Obamacare

Repealing Obamacare Is Harder Than It Looks

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Whitehouse.gov

Since the Affordable Care Act passed in 2010, House Republicans have taken dozens of votes to repeal the federal health law. For the most part, these votes have been fairly straightforward—symbolic statements of the Republican party's intent to repeal the entire law, full stop. Now that the GOP controls a majority in the Senate as well, plans are in the works for yet another repeal vote, one that, finally, won't be stopped cold by Senate Democrats. But this time around, it won't be so simple.

As a report in Politico notes, the complexity stems from the fact that the Republican Senate will have to use the reconciliation process, which short circuits the Senate's effective requirement that bills pass with 60 votes, and allows for passage with a simple majority.

But there are limits to what reconciliation can accomplish: Namely, the process only allows for the passage of provisions with a direct effect on the budget. Exactly what which provisions are up for grabs is up to the Senate parliamentarian, who doesn't tend to make decisions public without specific legislation. That alone adds a major element of uncertainty to the process, because the Parliamentarian essentially serves as a judge of what's allowable under Senate rules.

What it probably means, though, is that various regulatory provisions—like, for example, Obamacare's rules about selling insurance to individuals with preexisting conditions or requirements that insurers spend a certain amount of premium revenue on medical expenses—won't be on the chopping block. Republicans might be able to repeal some of Obamacare, but probably not all of it.

They might attempt to take out the entire law anyway, however, by making lawyerly arguments to the parliamentarian or perhaps trying to avoid separating out the budgetary provisions altogether. As Politico reports:

A senior GOP aide in the Senate told POLITICO they are considering arguing to the parliamentarian that such provisions actually do hurt the deficit and should be repealable. One potential case they'll make: These requirements drive up the cost of premiums, which are covered by federal subsidies, so they may increase the cost to the Treasury.

Some conservatives and staff in both chambers, like House Freedom Caucus Chairman Jim Jordan (R-Ohio), are urging the chambers to do a straight one- or two-sentence repeal of everything. They argue that the parliamentarian has to look only at the words in front of her during reconciliation and should not be able to force lawmakers to break out the provisions on their own.

These sorts of aggressive appeals—or other more creative tricks—might be worth trying, but they don't seem particularly likely to work. The parliamentarian is not likely to allow Republicans to essentially circumvent the parliamentarian's authority.

And even after all this is sorted out, there's still President Obama's veto pen. President Obama has made it quite clear that he won't agree to repeal any of the law's core provisions.

A Supreme Court ruling against the administration in the King case later this month, which would wipe out Obamacare's private health insurance subsidies in the majority of states, would probably give congressional Republicans some leverage (and also create some additional reconciliation-related complications for Republicans if they want to extend the subsidies at all). But it's not at all clear how much leverage, in part because it's not at all clear what sort of political dynamic would emerge following a ruling against the administration.

So Republicans trying to make headway against Obamacare have to contend with at least three types of highly interconnected uncertainty: what Senate rules—and the parliamentarian in charge of enforcing them—will allow to pass with a majority vote, what the Supreme Court will rule on King, and what sort of political situation emerges following the High Court's decision.

Adding to all of this is that, even after all these years, it seems evident that a lot of Republicans simply haven't thought through the details, in part because they haven't had to. There are definitely some Republican legislators who have worked through the details, but the lack of cohesion, or even a robust debate, when it comes to an Obamacare replacement strongly suggests it's still a minority. For the last five years or so, it's been enough to simply say that Obamacare should be repealed and hold ultimately meaningless votes to do so. That approach may have some political value, but it's not much of a legislative or policy strategy; Republicans hoping to make inroads on health policy need both right now. 

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  1. But there are limits to what reconciliation can accomplish:

    Didn’t reconciliation accomplish the leviathan that is called Obamacare?

    1. Some would say illegally so.

      1. Not the “some”that matter.

        1. It doesn’t matter if the legislative branch abolishes Obamacare or not. The market in the end is going to abolish the monster.

          I just did a check of healthcare costs for my family in CA, and here are the results.

          1) Obamacare – Bronze plan – $13K/yr + $12K dedutible + copays = $25K/yr for health care with a minimum of $15K/yr if we lightly use it.

          2) Non-compliant “short-term” health insurance – $3K/yr + $7.5K deductible + $1K max out of pocket on top = $12K/yr if we use a ton of health insurance, and $~5K/yr at our current usage rates.

          The non-Obamacare plans cost less than the premiums on the Obamacare plans.

