Obamacare

4 Things to Know About Obamacare After the Midterms

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Whitehouse.gov

Over the course of this year's midterm campaign, Republicans ran endless ads against the Affordable Care Act, the health care law better known as Obamacare. In weeks leading up to the vote, it was the top Republican ad issue for Senate campaigns by far.

So now that Republicans have won majority control of the Senate, and increased their majority in the House, what might that mean for Obamacare?

Here are four things to know and watch out for: 

1) Obamacare continues to be political poison for Democrats. Of the 60 Senators who voted for Obamacare in December of 2009, 24 are now out, as The Washington Examiner's Philip Klein points out. Now, some of them were replaced by Democrats, but  and not all of the turnover is strictly the fault of Obamacare. But the retention rate for upper-chamber legislators who voted for the law is not strong, and the majority of those who are gone were replaced by Republicans. It's worth singling out the Arkansas Senate race here. Incumbent Democrat Mark Pryor was the only Democrat in a close Senate contest to run an ad that could reasonably be described as supportive of Obamacare. Tellingly, the ad didn't name the law at all, but it did describe support for some of its benefits. Pryor lost, pulling in just 39 percent of the vote. In contrast, Ed Gillespie, the GOP Senate candidate in Virginia, was expected to lose by as much as 9 points. He was the rare GOP Senate candidate to endorse a relatively detailed Obamacare replacement plan—and he ended up losing in a squeaker of an election by less than a single point.

Pinning down the exact impact of Obamacare on the midterms is obviously difficult, but there's solid evidence suggesting that in 2010, voting for the law cost Democrats an estimated 25 seats in the House—enough that they lost control of the lower chamber because of it. Regardless of exactly how much Obamacare hurt Democrats politically, it's virtually impossible to make a case that it helped.

2) The bulk of Obamacare is not going to be repealed. Republicans have promised repeatedly to repeal Obamacare, and in a joint Wall Street Journal op-ed, GOP Senate Majority Leader Mitch McConnell and House Speaker John Boehner put "renewing our commitment to repeal Obamacare" near the top of the party's priority list. Expect to hear an awful lot about various strategies for using the reconciliation process, which would allow Republicans to move a partial repeal bill out of the Senate and to the president's desk with a simple majority vote. The details are complicated, and even experts don't know for certain exactly how much of Obamacare could be attacked using this process. The best guess? Most of it, perhaps, but almost certainly not all of it. 

But at least in the short term the particulars don't matter all that much. Regardless of the party's commitment to repeal or its procedural savvy, the vast majority of the law isn't going anywhere, because Obama isn't going to sign a bill that repeals it. If it wasn't already perfectly clear that he wouldn't agree to scrap his signature accomplishment, he reiterated his position at a press conference this week. "Repeal of the law—I won't sign," he said. That's that.

McConnell knows this. Boehner knows. Republicans aren't actually expecting to fully take the law down. Instead, they hope to keep pressure on the president regarding the unpopular law, highlighting the GOP's continued opposition and Obama's continued support.

3) Republicans will likely target specific components of the law—and might actually succeed in taking a few of them out. Most of the law will stay in place. But Republicans might be able to nibble around the edges. At the press conference this week, President Obama indicated that he might be willing to accept some changes to the law, so long as they didn't impact coverage.

What sort of small tweaks might Republicans aim for? The most likely item on the list is a repeal of the law's medical device tax, which is opposed by many Democrats—particularly those who represent states where the medical device industry has a strong presence. Republicans will try to make an issue out of the individual mandate which is widely disliked, but Obama won't let that one get through. The employer mandate, however, might be a successful target: The administration has delayed and undercut the provision on multiple occasions, and liberal policy shops have argued that it's not necessary.

4) There are still more glitches to come. At the press conference, Obama was adamant that the federal health insurance exchange, which failed so thoroughly when it opened last year, would work well. "We're really making sure that that Web site works super well before the next open enrollment period," he said. "We're double- and triple-checking it." There's no doubt that the exchange, the front end of which was reasonably functional by the end of last year's open enrollment period, will perform significantly better when this year's open enrollment period starts later this month. But much of the back-end functionality—the guts of the system—remains incomplete, and that's going to cause some problems. As The Wall Street Journal reported earlier this week:

Consumers who bought policies on the exchange for 2014 and switch to a different insurer for 2015 could end up enrolled in two plans, with bills for both, in January, according to two industry officials. Others who stopped paying premiums for their plans this year could find themselves automatically re-enrolled in those plans for 2015 regardless of whether they want them.

