Future of the ACA

[Scythia]

Given that the Republican controlled House has already voted to repeal it over 50 times, and that repealing it is part of the president elect's first 100 agenda, it seems pretty likely to be eliminated quickly. Seems like we're headed back to the bad old days of no coverage for any pre-existing conditions, and coverage being out of reach for many Americans.

My question is this: Should those who rely on the ACA for coverage even bother signing up for next year?

About costs.

Spoiler:

People who think the ACA was what caused the increasing healthcare costs are likely to be surprised when its repeal doesn't stem the tide.

[TimD]

While I'm no fan of the ACA, I can't conceive of it not being around at least that long. Not due to any lack of desire to watch it burn, but more due to the logistics and timeframes needed for the changes to permeate through the various regulatory agencies and then through the insurance companies themselves. Much as it wasn't able to immediately start, it won't be able to immediately stop. Too many things in motion.

[KingOfAnything]

It's very doubtful that repeal of the law would result in the immediate cancellation of policies. Get your coverage while you can, prepare as much as you can for being unable to renew again.

[Rednal]

That a Republican Congress is going to try and repeal it as soon as possible is, I think, inevitable - and I also think it sets a bad precedent if major legislation tends to get completely blotted away as soon as political control shifts. I... feel like that could generate a ton of instability in the markets.

That said, I'm waiting on the Republicans to propose an actual plan for health care coverage - one that has a workable budget, ensures people can get the care they need, and is generally functional. If they just want to get rid of the program and kick people onto the streets (more or less), that's probably going to come back to bite them in the mid-terms...

[Scythia]

I'm pretty sure market instability is already a feature of this incoming administration, judging by the drops in both U.S. and international markets.

I would also like to think they'll take the steady approach and wind down the program gradually, but I haven't had much reason to expect sensible political decisions lately.

[thejeff]

Rednal wrote:

That a Republican Congress is going to try and repeal it as soon as possible is, I think, inevitable - and I also think it sets a bad precedent if major legislation tends to get completely blotted away as soon as political control shifts. I... feel like that could generate a ton of instability in the markets.

That said, I'm waiting on the Republicans to propose an actual plan for health care coverage - one that has a workable budget, ensures people can get the care they need, and is generally functional. If they just want to get rid of the program and kick people onto the streets (more or less), that's probably going to come back to bite them in the mid-terms...

They've had plenty of time to propose one.

We know basically what it's going to look like: HSAs, less regulation, the ability to ignore state regulation when selling across state lines, maybe limits on malpractice suits.

All things we know won't work.

[CBDunkerson]

Note that Democrats could still filibuster to prevent most changes to the ACA.

If Republicans decide to remove the filibuster ('go nuclear') then I expect they would still keep coverage for pre-existing conditions, extended coverage of dependents, and several other very popular parts of the ACA. Essentially, if they make changes they are on the hook for the results, and thus this may actually make some parts of the act permanent and 'off limits' for the first time.

Keep in mind... the ACA is really a GOP design. It was developed by the Heritage Foundation and first enacted into law by Mitt Romney. Thus, it is entirely possible that the 'repeal' will be smoke and mirrors which keeps a lot of the act in place while allowing them to pretend that they replaced it with a 'new' plan.

[Irontruth]

There isn't a lot of Republican consensus on the "replace" portion of "repeal and replace". I think the odds are it'll be repealed, then they'll start arguing about what to put in it's place and we'll end up with very little to fill that void.

There are some Republican plans floating around as of 6 months ago if you want to look at them.

Mostly, all the consumer-side protections will be stripped out. Taxes on plans will change some, but not significantly. Medicare will be cut and moved towards privatization.

[CBDunkerson]

I think we'll find that there continues to be a huge difference between what Republicans SAY (balanced budgets) and what they DO (massive deficit increases).

After all, they SAID that they were in favor of cap and trade and an individual mandate insurance plan... until Obama offered to take them up on those things. Then suddenly they were evil incarnate.

In one sense they are in a bad position. They appear to have complete control of the government... the presidency and majorities in the House, Senate, and Supreme Court. However, the Democrats still have filibuster power... and if they use it the way the GOP did that means they can block almost everything. They probably won't because they don't want the GOP to take the filibuster away, but I don't see Democrats allowing Medicare to be privatized or significantly cut. Nor complete repeal of the ACA.

[Snowblind]

CBDunkerson wrote:

...

They probably won't because they don't want the GOP to take the filibuster away
...

Can I seriously ask how true this is?

