We may be jumping the gun on this because the SCOTUS has yet to rule on the premium subsidy lawsuit before it. But there is the potential that six million Americans could lose their subsidy. Recognizing the chaos potential, a Republican Senator has proposed a “fix.” Which in my opinion is a joke, a very bad joke. The following is from the Center for American Progress, an organization I rarely agree with. In this case they have a point.
I call Progressives naive in their understanding of and solutions for social problems. In this case Republicans are not only naive, but out of touch with reality. You can’t fix Obamacare by tweaking the essential interlocking pieces, but of course you can destroy it and if that is your goal you better have a damn good alternative… and Republicans don’t. Republicans will pay a very high price at the polls should their stupidity ever be implemented.
Some of the consequences of the Senator’s bill are exaggerated by CAP. For example, eliminating essential health benefits could actually benefit many people by lowering premiums while there would still be competing higher cost plans. Eliminating the employer mandate is also not a big deal for consumers, but a cost issue to Obamacare because it could generate more subsidy payments.
On the other hand, dropping subsidies, the individual mandate and things like covering pre-existing conditions are big deals. This is where Republicans shine in their naivety.
Obamacare did not truly make health care affordable, but over the longer term did exactly the opposite. It expanded coverage and put greater strain on the system, but it’s here, it’s in place and functioning even if it is not and will not work as propagandized.
Regardless, surreptitiously destroying the law adds no value for anyone. We need to take a step back and rethink not only Obamacare, but Medicare and Medicaid and for some non-service related care, the VA system as well. Why do we need separate programs with vastly different coverage, different reimbursement schedules and cost? Something is not right. It’s not working and it’s not fair to anyone? Universal coverage may invoke big brother, but exactly what do we want and how will we pay for what we do want?
We look at health care expense coverage in a too compartmentalized way. We need an integrated approach considering the needs of every citizen and every health care provider. Why can’t we for example, pay the same amount for a procedure to every provider (adjusted only for area cost of living) regardless of the insuring entity, Medicare, Medicaid, VA, or other insurer through Obamacare or not?
From the Center for American Progress
Later this month, the Supreme Court will issue a ruling on King v. Burwell, the latest Republican attack on the Affordable Care Act, or ACA, through the courts. If the Court rules for the plaintiffs, 6.4 million people will lose tax credits in states using the federal marketplace, making health insurance unaffordable for millions. Fearing a political backlash, Senate Republicans have recently touted a bill sponsored by Sen. Ron Johnson (R-WI) that would extend the tax credits for current enrollees through 2017. While marketed as a compromise, the Johnson bill includes many of the same proposals to dismantle the core of the ACA that the House has been voting on nonstop for the past five years. What would the Johnson bill do?
Extend tax credits in states using the federal marketplace through 2017 but prevent new enrollees in every state from accessing tax credits: By limiting tax credits to current enrollees—even in the state-based marketplaces that would otherwise be unaffected by King v. Burwell—the bill would significantly curtail future enrollment in every state. This would also reduce current enrollment over time due to the high level of turnover in the individual market.
Repeal the individual mandate: This would reduce the number of younger and healthier people who enroll or stay enrolled in the future, driving up premium costs and leading to a so-called death spiral in the individual market. According to the American Academy of Actuaries, this provision of the bill would “threaten the viability of the health insurance market” in every state.
Repeal the employer mandate.
Repeal the federal essential health benefits that plans are required to cover under the ACA: This would increase the number of underinsured people, worsening access to services such as maternity care that were previously often excluded from coverage.
Expand the grandfather provision, undermining the ACA’s consumer protections: Some pre-existing insurance plans that did not meet the ACA’s requirements were temporarily grandfathered in to minimize disruption to enrollees. The Johnson bill would expand this provision, creating a massive loophole around many of the ACA’s consumer protections, including the ban on insurers discriminating against people with pre-existing conditions.
QUINNSCOMMENTARY 
The law requires members of Congress and their senior staff to experience PPACA by removing them from the FEBHP – allowing them to enroll in the public exchange. The Office of Personnel Management confirmed that the federal government could allow members of Congress and their senior staff to pay their portion of the premium using pre-tax cafeteria plan contributions and that their employer, the federal government, could contribute towards the cost of public exchange coverage.
Try that as any other employer and you pay $100 a day per employee fine – assessed by the IRS.
You and I may not agree with the decision in the statute to exclude members of Congress and their senior staff from the FEHBP, but, like all other PPACA provisions, it is part of the law drafted and approved by Congress, and signed into law by President Obama. They asked for this for themselves. As you know, historically, members of Congress have seen fit to exclude themselves from all sorts of laws and mandates. So, yes, that was a surprising change.