Meanwhile, lower-earning Americans who receive federal tax credits to offset the cost of their coverage might not get a form they need to file their 2014 taxes because the federal government has an incorrect address for them, these officials say.

 These issues are likely to have an impact on tens of thousands of people, according to the report, and some of them won't be apparent until tax time next year. Obamacare's second open enrollment period will be far smoother than last year's, but it will still be a bumpy ride.

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  1. Off topic:
    Wendy Davis lost because Ebola:
    http://www.breitbart.com/Breit…..s-On-Ebola

    1. So the same reason as the Bengals.

    2. Maybe had she quarantined her campaign for 21 days, this wouldn’t have happened.

    3. I thought it was her ablist rhetoric, or maybe the fact that Wendy Davis is no Ann Richards, and even Richards couldn’t fight the Republican tide of Texas voters 20 years ago.

      1. I watched that HBO doc on Richards. Like Obama, she rose to prominence by giving a speech at the DNC.

        A speech that, according to the people in the documentary, she didn’t write.

        I mean, I know that’s standard in politics, but it just seems to take the punch out of the story.

        1. She rose to national prominence that way. She became governor of the state by outdrinking, outswearing, and outfighting all the boys in the political club, then getting sober and raising her ground game.

    4. Thanks Ebola!

  2. On the first point, it would be interesting to compare the average retention rate for Senators over two election cycles against the retention rate for Senators who voted for OCare.

    I suspect that, if the OCare Senators had known that voting the way they did was liking playing Russian roulette with an extra bullet or two in the cylinder, it would never have passed.

    1. They thought the exact opposite – that it would ensure a permanent Team Blue Majority at the federal level and that Team Red would be condemned to the wilderness for being on the wrong side of history.

  3. So basically Congress will be blue or split again in 6 years after the GOP cancels everyone’s health care by removing one or two minor pieces of Ocare.

    1. “So basically Congress will be blue or split again in 6 years after the GOP cancels everyone’s health care by removing one or two minor pieces of Ocare.”

      I believe the correct phrasing is “the GOP destroyed civilization as we know it, and the survivors are eating each other in the ruins” because they removed the Obamacare mandate.

  4. I’ll buy that with your dollars!

  5. My prog friends had all sorts of dark warnings about what would happen if the Rs won. “They’ll impeach Obama! They’ll get rid of the IRS! They’ll end public education! They’ll repeal Obamacare!”

    If I believed any of that, I might have voted Republican.

    1. Yes, the evil version of the Republicans conjured up by Democrats to scare their children sound much more worthy of support than their real-life counterparts. C’est la vie…

    2. If McConnell had run on that, I would have voted for him.

      And, re discussion yesterday, there is nothing in that to drive away socon votes.

  6. Obamacare continues to be political poison for Democrats.

    LIES!!! IT IS NOTHING…I MEAN, WELL BELOVED!

    /shriek

  7. I think any repeal measures (part or full) will have support from some Democrats. Remember when the ACA was passed, the Democrat leaders knew it would be tough but pushed for some in their party to fall on the sword and vote for it anyway. Now, any repeal measures will be opposed by Obama, Pelosi, etc., but they won’t be able to create a unified front. I think at least some Democrats will issue a polite “Fuck off, I’d rather get re-elected than go down with that sinking ship.”

    1. Poor Allison Lundergan Grimes will never get a chance to show us how fiercely independent she could have been.

      1. She hasnt conceded yet, so maybe there is still hope.

  8. “We’re double- and triple-checking it.”
    ——————-
    Come on, we non-technical folks can’t understand that lingo.

  9. If they eliminate the employer mandate but not the individual one, I will be extremely pissed.

    1. Just make the mandatory minimum for the individual plan a very minimal plan.

      The employer-based system stinks for all sorts of reasons. I could imagine phasing us back into the individual market by getting rid of the employer based system first, then phasing out the individual mandate.