It seems like filibustering has not helped the Democrats very much, given the GOP's behavior. Forcing the GOP to kill off one of their weapons or suffer a crippled administration might be worth considering.

[CBDunkerson]

Snowblind wrote:

CBDunkerson wrote:

...

They probably won't because they don't want the GOP to take the filibuster away
...

Can I seriously ask how true this is?

It seems like filibustering has not helped the Democrats very much, given the GOP's behavior. Forcing the GOP to kill off one of their weapons or suffer a crippled administration might be worth considering.

The Republicans used the filibuster to cripple the first six years of the Obama administration (the last two they actually had a Senate majority) and in that time the Dems only 'killed it off' for judicial nominations.

That said, I wouldn't expect the GOP to show anything close to that level of restraint. If Dems are even half as obstructionist as the Republicans were then I'd bet on the filibuster being removed entirely. That's why I expect they will pick their fights carefully rather than blocking EVERYTHING the way the GOP did to Obama.

As to it being a 'good thing' if the GOP nukes the filibuster permanently... I wouldn't want to see the kind of horrors they could unleash in that case.

[thejeff]

CBDunkerson wrote:

Snowblind wrote:

CBDunkerson wrote:

...

They probably won't because they don't want the GOP to take the filibuster away
...

Can I seriously ask how true this is?

It seems like filibustering has not helped the Democrats very much, given the GOP's behavior. Forcing the GOP to kill off one of their weapons or suffer a crippled administration might be worth considering.

The Republicans used the filibuster to cripple the first six years of the Obama administration (the last two they actually had a Senate majority) and in that time the Dems only 'killed it off' for judicial nominations.

That said, I wouldn't expect the GOP to show anything close to that level of restraint. If Dems are even half as obstructionist as the Republicans were then I'd bet on the filibuster being removed entirely. That's why I expect they will pick their fights carefully rather than blocking EVERYTHING the way the GOP did to Obama.

As to it being a 'good thing' if the GOP nukes the filibuster permanently... I wouldn't want to see the kind of horrors they could unleash in that case.

It's tricky because the filibuster is a much better tool for Republicans than Democrats. All it can do is obstruct, shut things down, produce gridlock. Create the perception (or even reality) that government is broken and doesn't work.

Which is a Republican theme. Government not working moves people to support Republicans, even when it's Republicans breaking it. Democrats need to show government works. Breaking it makes people trust it less and pushes them towards Republicans.

That said it's almost certainly going to be necessary to use the filibuster and make the Republicans deal with it. Ugly though the results may be, they can't be worse than giving them a free hand and preserving the filibuster for them to use later on. But I'd expect Democrats to reserve it for the larger things, not follow the GOP's example and try to force 60 votes to do anything.

[Drahliana Moonrunner]

Scythia wrote:

Given that the Republican controlled House has already voted to repeal it over 50 times, and that repealing it is part of the president elect's first 100 agenda, it seems pretty likely to be eliminated quickly. Seems like we're headed back to the bad old days of no coverage for any pre-existing conditions, and coverage being out of reach for many Americans.

My question is this: Should those who rely on the ACA for coverage even bother signing up for next year?

About costs.** spoiler omitted **

Yes... keep yourself in play.... unless you have a better alternative right NOW. Also states that authorised the medicare expansion will still have it running even if Trump signs a repeal bill in January.

[thejeff]

CBDunkerson wrote:

Note that Democrats could still filibuster to prevent most changes to the ACA.

If Republicans decide to remove the filibuster ('go nuclear') then I expect they would still keep coverage for pre-existing conditions, extended coverage of dependents, and several other very popular parts of the ACA. Essentially, if they make changes they are on the hook for the results, and thus this may actually make some parts of the act permanent and 'off limits' for the first time.

Keep in mind... the ACA is really a GOP design. It was developed by the Heritage Foundation and first enacted into law by Mitt Romney. Thus, it is entirely possible that the 'repeal' will be smoke and mirrors which keeps a lot of the act in place while allowing them to pretend that they replaced it with a 'new' plan.

It's a GOP design, but they never liked it. It was always intended to forestall a better plan, not something they actually wanted to implement.

I don't see how they can keep the popular parts without keeping the rest. It really does all fall apart. The insurance companies can't accept coverage for pre-existing conditions without the mandate and you can't keep the mandate without the subsidies.

