visa lottery.  The outrage by Democrats over Trump’s language is proof that the change in message was necessary to thwart a clear understanding by the public of how the Democrats rolled the Republicans.

Repatriation of companies’ foreign assets, as Apple has announced, will occur quietly among most businesses.  Growth of factory jobs will ensure that the forgotten blue-collar middle Americans support the administration.  These voters will continue to support Trump despite the press reports.

Despite a year of nonstop negative reports, Trump has managed to govern.  His supporters do not miss this.  Moderates will slowly see his bombast as distinct form his policies over time. 

As the DOJ begins to unravel the corruption in the previous administration, the Democrats will find it harder to scream about Trump collusion.  Robert Mueller and his investigators will not go away quickly, but as time marches on, the public will forget the details.  Unless they can find some direct illegality by Trump or his family, the damage will be limited.

The Democrats have one strategy to stop Trump’s policies.  Stalling and opposition can be a great defense, but the Republicans must be on the offense.  This is the reason Trump tweets daily.  Perhaps the Republican legislators can learn this technique.  Effective communications have not been the hallmark of Republicans.  If they learn how to press the issues, they will prevail in the off-year elections of 2018.

Daily reports by the media express the likelihood that the Republicans will lose seats in both Houses of Congress.  They point to loses in Alabama, Virginia, and Wisconsin by Republicans as proof that Donald Trump is dragging down the party.  Trump’s poll numbers are offered to demonstrate his unpopularity.  These numbers are questionable, to be sure, as Democrats are often over-represented. 

Clearly, these polls demonstrate how Trump’s personal style rattles many.  They reflect the constant negative press reports, which do not recognize his impact upon our national economy.   Routinely, the off-year elections will cost the party that occupies the White House seats in the Congress.  Yet there is a way to ensure that this effect is minimized or reversed.

The Republicans must draw a stark contrast with the Democrats.  The best way to do this is to put together legislation that makes the reduction in the personal tax rates (just enacted at the end of 2017) permanent.  Bringing this legislation forward will draw a direct line that any Republican can support and run on.  The public will gladly support this in most states.  The few exceptions, such as New York and California, are already a lost cause for gaining any seats.

Many Republicans from these states are planning on retiring (so far, a total of 30 have indicated this desire), which will likely put pressure on Republicans to hold their numbers.  They need good and thoughtful candidates to run for office.

In the Senate, it is possible to gain seats, as more Democrats are up for re-election.  Many are in states that supported Trump.

The best way for Republican candidates to gain victories is to align themselves with Trump’s economic policies.  The economy is booming, and with sustained growth due to the new tax law, this benefit will accrue to the administration.  If the primaries give candidates like Judge Moore, then the outcome is problematic. 

Further, the Republicans must place long-term funding for the military within the continuing resolutions, taking this issue off the table.  Let the Democrats decide if they want to stop funding national priorities over ensuring that the military is funded sufficiently.  Today, most voters will not support this, as the military is now viewed positively.  As the economy improves, the pressure to support social welfare programs diminishes among most citizens.

If the House were to bring forth an immigration bill that the White House could support, then that would also put the Senate Democrats on the line to decide which priorities are critical for them.  The compromise offered by the Gang of Six senators gave a clear negotiated victory to the Democrats on chain migration, the wall, and the visa lottery.  The outrage by Democrats over Trump’s language is proof that the change in message was necessary to thwart a clear understanding by the public of how the Democrats rolled the Republicans.

Repatriation of companies’ foreign assets, as Apple has announced, will occur quietly among most businesses.  Growth of factory jobs will ensure that the forgotten blue-collar middle Americans support the administration.  These voters will continue to support Trump despite the press reports.

Despite a year of nonstop negative reports, Trump has managed to govern.  His supporters do not miss this.  Moderates will slowly see his bombast as distinct form his policies over time. 

As the DOJ begins to unravel the corruption in the previous administration, the Democrats will find it harder to scream about Trump collusion.  Robert Mueller and his investigators will not go away quickly, but as time marches on, the public will forget the details.  Unless they can find some direct illegality by Trump or his family, the damage will be limited.

The Democrats have one strategy to stop Trump’s policies.  Stalling and opposition can be a great defense, but the Republicans must be on the offense.  This is the reason Trump tweets daily.  Perhaps the Republican legislators can learn this technique.  Effective communications have not been the hallmark of Republicans.  If they learn how to press the issues, they will prevail in the off-year elections of 2018.