      1. It’s already a very minimal plan. It just costs the same as a really good plan.

  10. my buddy’s sister makes $84 an hour on the internet . She has been out of work for 7 months but last month her pay was $18232 just working on the internet for a few hours. this page….

    ????? http://www.netjob70.com

    1. Either that was a loooong month or you have a strange definition of “few”.

      1. Well when you really enjoy your work, time just flies by.

        1. To the tune of 54 hours a week!

  11. So… any word on whether enrollees on the Federal exchange will continue getting their subsidies? Also, will the IRS be penal-taxing people come April?

    1. Iirc, the penaltax was delayed another year. Illegally, I think.

      1. “Iirc, the penaltax was delayed another year. Illegally, I think.”

        I believe that the penaltax kicks in as of this year. Indeed, if you don’t have health insurance as of May you are subject to the fine.

        “To avoid the penalty you needed coverage that started by May 1st, 2014. If you missed the deadline you’ll have to wait until the marketplace opens again on November 15th, 2014 to get marketplace coverage unless you qualify for a special enrollment period.”

        http://obamacarefacts.com/obam…..l-mandate/

        1. How convenient that my old policy was canceled in April.

  12. I’d be interested to see a spelled out vision of the healthcare system pachyderms want to have in place. If they have an idea what they are trying to get to, they haven’t shared it. I know they hate them some ACA, but FFS they are unwilling to describe what they want.

    For example, if they like HDHP+HSA plans, firm up the definitions and reimbursement ratios and etc in ACA to make those plans with HSAs clearly denoted and approved as allowable plans in the exchanges. If we live in a world where there is a mandate and the outcome is a lot more people with HDHP and HSA, that’s a better world than the one we live in now. Prices rationalize, providers begin to compete clearly on price, everyone gets used to the idea that stuff costs money, you get catastrophic coverage, premiums in these plans are lower, etc.

    1. “If we live in a world where there is a mandate and the outcome is a lot more people with HDHP and HSA, that’s a better world than the one we live in now.”

      This is my thinking. I know it’s heresy from a libertarian perspective, but half a loaf is better than none.

    2. They already have those on state exchanges. They are expensive. No matter what they want the young and healthy to pay to prop this shit up.

  13. 1) Obamacare continues to be political poison for Democrats.

    and

    2) The bulk of Obamacare is not going to be repealed.

    I am not sure those two things can both be true. If Obama continues to be an unpopular President and an anchor on Congressional Democrats and the law continues to be massively unpopular, why is it so unthinkable that enough Congressional Democrats wouldn’t vote to override an Obama veto?

    An override would require 66 votes in the Senate and 354 votes in the House. The Republicans will have 53 Senate votes and around 250 House Votes. That means it would take 13 of the 47 Democratic Senators and 104 of the 185 Democrats in the House to override. That is not likely but I don’t think it is impossible, especially after the full force of the premiums increases and the employer mandates hit next year.

    Do Congressional Democrats really want to run in 2016 defending another vote to uphold Obamacare? And are they willing to do that just to defend a lame duck President whose unpopularity got them killed in the last two midterms?

    1. Another thing to remember is that a huge chunk of the people who drafted and voted for Obamacare are no longer in Congress. Nearly all of the Democrats who are not hard leftist who voted for the thing have either been voted out of office or retired. Why would someone like Joe Donelly who never voted for the damn thing and who represents a red state like Indiana feel any loyalty towards Obamacare?

      1. Because, well, TEAM!

    2. They are true, I believe, because the Repubs are too gutless to repeal OCare even though they could probably get the handful of Dem votes they need to at least send it to Obama.

      Could they override his veto? They’d need a lot more Dem votes for that.

      But it boils down to the Repubs lack of willingness to push the issue to the wall, not necessarily the lack of Dems willing to cross the aisle on this issue.

      1. re: gutless. agreed.

        However, the Rs are still politicians and they have been pissed upon for 6 years. They may wind up doing repeal out of pure, unadulterated spite. This will be a thing of beauty to behold.

    3. Some of them probably would vote to override, but I doubt enough would. Many of them are in safe districts no matter what they do with Obamacare. And the ones who might override would have to weigh it against a potential loss of support from the party. I admit an override seems possible, but highly unlikely.