I'm also not sure how after running for 6 years on "Repeal Obamacare" they survive not actually repealing Obamacare now that they trivially can. And frankly, there's a good chunk of the House especially that doesn't really have a clue how this whole governing thing works. They're mostly new, tied to the Tea Party, and haven't ever had to do anything in Congress but stop Obama. Can Ryan control them, newly revitalized with a Trump victory? I don't think they can get by without at least a clean vote to repeal in the House, which will pass easily.

I wonder if cooler heads will prevail in the Senate and let the filibuster stand just so Democrats can save them from themselves?

[thejeff]

Drahliana Moonrunner wrote:

Scythia wrote:

Given that the Republican controlled House has already voted to repeal it over 50 times, and that repealing it is part of the president elect's first 100 agenda, it seems pretty likely to be eliminated quickly. Seems like we're headed back to the bad old days of no coverage for any pre-existing conditions, and coverage being out of reach for many Americans.

My question is this: Should those who rely on the ACA for coverage even bother signing up for next year?

About costs.** spoiler omitted **

Yes... keep yourself in play.... unless you have a better alternative right NOW. Also states that authorised the medicaid expansion will still have it running even if Trump signs a repeal bill in January.

Until they can't pay for it without the federal support. I doubt even most blue states will be able to keep it going.

[Scythia]

Given that the Medicaid expansion was part of the ACA, wouldn't repealing it remove the federal funding for those expansions?

[Comrade Anklebiter]

I don't have any details, just saw some headlines, but, apparently, Trump's already walking back some of his campaign promises, including, apparently, some of the anti-Obamacare rhetoric.

Beats me.

[MMCJawa]

apparently he plans on keeping the part that allows young adults to stay under their parent's policies longer, and the part preventing denial of coverage due to "pre-existing conditions"

[Rednal]

Steve Pearlstein, writing for the Washington Post, has some thoughts on that.

[BigNorseWolf]

MMCJawa wrote:

apparently he plans on keeping the part that allows young adults to stay under their parent's policies longer, and the part preventing denial of coverage due to "pre-existing conditions"

and if your income is less than what healthcare costs?

[thejeff]

BigNorseWolf wrote:

MMCJawa wrote:

apparently he plans on keeping the part that allows young adults to stay under their parent's policies longer, and the part preventing denial of coverage due to "pre-existing conditions"

and if your income is less than what healthcare costs?

Well, I suspect the subsidies go away, though not the taxes that paid for them, so you're out of luck. The mandate goes away, so at least you won't be punished, you just won't have insurance.

Without the mandate & subsidies keeping relatively healthy people in the pool and with no ban on pre-existing conditions, only sicker people sign up and people who do get badly sick do get on insurance so the prices soar, far faster than they are now. The total collapse in a couple years is blamed on Obamacare itself, not the changes made to it. Democrats take a hit as does the very idea of functioning government.

Meanwhile, the Medicaid expansion gets cut so the poor who were helped get screwed. And Paul Ryan proposes gutting Medicare by turning into a voucher program.

[CBDunkerson]

BigNorseWolf wrote:

MMCJawa wrote:

apparently he plans on keeping the part that allows young adults to stay under their parent's policies longer, and the part preventing denial of coverage due to "pre-existing conditions"

and if your income is less than what healthcare costs?

Not really an issue.

If it doesn't cost less than it will save you in treatment costs... don't buy it. The insurance companies can't deny you coverage (at community rating) so... just wait until you have tens of thousands of dollars of medical expenses, pay an initial premium of a few hundred dollars, and force the insurance company to cover the rest.

The Donald has the bestest healthcare plans.

thejeff wrote:

The total collapse in a couple years is blamed on Obamacare itself, not the changes made to it. Democrats take a hit as does the very idea of functioning government.

While this is pretty much Republican strategy 101, I don't think it would work out in this case... because the collapse wouldn't take a couple of years. Every rational health insurance company would stop serving the US individual market immediately. This nonsense has been done before at the state level. They know how it turns out. They'd bolt and leave Trump holding the bag.

That said... Trump has no power to do this. He would need the GOP congress to do so... and it doesn't seem likely that they will cut their own throats... or that the Democrats would let them, since it would also be an absolute disaster for the country.

[thejeff]

CBDunkerson wrote:

thejeff wrote:

The total collapse in a couple years is blamed on Obamacare itself, not the changes made to it. Democrats take a hit as does the very idea of functioning government.

While this is pretty much Republican strategy 101, I don't think it would work out in this case... because the collapse wouldn't take a couple of years. Every rational health insurance company would stop serving the US individual market immediately. This nonsense has been done before at the state level. They know how it turns out. They'd bolt and leave Trump holding the bag.