Source link

Health care Reform: Compromise is Not a Dirty Word


A significant deadline is approaching. The federal fiscal year ends on Sept. 30 and with it this year’s opportunity to use reconciliation to reform and replace ObamaCare. Time is running out to make changes that will devolve any power back to the people and the states, a component of federalism. For Republicans, it may be the last chance to fulfill any aspect of the promise that they have campaigned on for over eight years. Hesitant politicians in Congress should support this effort through the Graham-Cassidy bill, despite its shortcomings.

Senator Rand Paul, a physician, has argued for a complete repeal and replacement with large private associations to eliminate the penalty of pre-existing conditions. A dedicated purist, he is presently against this rendition of reform as he considers it “ObamaCare-lite” since it does not eliminate all the funding nor the regulatory mandates under the existing laws. This is correct (though block-granting funds will reduce spending by 5-10%), but it misses an essential point. The longer the ACA law remains in effect, the harder it is to replace it with an improvement, as the entrenched and dependent constituency grows. An addition to the bill which might garner Paul’s support could include cross-state insurance purchasing or more regulatory flexibility at the state level.

Already, the most progressive wing of the Democratic party (led by Senator Bernie Sanders, a registered Independent) has unveiled a version of a national single-payer system. This version supported by 16 Democratic senators, according to their estimates (which are always below the real costs) will require expenditures of $32 trillion while funding is only $16 trillion over ten years. Clearly this deficit dwarfs the cost of ObamaCare and will bankrupt this nation. All efforts at socialism successfully rob a nation of its wealth. The ACA is not sustainable without tremendous infusions of federal dollars, so significant changes must occur. Will we miss this last chance to end the individual and employer mandates?

The 2012 Supreme Court ruling essentially concluded that the ACA was a tax scheme. Chief Justice Roberts, voting with the four liberal judges, legitimized the effort to nationalize healthcare. This is now settled law and one only needs to consider the 1937 ruling giving Social Security its legitimacy (under the same concept) and turning that program into the “third rail” of politics (as it is deadly to tinker with its benefits). History has taught the open-minded that programs rarely shrink with time.

Bipartisan attempts to reform ObamaCare in the Senate have failed since the divide is too wide. Democrats led by Senator Patty Murray sought to expand the federal subsidies to stabilize the private insurance health care markets. She wanted several years of financing with the Congress bypassing President Trump. Going down this road ensures the expansion of Obamacare which is not supported by the chairman, Senator Lamar Alexander, who supports one year of subsidies voted by the Congress. Under present law, the president has great latitude to manage these subsidies (including one for Congress itself).

The failed Senate attempt in August to repeal and replace ObamaCare mustered only 49 Republican votes. Senators Susan Collins, John McCain and Lisa Murkowski opposed the “skinny repeal,” fearing the impact upon their states. This version of repair provides some relief for their states. In fact, the losers will be the more liberal states with mostly Democrat senators that receive a disproportionate amount of Medicaid dollars. Already, Governor Christy of New Jersey has voiced objections as it cuts $4 billion from state funding. Most Republican governors support this bill. The distribution of funds will become more equitable on a population basis. This may help secure sufficient votes.

Senator Collins, who has consistently voted against repeal of ACA, has some concerns about the impact of block-granting Medicaid funds. Uncertainty scares some people, but the present system is unsustainable. Rural hospitals and clinics depend upon Medicaid funding for their survival. These institutions have few options for alternate sources of financing healthcare delivery. Under the proposed bill, states could improvise. Previously I suggested that those with limited funds could purchase Medicaid coverage on a sliding scale based upon income. This legislation could give this freedom to the states, as an alternate to unaffordable private insurance.

Senator Murkowski has not identified specific objections to the “skinny repeal.” Her position could be influenced by sweeteners (the way of the swamp) for Alaska. The enormous pressure upon her (since she previous voted for repeal) may induce a positive vote next week for Graham-Cassidy.

Senator McCain, who voted against the August bill, has stated that he will do the same in the next vote.

For a century, the Democrats have sought national health care. First proposed by Woodrow Wilson, the progressives have used incrementalism to move toward complete socialized medicine. In Canada, the final process took 20-40 years. Obama sought to accomplish this in half the time. Senator Graham states that the choice is between socialism or federalism.