      1. I am not saying it is likely. I am saying that it is not unthinkable.

        I don’t’ see what loyalty the Democrats in Congress have to Obamacare. A whole bunch of them were not in office when it was passed.

        People hate this law. And it is not just Republicans who hate the law. There are a ton of loyal Democratic middle and upper middle class voters in Democratic districts that are getting completely screwed by this thing. This is going to be even more true next year when the full force of it hits. A large number of people have been shielded from getting screwed by Obama ignoring the law. Well, that is going to end. Obama is going to put the full force of his signature accomplishment onto America.

        You tell me why any Democrat wouldn’t want to vote to kill it other than out of blind party loyalty? Loyalty is a very powerful thing. But it is not all powerful. This bill is a disaster and there is tremendous pressure coming from voters on both sides to do something. Obama isn’t ever going to run for office again and doesn’t give a fuck if he leaves office with the Democratic Party in ruins. So he will of course veto no matter what. The Democrats in Congress have to run for election and live with the consequences of Obama’s actions.

      2. I can’t see Obama agreeing to anything. But I also can’t see how the Democrats in Congress are suicidal enough to stand by him on that. Something has to give. Either they effectively gut this thing or the Democrats run in 2016 trying to explain why they didn’t do anything to fix it or repeal it. Worse, there is no way to finesse this. The Democrats can’t pass a couple of meaningless fixes and get the public to like the bill. The only way to satiate the public is to gut it. They are in a hell of a tough spot.

        1. “But I also can’t see how the Democrats in Congress are suicidal enough to stand by him on that. Something has to give.”

          I think it’s a matter of degree.

          Currently Obamacare has a:
          37% approval vs 53% disapproval (-16%)

          Generally, crossing (-20%) is a bad sign, but not necessarily fatal. Particularly, if there’s Media support and a hard core defender (President Obama).

          If the penaltax starts hitting people in April and other negative affects of the law start getting a lot of publicity, then yes, Democrats will start bailing. But it’s going to have to get pretty bad for 6 Democrat Senators to vote to over ride a Veto.

          I’m guessing that it would take something like -30% for several quarters before we’ll see a re-alignment. And it’s no where near that yet.

    4. I think your math on the House is a bit jacked up, John. Doesn’t only take a 2/3 majority of each house to override? So, with 435 Reps, you need 290 votes to override. Subtract the 250 GOP votes you mentioned, and that means you only need to pry away 40 Dems out of 185. I think that’s actually doable, especially with your point that a lot of the schmucks that voted for this law are no longer in Congress.

  14. Suppose the Republicans pass a bill that while doesn’t fully repeal, ends the employee mandates, the individual mandates and the coverage mandates along with the medical device tax and continues just the pre-existing condition rule and the insurance exchanges. That would effectively gut Obama care but contain only repeal really unpopular shit. I don’t think it is far fetched to think enough Democrats wouldn’t sign onto that deal to override a veto.

    1. That would be an interesting proposal to push. If nothing else, it would probably isolate some vulnerable Dems on the wrong side of the issue, so they can be picked off in 2016.

      1. And without any cost controls at all the rest of the law should implode shortly thereafter. How long could plans stay on the exchanges with no mandates?

        1. That is the problem. The law as it is written is horrible and politically unsustainable. But it is impossible to do any kind of partial fix without killing the law entirely.

          The law is going to be repealed either by Congress or by the realities of the market. The effects of it are so bad that Congress is not going to be able to ignore it forever and just pretend the issue is going to go away. But there is no way to fix the law without repealing it.

        2. “How long could plans stay on the exchanges with no mandates?”

          Not long without subsidizing the health insurance industry, but I wouldn’t put it pass Obama to just unilaterally move some money into their hands. Sure the Supreme Court would eventually squash his move, but if he can delay it past 2016, then it might be worth it.

          Then his replacement will just say, Obamacare would have worked, but the Rightwing Nut jobs on the Supreme Court destroyed it.

    2. The trick is to make changes that will subtly undercut the intent of the law, without making it obvious that’s what’s happening.

      See my proposal below to change the “mandatory minimum” qualifying plan.