That said... Trump has no power to do this. He would need the GOP congress to do so... and it doesn't seem likely that they will cut their own throats... or that the Democrats would let them, since it would also be an absolute disaster for the country.

What do the Democrats have to do with it? They can't do anything to stop it.

Nor am I at all sure, given how much they've focused on it for 6 years that the Republican Congress will refuse to touch Obamacare. I've got much less faith in their sanity or understanding of how government works. The GOP base hates Obamacare, even if they benefit from it. An all-out repeal would certainly pass the House and I'm not at all convinced Ryan can survive not calling such a vote. He might be able to stall a bit, pretending to put a "replace" plan together, but that's just stalling, since there's no such plan they'd accept. He might be able to get a "just repeal the bad parts version" vote instead, but we know that just blows up.
There best course might be to let Democrats filibuster it in the Senate and blame them for keeping it. Only turns into a problem when they want to kill the filibuster for something else.

[CBDunkerson]

thejeff wrote:

What do the Democrats have to do with it? They can't do anything to stop it.

Um... they can filibuster it... as you obviously know;

Quote:

There best course might be to let Democrats filibuster it in the Senate and blame them for keeping it. Only turns into a problem when they want to kill the filibuster for something else.

Yep, 'those evil Dems stopped us from killing Obamacare' seems one of the more likely solutions.

Failing that, I expect they will 'replace' it with another version of itself. Instead of an 'individual mandate' (since that was declared evil) it could have a 'health care tax' that everyone has to pay... UNLESS they have health insurance.

[DominusMegadeus]

You guys are crazy. Trump said he'd fix everything instantly with his yooj, white hands. Do you think he was just lying or something?

[thejeff]

CBDunkerson wrote:

thejeff wrote:

What do the Democrats have to do with it? They can't do anything to stop it.

Um... they can filibuster it... as you obviously know;

Quote:

There best course might be to let Democrats filibuster it in the Senate and blame them for keeping it. Only turns into a problem when they want to kill the filibuster for something else.

Yep, 'those evil Dems stopped us from killing Obamacare' seems one of the more likely solutions.

Failing that, I expect they will 'replace' it with another version of itself. Instead of an 'individual mandate' (since that was declared evil) it could have a 'health care tax' that everyone has to pay... UNLESS they have health insurance.

Taxes are even more evil than mandates. I don't see that happening.

If they try to just keep the "good parts" it all blows up. The only real "replace" plan I've seen is the old "HSAs, sell across state lines, tort reform" plan, which is a joke.

I really can't predict what might happen. I'm not sure who's the adult in the room capable of looking at the actual practical effects of policy. Paul Ryan's back to pushing his "turn Medicare into a voucher program" plan - also known as the "let old people die when they get sick" plan. If he can't see that won't work, maybe he really thinks you can pull random bits out the ACA without it falling apart.

And he's their serious policy wunderkind.

[Crusinos]

CBDunkerson wrote:

Every rational health insurance company would stop serving the US individual market immediately.

Isn't this already happening? I know that insurance companies and hospitals have been pulling out of it over the years.

[CBDunkerson]

Crusinos wrote:

CBDunkerson wrote:

Every rational health insurance company would stop serving the US individual market immediately.

Isn't this already happening? I know that insurance companies and hospitals have been pulling out of it over the years.

Depends on the state. Some of the GOP controlled states refused to do anything to promote it, actually prohibited people from explaining how/why to sign up for the ACA, and otherwise sabotaged the program well enough that they didn't get enough people signing up to make it worthwhile... and thus have had insurance companies pulling out of the marketplace. Other states have a much larger signup rate and thus are doing just fine. A classic example of Republicans convincing people that government doesn't work because GOP government doesn't work.

[Crusinos]

CBDunkerson wrote:

Crusinos wrote:

CBDunkerson wrote:

Every rational health insurance company would stop serving the US individual market immediately.

Isn't this already happening? I know that insurance companies and hospitals have been pulling out of it over the years.

Depends on the state. Some of the GOP controlled states refused to do anything to promote it, actually prohibited people from explaining how/why to sign up for the ACA, and otherwise sabotaged the program well enough that they didn't get enough people signing up to make it worthwhile... and thus have had insurance companies pulling out of the marketplace. Other states have a much larger signup rate and thus are doing just fine. A classic example of Republicans convincing people that government doesn't work because GOP government doesn't work.

And then the media making the mess worse in the name of ratings.