Funding determines who makes the rules. A single source of funding will limit creativity, efficiency, and excellence. The ultimate national plan would be a Medicaid organized medical payment program as Medicare costs could not be sustained. The deficit under the Sanders proposal is evidence for this. In all of this, people have missed the substantial proportion of health care dollars the private insurance system underwrites. If this system disappears then the pressures upon the institutions accelerates. Senator Collins must understand this issue.

Attempts to roll back ObamaCare have been unsuccessful. The entire health care financing system is under pressure. The quality of our services depends upon the financing, innovation, dedication of providers, research efforts, and regulatory pressures (to name a few issues). Democrats argue to improve Obamacare, which means adding more federal government control of our health care.

This bill is the compromise that our governing elite have wrought. We seize it or fail to improve the dying system. When you are drowning, it is not time to question the color of the rope thrown your way. Voltaire said “perfect is the enemy of the good.” If this bill passes, further improvements are possible. If it fails, then we are dead in the water and progressives will determine our future.

A significant deadline is approaching. The federal fiscal year ends on Sept. 30 and with it this year’s opportunity to use reconciliation to reform and replace ObamaCare. Time is running out to make changes that will devolve any power back to the people and the states, a component of federalism. For Republicans, it may be the last chance to fulfill any aspect of the promise that they have campaigned on for over eight years. Hesitant politicians in Congress should support this effort through the Graham-Cassidy bill, despite its shortcomings.

Senator Rand Paul, a physician, has argued for a complete repeal and replacement with large private associations to eliminate the penalty of pre-existing conditions. A dedicated purist, he is presently against this rendition of reform as he considers it “ObamaCare-lite” since it does not eliminate all the funding nor the regulatory mandates under the existing laws. This is correct (though block-granting funds will reduce spending by 5-10%), but it misses an essential point. The longer the ACA law remains in effect, the harder it is to replace it with an improvement, as the entrenched and dependent constituency grows. An addition to the bill which might garner Paul’s support could include cross-state insurance purchasing or more regulatory flexibility at the state level.

Already, the most progressive wing of the Democratic party (led by Senator Bernie Sanders, a registered Independent) has unveiled a version of a national single-payer system. This version supported by 16 Democratic senators, according to their estimates (which are always below the real costs) will require expenditures of $32 trillion while funding is only $16 trillion over ten years. Clearly this deficit dwarfs the cost of ObamaCare and will bankrupt this nation. All efforts at socialism successfully rob a nation of its wealth. The ACA is not sustainable without tremendous infusions of federal dollars, so significant changes must occur. Will we miss this last chance to end the individual and employer mandates?

The 2012 Supreme Court ruling essentially concluded that the ACA was a tax scheme. Chief Justice Roberts, voting with the four liberal judges, legitimized the effort to nationalize healthcare. This is now settled law and one only needs to consider the 1937 ruling giving Social Security its legitimacy (under the same concept) and turning that program into the “third rail” of politics (as it is deadly to tinker with its benefits). History has taught the open-minded that programs rarely shrink with time.

Bipartisan attempts to reform ObamaCare in the Senate have failed since the divide is too wide. Democrats led by Senator Patty Murray sought to expand the federal subsidies to stabilize the private insurance health care markets. She wanted several years of financing with the Congress bypassing President Trump. Going down this road ensures the expansion of Obamacare which is not supported by the chairman, Senator Lamar Alexander, who supports one year of subsidies voted by the Congress. Under present law, the president has great latitude to manage these subsidies (including one for Congress itself).

The failed Senate attempt in August to repeal and replace ObamaCare mustered only 49 Republican votes. Senators Susan Collins, John McCain and Lisa Murkowski opposed the “skinny repeal,” fearing the impact upon their states. This version of repair provides some relief for their states. In fact, the losers will be the more liberal states with mostly Democrat senators that receive a disproportionate amount of Medicaid dollars. Already, Governor Christy of New Jersey has voiced objections as it cuts $4 billion from state funding. Most Republican governors support this bill. The distribution of funds will become more equitable on a population basis. This may help secure sufficient votes.

Senator Collins, who has consistently voted against repeal of ACA, has some concerns about the impact of block-granting Medicaid funds. Uncertainty scares some people, but the present system is unsustainable. Rural hospitals and clinics depend upon Medicaid funding for their survival. These institutions have few options for alternate sources of financing healthcare delivery. Under the proposed bill, states could improvise. Previously I suggested that those with limited funds could purchase Medicaid coverage on a sliding scale based upon income. This legislation could give this freedom to the states, as an alternate to unaffordable private insurance.