      1. That is the trick Hazel. Everyone knows the law has to go. You can tell that because the supporters people like Sudderman who specialize in giving warmed over Washington conventional wisdom are so dismissive of it being repealed. They know it is has to go but can’t admit it.

        The trick is how do you repeal it in a way that allows the people who supported it and believed it to retain some dignity and not have to admit to themselves even how badly they fucked up. The “repeal” when it happens will be a bill that repeals it while letting the law’s supporters pretend it was just “fixed”.

        1. Everyone knows the law has to go.

          Not the parade of dolts who parrot the talking points of “the law is WORKING” and “10 million more people now have coverage” which are both bullshit.

        2. Right. The way to go about it is to “fix” it in a way that guts most of the major provisions without obviously appearing to do so. Keep a few token elements to let the law’s supporters save face.

          This shouldn’t be that difficult. The law is sufficiently complicated that hardly anyone is going to understand the impacts of what you’re doing, and those that do won’t be able to explain it to anyone else.

  15. Repeal of ACA is a loser issue for republicans in the absence of defined counter proposal. Has been since they first started screaming about it. I don’t buy, nor do most people, that the previous system with supports and medicare payments and employer plans and $30 co pay for everything is anything like coherent, and it certainly isn’t reflective of limited government influence in healthcare.

    1. Repeal of ACA is a loser issue for republicans in the absence of defined counter proposal.

      The ACA is a cancer. You don’t replace cancer. You get rid of it.

    2. The usual Total State blinders: Its not a reform unless it creates a new bureaucracy with a bigger budget.

      No, flatout repeal is also reform.

    3. Yeah but the counter proposal could be something like repeal coupled with reform of health insurance regs (allowing interstate sales, for one), tax deductions for individual plans, etc., that would represent a smaller-government, free market approach. This is what the Reps should’ve come out with before this dog ever got drafted, instead of just sticking their fingers in their ears.

      1. allowing interstate sales

        I think that “small” change in the law would create huge changes in health insurance and make it cheaper.

  16. They might not be able to repeal the individual mandate outright, but they might be able to amend it to allow bare-bones catestrophic coverage plans to qualify.

    Basically, an individual should be able to avoid the penalty if they have a plan that has a $10,000 deductible and the following 4 of the 10 essential benefits: Emergency room care, hospitalization, labs, and outpatient care.

    1. Unfortunately, that’s just the crazy talk that got us into this mess.

      The idea that someone could buy a high-deductible plan was the very market failure the Democrats are “fixing”.

      1. That’s funny, because the “fix” includes plans with $8K deductibles that cost ten times what one of those icky high-deductible plans used to cost, and they have less coverage.

        1. Right it costs more because the “essential benefits” includes all sorts of things that many people don’t need, like maternity coverage, substance abuse treatment, disability support, and pediatric dental.

          If you think about what that means in the context of community rating. It means that your insurance premiums are going to help pay for a quadrepelegic’s wheelchairs and prosthetics, the welfare mom’s fifth kid, and the kid’s braces, and the drug addict’s trips to the methadone clinic.

          It means that anyone who makes choices that cause them to not need medical care will be paying the same price as all the people who make choices that cause them to need lots of medical care.

          1. We’ve had community rating for a while here in Maine. It sucks. The only bright side is that health insurance here was already expensive, so it didn’t go up as much as in places that did not already have that fucked up rule.

            1. Yes, but community rating doesn’t suck AS HARD if you reduce the essential benefits list to just those things that people REALLY need.

              So it’s socialized payment for emergency room treatment and hospital says, but it doesn’t socialize kids braces and methadone clinics, see?

        2. ” but they might be able to amend it to allow bare-bones catestrophic coverage plans to qualify.”

          I’d add a tax deductible HSA plan to that and you’ve got a winner. Maybe change the employer mandate to “Employer without Health insurance must contribute $1,000 per year to an HSA.”

          1. As long as the HSA money rolls over if you don’t spend it, that could work.
            At my company, if you put money into an HSA and don’t spend it, you just lose it. It’s gone.
            it compeltely fucks up the system.

            I would much rather just have a requirement that you declare X amount of dollars in assets, so you can prove you can cover the deductible.
            Like a car title would be sufficient for many people.
            Worst case scenario, you sell your car to pay the $10K deductible.