          Now if you say “but the penalty will force people onto Obamacare”, well look at the exceptions. ANYONE can get out of the penalty. My favorite is the “utility shut off notice”, just be late paying your water bill, get a shut off warning, and poof, no penalty for 2 years.

          The republicans should simply refuse to change anything, leave the exceptions open and let the short-term alternatives (which are absurdly cheaper) destroy Obamacare. It will happen, and given the prices I’ve seen, it will happen quickly.

          1. The same way “the market” abolished transportation rate schedules for transportation? I really don’t think so. The overlords always have enough money to throw boat rockers in jail.

            1. There weren’t alternatives to the transportation rate schedules though, but there are for Obamacare.

              The ACA is simply a tax on people not in an ACA plan, and rules for what ACA plans are. It is an opt-in process according to the supreme court. This means that they can not outlaw non-ACA plans.

              This provides a market choice. Healthy people will gravitate towards non-ACA plans which are very significantly cheaper than ACA plans (knowing they can switch later if needed). While ACA plans will be loaded with the sickies.

              This is a perfect positive feedback cycle which will make ACA plans more and more expensive against non-ACA plans, driving more and more healthy people off of ACA plans.

              The end result will be ACA plans will only have high expense people, and become both completely unprofitable to insurers and completely unaffordable. At the same time everyone will figure out how to be exempt from the penalty, which the democrats made very easy, because all they ever want to do is give people break.

              The ACA law and benefit will never be abolished, it will simply become a program that no one participates it, insurers will walk and so will consumers as the pools become absurdly expensive.

              The ACA can not function if there are market alternatives for health people and the penalty does not have teeth. Guess what, there are market alternatives and the penalty does not have teeth.

              1. Most people are insured either through their employer or through Medicare, and both of those are deeply caught up in ACA, its pricing, and its regulations.

                1. But they (Employer plans) are not a part of the public marketplace and pricing. Corporate plans may have to be ACA-compliant in terms of what they offer, but employers negotiate rates with insurers which differ from the rates on the public marketplace. Example: My employer pays quite a bit less than what I see in the public ACA marketplace for the same plan, the reason is because my employer’s pool is in general more health than the ACA public pool.

                  The thing to compare are the public markets for individuals. There are 2 public markets, 1) ACA-compliant plans and 2) non-ACA-compliant plans (short-term). The non-compliant plans are drastically cheaper already, and this gap will grow to the point that the ACA-compliant plans will become unaffordable and people will work hard to avoid them.

                  The only way to avoid this insurer death spiral, was to make the penalty have teeth. But the democrats softened the penalty so much as to make it ineffective. The only way Obamacare can work is if you hurtfully tax struggling single mothers who don’t comply, democrats don’t have the stomach for that, and so ACA will eventually fail in the market without a legislative act.

  2. Got to replace it with something! I mean, after you remove a cancerous tumor, you’ve got to replace it with something!

    1. Sutures. 😉

    2. Exactly; I have watched politics since roughly Nixon’s departure, and in that time I notice that Congress doesn’t repeal something that doesn’t work, it replaces it. And when it enlaces it it has been my impression that the removal of the previous layer of legislation and regulation is most often imperfect. So any problem that Congress is likely to consider serious ends up a mass on partly removed and then papered-over bandages. And so we frequently have little or no idea what is underneath the bandages.

      I would like to see the nitwits in Washington dig all the way down to bedrock and then sit back for at least five years to see what happens. I would also like to be able to fly like a bird. I think that latter dream is somewhat more likely.

      1. Unintended consequences of shitty legislation beget more shitty legislation with unintended consequences that beget more shitty legislation with unintended consequences, with the logical conclusion being a totalitarian state.

        1. You’re just being ..sarcastic…or something.

          Be part of the solution, not the problem.

          Forward !!11!1

    3. Replace it with a law that allows selling insurance across state lines, repeals all other federal regulation of health industries, including employer tax breaks, and includes some amount of tort reform.

      Hell they could just pass this law, without repealing Obamacare and it would do a world of good. It might even make Obamacare sustainable.

      1. No, it wouldn’t.

        It would make it work for longer but in the end it still wouldn’t be sustainable because the socialized medicine nutjobs have it exactly backwards. We don’t need to subsidize health care becuase it is a special class of service, we can’t subsidize it for that reason.

        See, the problem is that Obamacare doesn’t actually sell insurance, in fact it specifically makes it illegal to sell health insurance by outlawing differential pricing based on existing conditions and compelling coverage of known costs. Insurance is specifically a hedge against risk, so covering your annual physical, or your birth control usage, or a pre existing condition means that there is no risk so you don’t have insurance you have a prepaid medical plan.