Senator Murkowski has not identified specific objections to the “skinny repeal.” Her position could be influenced by sweeteners (the way of the swamp) for Alaska. The enormous pressure upon her (since she previous voted for repeal) may induce a positive vote next week for Graham-Cassidy.

Senator McCain, who voted against the August bill, has stated that he will do the same in the next vote.

For a century, the Democrats have sought national health care. First proposed by Woodrow Wilson, the progressives have used incrementalism to move toward complete socialized medicine. In Canada, the final process took 20-40 years. Obama sought to accomplish this in half the time. Senator Graham states that the choice is between socialism or federalism.

Funding determines who makes the rules. A single source of funding will limit creativity, efficiency, and excellence. The ultimate national plan would be a Medicaid organized medical payment program as Medicare costs could not be sustained. The deficit under the Sanders proposal is evidence for this. In all of this, people have missed the substantial proportion of health care dollars the private insurance system underwrites. If this system disappears then the pressures upon the institutions accelerates. Senator Collins must understand this issue.

Attempts to roll back ObamaCare have been unsuccessful. The entire health care financing system is under pressure. The quality of our services depends upon the financing, innovation, dedication of providers, research efforts, and regulatory pressures (to name a few issues). Democrats argue to improve Obamacare, which means adding more federal government control of our health care.

This bill is the compromise that our governing elite have wrought. We seize it or fail to improve the dying system. When you are drowning, it is not time to question the color of the rope thrown your way. Voltaire said “perfect is the enemy of the good.” If this bill passes, further improvements are possible. If it fails, then we are dead in the water and progressives will determine our future.



Source link

The CBO and its big lie



As CBO studies the revised Senate healthcare reform bill, both sides await their prognostication. It may provide cover for the difficult decisions the GOP must make.



Source link

at-painter-og-image.png

A Sober Look at Obamacare Repeal and Replacement


Since 2009 I have written about problems with national healthcare reform for this website. I oppose Obamacare and would prefer a complete repeal and replacement with a market-based system. However, we must contend with political realities. A Democrat filibuster in the Senate means the end of any repeal and a guarantee of a financial failure of the ACA which may lead to a single-payer system that they prefer. Many others have already written about details of the GOP House plan, which is but a beginning to revoking ObamaCare. Speaker Paul Ryan has said that there will be three phases in this process, requiring the conventional legislative process. Improving this bill by empowering participation through amendments that do not prevent the reconciliation process will be beneficial.

We must understand whether we seek insurance or prepaid healthcare costs. Insurance is based upon risk assessment and premiums are arranged according to the potential costs for the insurance companies. Those with increased risks will pay higher premiums, reducing such behavior and controlling costs. The federal government transfers payments from one entity to another, without apportion to risk. Dr. Ezekiel Emanuel (the ObamaCare architect) thinks that everyone must share in this higher cost which is social welfare, a distortion of these economic principles. With pre-paid costs, there is no incentive to reduce risks and problematic behavior. The GOP plan moves federal healthcare toward private insurance coverage from an ObamaCare welfare program, thus reducing the cost growth curve.

Do the Republicans have a clean repeal and replacement bill? Do they have the votes to overcome a filibuster in the Senate? If they do not have at least eight votes from Democrats (assuming all Republicans agree) what compromises will the reconciliation process require? The principal problem with reconciliation is that the Parliamentarian of the Senate has enormous powers to declare portions of the legislation void. A full replacement bill cannot be passed through reconciliation. Passing the first phase will strengthen the president’s hand to gain votes for the next phases.

The ACA requires ten essential benefits of coverage. This regulatory requirement forces costs upward. Younger persons do not need all these requirements and are less likely to purchase coverage. Presently, more of this age group choose to pay the penalty rather than purchase care. Any reduction in statutory regulatory power is helpful to reduce costs. Further, the Secretary of Health and Human Services, Dr. Tom Price, has stated that he intends to reduce this burden on his own. Any move in this direction kills ObamaCare by a thousand cuts. This bill does not reduce benefits and would be improved by some adjustment.

Presently, premiums and deductibles under ObamaCare are excessive and these policies become catastrophic care rather than insurance for those purchasing it. Only those subsidized by the government find this insurance beneficial. Individual businesses are burdened so they may choose to forgo policies and pay the fine.

Medical costs are not determined by a simple marketplace. Third party payments by governmental agencies (Medicaid and Medicare), insurance through employers, and private insurance companies distort the use and misuse of healthcare dollars. The most effective way to restore this market place is through the use of Health Savings Accounts where individuals make these decisions directly. Expansion of HSAs is a move in the correct direction. The plan creates a significant expansion of HSAs.