      2. That isn’t how it was sold. One of the D’s primary arguments for the mandate is uncompensated care in emergency rooms. If we allow people to buy a plan that JUST pays for emergency room treatment and hospitalization, with none of the other frills the D’s added on, then we take that argument away from them. They then have to make an argument for why people should be forced to buy coverage for psychotherapy and pediatric dental care (when they don’t have kids).

        1. Do remember though that smaller-class-size-like, they’ve completely bought into the magic of preventive medicine.

          They’ve bought into the idea as a matter of undisputed fact: if a doctor is staring up your ass 24/7, your healthcare costs will go down.

          1. If necessary, throw in preventive care then. One free office visit per year.

            My point is, it’s possible to reduce the “mandatory minimum” required by the ACA.
            The R’s should be working to reduce it as much as they can without being vetoed.

            Preferably don’t just chip it down, seize the opportunity to take a big chunk out of it now.

            1. That’s a reasonably pragmatic approach. I’m for it.

              I remain aware that my path of good intentions may lead to a rather hot and unpleasant destination.

            2. What you are basically doing is allowing broader range of plan designs with HDHP + HSA and tweaking the minimum benefit calculations to allow for this coverage design. The HSA regs already have provision for preventive care and it works pretty well. I support this approach. My point is to present the vision of coverage you want and stop repeating repeal in a vacuum.

              1. Yes, that could be a politically feasible compromise.

                I’m not sure how HSAs work though. Some of them seem to be “use it or lose it”, and I don’t like that, as it creates perverse incentives to spend everything in the HSA at the end of the fiscal year.

                HSAs should just work like tax-deductible savings accounts period. As long as you keep enough money in the account to cover the deductible, you should be golden.

                1. Slight detour here: you are confusing Flexible Spending Accounts which were use it or lose it tax advantaged accounts that existed for years with Health Savings Accounts that only became a thing after Bush passed the 2003 Medicare Modernization act. HSA’s are the most tax advantaged accounts in America right now – they are pre tax dollars going in and they come out tax free for qualifying medical expenses. That means principal and earnings are never taxed. To qualify for an HSA, you must enroll in a qualifying High Deductible Health Plan that currently has a minimum deductible of $1,300 (individual). The idea is you use the HSA dollars to fund expenses up to the deductible. The HDHP has a maximum annual out of pocket of like $6,000 per individual, and it is under most plans supplemented with a preventive care plan that is pretty cheap and allows checkups etc for minimal co pay. As a result, the existing HSA regs basically do what you were suggesting above, except you’d want to make sure under reformed ACA you permitted plans with really high deductibles like 10k per individual or whatever you like to consider catastrophic.

              2. I would submit too that this reform would be actually better than full repeal if full repeal would mean return to pre ACA incentive structures. My own preference would be to have mandatory coverage in place, purchased in private insurance markets, with HDHP or catastrophic plus HSA baked in as the form of insurance most people are using, a sliding subsidy for lower income households to purchase coverage of such plans, and if you tell me you need it as a matter of welfare, reforms to medicare that transform it into an insurer of last resort beyond its role in old age care.

    2. A sky high deductible is worthless if the premiums are still high, which is the way it is now. I can get a $6000 deductible plan on the exchange and it would cost me 5% of my income.

      1. That’s gross income.

        1. Er, 5% isn’t that much for health coverage. Most health care wonks talk about things north of 9% cost out of pocket being scary. Individual cases have individual issues of course, and certainly prices aren’t optimal, but premiums have been coming down for a few years and HDHP is way cheaper than low deductible. Way. At a certain point it’s a thing that has a cost and no free lunch etc.

  17. Can’t the R’s just slip removal of the penaltax into any bill that Obama does want to sign, expecting he isn’t going to read it, or it’s something he really wants to pass or look awful vetoing? Then when the tax is gone, file a new lawsuit to SCOTUS. Without the tax, it’s unconstitutional, right John Roberts, you piece of shit?

  18. I want them to keep Obama’s promise by retroactively grandfathering in policies that were canceled this year. Insurance companies will still probably not offer them, but at least they would legally be allowed to.

  19. How can “Obamacare continue to be political poison for Democrats” yet God help anyone that tries to eliminate it or roll t back? .

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