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And, yes, PPACA is a failure. Remember, it was going to cure medical bankruptcies – studies show it has had no impact, and studies confirm that the arguments made about medical bankruptcies were never true to begin with.
PPACA was going to ensure all those Americans who were denied coverage by the big bad insurance companies due to preexisting conditions would not have access. The estimate was 400,000 – 600,000 Americans. Less than 20,000 enrolled prior to the program ending in 2014: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/pcip-enrollment.html
Finally, forget about the promises discussed in my first note.
If your definition of success, like the Democrats, is that 10 – 15 MM Americans are now covered under Medicaid and public exchanges, what about the other 35 – 40MM Americans who remain uninsured? Such a success. Similarly, what you are telling me is that we got 10 – 15 MM Americans (almost 90% of those in public exchange plans, and almost everyone in Medicaid) to enroll in taxpayer subsidized coverage. I don’t think we call that a success – where we incent 50+MM to enroll with taxpayer subsidies and 10 – 15MM take us up on the deal.
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I’m not one saying it is a success, but it’s here and it’s not going away and it needs to be the starting point to really fix things … someday.
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You miss my main point. The law specifically limited subsidies to those enrolled in state-established exchanges. I am all for administering the law as it is written – not as HHS, DOL and the IRS deem needed to facilitate implementation or to buy votes for Democrats. Where there are mistakes, Congress has had 5+ years to do technical corrections, or to substantially amend the law. And, don’t forget, they have made changes – repeal CLASS, drop 1099 requirement, drop the voucher program, eliminate the maximum deductible for individual and small group coverage, to name a few. Johnson’s proposed legislation need not be approved as proposed … that is part of the legislative process.
My complaint is that CAP’s comments are self-serving … no matter what the Supreme Court decides, they want the agencies to administer the law now as written, but in a manner that Democrates hope will buy votes (which was a top priority all along).
Note the recent article in Forbes.
Gruber’s Role, His Explanation for Language on Limiting Taxpayer Subsidies to Public Exchanges. Forbes article has video of Gruber embedded. See: http://www.forbes.com/sites/theapothecary/2015/06/21/contrary-to-white-house-denials-emails-show-jonathan-gruber-was-integral-to-obamacare/2/
Excerpts:
“… Last fall, videos emerged showing MIT economist Jonathan Gruber—the architect of Obamacare—mocking “the stupidity of the American voter” for not perceiving the ways in which the controversial health law concealed its true costs. At the time, President Obama and others went through great lengths to deny Gruber’s centrality to Obamacare. But 20,000 pages of new emails, obtained from MIT by the House Oversight Committee, appear to prove Gruber’s critical role. …”
“… Gruber was no independent expert. The Obama administration paid him nearly $400,000 as a consultant on Obamacare’s design, especially its new layer of federal health insurance regulation. But Gruber tried to avoid disclosing this conflict in his public commentary and appearances. Democratic officials did as well, in order to maintain the pose that Gruber’s opinions were non-partisan. Indeed, when Sen. Mike Enzi (R., Wyo.) specifically asked the U.S. Department of Health and Human Services for a list of all its paid consultants, Gruber’s name was mysteriously omitted. The emails obtained from MIT show that on January 8, 2010, Gruber emailed Jeanne Lambrew—the White House’s most important internal employee on Obamacare issues—for advice on how to handle an inquiry from Politico about his lucrative contract. Gruber kept Lambrew and her colleagues apprised of his discussions with Ezra Klein, and Lambrew praised Gruber for “being an integral part” of Obamacare’s development. …”
“…Why all this fuss as to whether or not Gruber was central to Obamacare? … Rich Weinstein, the man who scoured the Gruber videos, found footage of Gruber observing that the Affordable Care Act does not allow insurance subsidies to flow through Obamacare’s federal insurance exchange. Said Gruber: “What’s important to remember politically about [Obamacare] is if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that’s a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this.” This is precisely the position taken by challengers to the Obama administration in the King v. Burwell case that the Supreme Court will decide in a matter of days. Democratic partisans—including Gruber himself—tried to dismiss the challenge as intellectually bankrupt, before the Weinstein videos surfaced. It’s no coincidence that President Obama, when asked about Gruber’s off-script remarks, described Gruber as “some adviser who never worked on our staff [and] expressed an opinion I completely disagree with.”