When Justice John Roberts ruled that ObamaCare was legally a tax, all ability to argue against federal government intrusion into healthcare was ended. After all, we have the Medicaid and Medicare systems which are federal programs that are entrenched in our society. Block granting Medicaid to the states would move the cost curve down federally. It would allow the states to innovate within the program. This would reduce the bureaucracy necessary to administer Medicaid. Allowing individuals of low income to purchase into Medicaid might further provide options for states. Further, sunsetting the provisions expanding Medicaid would force the Congress to create a new system that is financially solvent.

The GOP plan removes the individual and business (for over 50 employees) mandate. This is an improvement as it reduces government requirements and intrusions. The cost for insurance purchased after discovery of an illness will be increased by 30% one time. This could be modified upward to increase the incentive to purchase insurance prior an illness.

Tax credits are used to induce insurance purchases. This is preferable to direct subsidies in giving freedom to choose. The ability to purchase insurance through families till age 26 is continued as it is popular. An increase in premium might be considered for this option. This bill allows insurance companies to charge up to five times the premium for older patients compared to younger ones. In Obamacare, the limit is three times. Again, this adjusts risk as most healthcare dollars are spent at the end of life.

There are interested groups opposing the GOP plan. These include the AMA, hospital groups and insurance companies. We should not forget that these groups supported Obamacare and are not objective. Their opposition might be meaningful as the Democrat opposition means the GOP plan has some merit.

The mainstream media is working against the GOP plan to replace ObamaCare. Damaging this effort would hurt the Republicans in Congress and the president in any future legislative initiatives. Few practicing physicians and dentists have found the ACA to be helpful in providing medical care. Nurses and hospitals have been burdened with additional paperwork. Yet, elements of these industries have already become entrenched in the ACA.

The promised reduction in costs has not materialized. Some 10-20 million people have ObamaCare, but how many (perhaps 10 million) have lost their private insurance? Therefore, there will be some who will lose under any replacement plan. Are these affected people likely Republican voters?

Republicans are concerned that some will prevent their re-election if the ACA is repealed. They seek a smooth transition so few are adversely affected. Senator Susan Collins represents this group. Others, in the conservative movement, want a clean repeal. Senator Rand Paul leads this movement. The GOP can only lose one vote in the Senate under reconciliation. Finding a middle ground is not easy.

During the ACA debate, Republicans suggested ideas to increase the individual choices of consumers. These ideas were not used as the Democrats wanted a governmental regulatory program. This program had little chance of success and then the result would be a single-payer system. Senator Schumer and Nancy Pelosi are hoping for such a failure.

Now that two House committees have marked-up the legislation, the sausage process will begin. Hopefully, a plan can emerge that will make it through the Senate. A clean repeal might not be acceptable through reconciliation, but would be preferable. However, a complete replacement is not possible through reconciliation. Now we understand why healthcare reform is difficult. Future bills are necessary either way. The enemies are on the frontlines of Congress. Will the people emerge unscathed?

Since 2009 I have written about problems with national healthcare reform for this website. I oppose Obamacare and would prefer a complete repeal and replacement with a market-based system. However, we must contend with political realities. A Democrat filibuster in the Senate means the end of any repeal and a guarantee of a financial failure of the ACA which may lead to a single-payer system that they prefer. Many others have already written about details of the GOP House plan, which is but a beginning to revoking ObamaCare. Speaker Paul Ryan has said that there will be three phases in this process, requiring the conventional legislative process. Improving this bill by empowering participation through amendments that do not prevent the reconciliation process will be beneficial.

We must understand whether we seek insurance or prepaid healthcare costs. Insurance is based upon risk assessment and premiums are arranged according to the potential costs for the insurance companies. Those with increased risks will pay higher premiums, reducing such behavior and controlling costs. The federal government transfers payments from one entity to another, without apportion to risk. Dr. Ezekiel Emanuel (the ObamaCare architect) thinks that everyone must share in this higher cost which is social welfare, a distortion of these economic principles. With pre-paid costs, there is no incentive to reduce risks and problematic behavior. The GOP plan moves federal healthcare toward private insurance coverage from an ObamaCare welfare program, thus reducing the cost growth curve.