        Now, there is nothing inherently wrong with a prepaid medical plan, the problem is when you try to make the costs of such a plan the same for everyone regardless of their usage of it you strongly encourage overuse and the one area that medical coverage is special is that there is no limit to how much of it people will want because people want to live forever and be able to do whatever they want without any long term consequences.

        1. But it is not illegal to sell non ACA health care plans. They are now called short term health insurance. Look them up and compare the rates to obamacare rates.

  3. I dunno, Petey. It looks pretty fucking hard to me.

  4. “Don’t end it, mend it!”

  5. Repealing Obamacare Is Harder Than It Looks

    Obvious article title is obvious. Pretty hard to find a single example of an entitlement that has been contracted, much less eliminated after the teet starts producing that delicious milk.

    1. CONRAIL, Resolution Trust Corporation, some Electrification Commission too IIRC.

      1. Those are pretty narrowly focused. If there’s one thing pols are good at it’s throwing a minority under the bus for political gain.

  6. Posted this last night during the witching hour. Might deserve another volley:

    Bad news, Seattle smokers. The city has decided not to fine you $27 if they catch you puffing away on a cigarette in a city park.

    Why is this bad news? Because they’re replacing the fines with something more painful: Lectures.

    […]
    Now instead of that we have as official city policy something called “de-normalization.”

    “Why a smoking ban?” asks a memo from Seattle Parks and Recreation. “It is about de-normalizing tobacco use, especially for young people.”

    De-normalization, as one researcher described it, is the use of rules to put societal pressure on “those who fail to aspire to a specific preferred image of the future self.”

    http://www.seattletimes.com/se…..oking-ban/

    1. smoking is bad, mmkay?

    2. That New Soviet Man ain’t gonna build himself ya know!

    3. How much is the fine for skipping the lectures?

      1. Probably less annoying than the constant flow of stop smoking ads we get on the TV here.

    4. Are the lectures non-smoking?

    5. Eliminate those cigarette cravings with new G-27 Paxalon Hydro Chlorate

      Guaranteed to eliminate ALL cravings*

      * In a small number of cases certain mental side effects were noted

  7. it’s not at all clear what sort of political dynamic would emerge following a ruling against the administration.

    Sheesh, it’s not at all clear what sort of political dynamic would emerge following a ruling *for* the administration.

    1. Just more of the same: words mean what we say they mean, no matter what the words actually say.

  8. It’s simple but hard.

    Simple to pull the whole thing down, cut all the funding, and fire everyone involved.

    Hard because it would take balls and maybe cost a few political careers. Republicans are known for noisy surrenders, not gutsy moves.

  9. Uh, no it’s NOT. The ACA was never a “law”, or a “tax”. A “tax” must originate in the house of “representatives” NOT the white house. The second problem with the ACA is that the stupreme court CAN’T legislate a “tax” from the bench. The third problem is “if any part of a contract is fraudulent, the whole contract is NULL AND VOID. The ACA was sold to the American people on LIES and false promises. VIOD. Here’s an example: “If you like your doctor, you can keep your doctor” and “If you like your plan, you can keep your plan”. No law may interfere with the obligation of contracts, strike four.

  10. . . . and it’s a long way to the top if you wanna rock’n roll.

  11. Google pay 97$ per hour my last pay check was $8500 working 1o hours a week online. My younger brother friend has been averaging 12k for months now and he works about 22 hours a week. I cant believe how easy it was once I tried it out.
    This is wha- I do…… ?????? http://www.jobnet20.com

  12. This sounds like it’s coming from these “REPUBLICAN QUISLINGS”. Why is it so “HARD” to get rid of OBAMA CARE? Oh, they are worried about the 3, or 4 or even 7 million people that have signed up for OBAMA CARE? I noticed that they didn’t worry about the 84 million people that lost their medical insurance, when OBAMA CARE became law? None of these “QUISLINGS”, worried, when OBAMA lied through his teeth, when he said that “IF YOU WANT TO KEEP YOUR DOCTOR, YOU CAN KEEP HIM”, and another lie “IF YOU WANT TO KEEP YOUR COVERAGE, YOU CAN KEEP IT”. This OBAMA CARE was given to us through a lie, or lies. I always thought that when any one signs an agreement, and that agreement was based on a lie or lies, that agreement is declared NULL & VOID.

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