“… The fact is that the wording of the Affordable Care Act is clear, and has been since the beginning. The law authorizes taxpayer-funded “premium assistance” only for individuals enrolled “through an Exchange established by the State under [Section] 1311 of the Patient Protection and Affordable Care Act.” (As Iexplained in 2011, Section 1311 is the portion of the law devoted to state-based exchanges, whereas Section 1321 discusses federally-run exchanges.)…”
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Why did they draft it saying “the” state as opposed to a or each state if that was the intent? “The” state can be construed as intended to mean the broader definition of government as the state. As I said previously, if the intent was to push the state’s to set up exchanges why be so ambiguous knowing the possible result would be as it is now?
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If we continue to enable the law, versus amending it or pursuing technical corrections, what is already a failure will become a catastrophe. Do we want more and more Americans dependent on the taxpayer subsidized dole – what one CMS leader confirmed, when asked, that health reform is by its nature redistributionist? Or, do we want more and more Americans to gain the skills and capabilities, experience and education necessary to compete for quality jobs with quality employers that offer health coverage as part of the total rewards package?
CAP, President Obama and the Democrats think 19MM Americans in taxpayer subsidized public exchanges and Medicaid expansion is a success. If we (taxpayers, republicans, anyone) allow that to continue when the statute clearly says otherwise, we endorse their position, and ensure an even longer period of failure and potentially more and more and more individuals dependent/smoking the crack pipe of government entitlement .
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Johnson is anything but a right wing goofball. He is the individual who sued the federal government based on extending tax preferences to members of Congress and their senior staff whose incomes were too high for public exchange subsidies – tax preferences the IRS came out and clearly regulated out of existence for all other Americans.
However, even taking CAP at their word, I would note:
Extend tax credits in states using the federal marketplace through 2017 but prevent new enrollees in every state from accessing tax credits Is this a surprise? If the law says no tax credits for those who are not enrolled in a state exchange, why would you have a transition rule that runs indefinitely, and encourages new individuals to enroll – when the replacement (whatever that is), won’t have the same structure?
Repeal the individual mandate. CAP wants the individual mandate to apply in 16 states but not in 34 other states? Without taxpayer subsidized coverage, those with incomes 8% of their household income, meaning that the individual mandate wouldn’t apply anyway. Why penalize only a portion of the citizens and only in some states?
Repeal the employer mandate. Again, if there is no subsidized coverage in federal public exchanges, no employer mandate (“play or pay”) applies to those individuals in those states. That is, a multistate employer, would have to comply with the employer mandate in 16 states, but not in 34 others. That make sense to you?
Repeal the federal essential health benefits that plans are required to cover under the ACA: Those are state EHB’s. The federal government never had the guts to announce a federal version of EHB. So, you already have a massive inconsistency from state to state anyway.
Expand the grandfather provision, undermining the ACA’s consumer protections: I am sure CAP supported HHS’s decision, without any legislative support, to extend access to certain non-PPACA compliant coverage in the individual marketplace from 2012 through 2016 – where states agreed to play along (note that many states rejected the “transition”). How is it that legislation that would further extend the transition takes a good thing and makes it bad?
Give me a break. The law is, was and will continue to be crap. Implementation was delayed and adjusted with an eye on buying votes. They frontloaded the positives and backloaded the negatives. The incidence of the taxes to fund the coverage expansion are on insurance companies, employers, drug manufacturers, medical device manufacturers, while the impact of the taxes land on working, taxpaying Americans.
All of the promises about the law were knowing lies. The PPACA cost taxpayers more than one thin dime – the deficit and debt are higher, not lower due to the coverage expansion. You can’t keep your doctor. You can’t keep your plan.
CAP’s argument is that once a new subsidy is put in place, it should remain in effect forever – even if the law is a failure. I am surprised you agree with that position.
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I don’t understand your first paragraph. Are you talking about the issue of forcing Congressional staff into exchanges as opposed to continuing to treat them as government employees like a million other federal employees or other employees of any company for that matter?
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“The State” is the appropriate English grammer – they could have said “a” if they wanted to, but they did not. The reference to State based exchanges in 1311 is clear, and it DOES NOT include federal run exchanges in 1312.
You have to stretch the language, like supporters have stretched the truth to get to include federal exchanges.
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I was reading what you wrote about the 2nd amendment and before I could comment, it disappeared. In any case, it seem to me the arguments about individual rights always ignore the key words: “A well regulated Militia, being necessary to the security of a free State…” Since there was no standing army to speak of at the time nor did they want a strong central army, why doesn’t this speak to the need for a state militia which necessitates individuals to carry arms in their duties related to the militia? Needless to say having a gun in the 18th century was a necessity for many, but going into the 21st century context the same intent of a state militia still seem relevant more than every citizen unrelated to a common security issue needs to carry a gun.
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