Do the Republicans have a clean repeal and replacement bill? Do they have the votes to overcome a filibuster in the Senate? If they do not have at least eight votes from Democrats (assuming all Republicans agree) what compromises will the reconciliation process require? The principal problem with reconciliation is that the Parliamentarian of the Senate has enormous powers to declare portions of the legislation void. A full replacement bill cannot be passed through reconciliation. Passing the first phase will strengthen the president’s hand to gain votes for the next phases.

The ACA requires ten essential benefits of coverage. This regulatory requirement forces costs upward. Younger persons do not need all these requirements and are less likely to purchase coverage. Presently, more of this age group choose to pay the penalty rather than purchase care. Any reduction in statutory regulatory power is helpful to reduce costs. Further, the Secretary of Health and Human Services, Dr. Tom Price, has stated that he intends to reduce this burden on his own. Any move in this direction kills ObamaCare by a thousand cuts. This bill does not reduce benefits and would be improved by some adjustment.

Presently, premiums and deductibles under ObamaCare are excessive and these policies become catastrophic care rather than insurance for those purchasing it. Only those subsidized by the government find this insurance beneficial. Individual businesses are burdened so they may choose to forgo policies and pay the fine.

Medical costs are not determined by a simple marketplace. Third party payments by governmental agencies (Medicaid and Medicare), insurance through employers, and private insurance companies distort the use and misuse of healthcare dollars. The most effective way to restore this market place is through the use of Health Savings Accounts where individuals make these decisions directly. Expansion of HSAs is a move in the correct direction. The plan creates a significant expansion of HSAs.

When Justice John Roberts ruled that ObamaCare was legally a tax, all ability to argue against federal government intrusion into healthcare was ended. After all, we have the Medicaid and Medicare systems which are federal programs that are entrenched in our society. Block granting Medicaid to the states would move the cost curve down federally. It would allow the states to innovate within the program. This would reduce the bureaucracy necessary to administer Medicaid. Allowing individuals of low income to purchase into Medicaid might further provide options for states. Further, sunsetting the provisions expanding Medicaid would force the Congress to create a new system that is financially solvent.

The GOP plan removes the individual and business (for over 50 employees) mandate. This is an improvement as it reduces government requirements and intrusions. The cost for insurance purchased after discovery of an illness will be increased by 30% one time. This could be modified upward to increase the incentive to purchase insurance prior an illness.

Tax credits are used to induce insurance purchases. This is preferable to direct subsidies in giving freedom to choose. The ability to purchase insurance through families till age 26 is continued as it is popular. An increase in premium might be considered for this option. This bill allows insurance companies to charge up to five times the premium for older patients compared to younger ones. In Obamacare, the limit is three times. Again, this adjusts risk as most healthcare dollars are spent at the end of life.

There are interested groups opposing the GOP plan. These include the AMA, hospital groups and insurance companies. We should not forget that these groups supported Obamacare and are not objective. Their opposition might be meaningful as the Democrat opposition means the GOP plan has some merit.

The mainstream media is working against the GOP plan to replace ObamaCare. Damaging this effort would hurt the Republicans in Congress and the president in any future legislative initiatives. Few practicing physicians and dentists have found the ACA to be helpful in providing medical care. Nurses and hospitals have been burdened with additional paperwork. Yet, elements of these industries have already become entrenched in the ACA.

The promised reduction in costs has not materialized. Some 10-20 million people have ObamaCare, but how many (perhaps 10 million) have lost their private insurance? Therefore, there will be some who will lose under any replacement plan. Are these affected people likely Republican voters?

Republicans are concerned that some will prevent their re-election if the ACA is repealed. They seek a smooth transition so few are adversely affected. Senator Susan Collins represents this group. Others, in the conservative movement, want a clean repeal. Senator Rand Paul leads this movement. The GOP can only lose one vote in the Senate under reconciliation. Finding a middle ground is not easy.

During the ACA debate, Republicans suggested ideas to increase the individual choices of consumers. These ideas were not used as the Democrats wanted a governmental regulatory program. This program had little chance of success and then the result would be a single-payer system. Senator Schumer and Nancy Pelosi are hoping for such a failure.

Now that two House committees have marked-up the legislation, the sausage process will begin. Hopefully, a plan can emerge that will make it through the Senate. A clean repeal might not be acceptable through reconciliation, but would be preferable. However, a complete replacement is not possible through reconciliation. Now we understand why healthcare reform is difficult. Future bills are necessary either way. The enemies are on the frontlines of Congress. Will the people emerge unscathed?



Source link