Obamacare

Rand Paul May Disrupt the GOP's Terrible Plan to Repeal and Delay Obamacare

The Kentucky senator says he doesn't support a rollback of the health law without a replacement in place.

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CreditTrey Kennedy The Photo Access/Newscom

When the year began, Senate Majority Leader Mitch McConnell's number one priority was to quickly move forward with a plan to repeal Obamacare—but in a way that delayed the repeal while the GOP settled on some sort of replacement plan.

That plan came with many potential pitfalls, and now it looks as if it may not work out after all—thanks in large part to opposition from Sen. Rand Paul (R-Kentucky).

McConnell's intention was to use the reconciliation process, which allows the Senate to pass certain types of bills that are directly relevant to the budget with a simple majority, to strip out certain key components of the law, including its individual mandate, taxes, and insurance subsidies. Those changes, however, would not go into effect for somewhere between two and four years. During that time, the hope was that Republicans in Congress would finally work out some sort of replacement plan.

The problem with this plan was that it was bound to create uncertainty and disruption in the individual insurance market. And Republicans, who have failed for years to unify around a replacement plan, might never actually coalesce around an alternative, leading to more instability and the possibility that the delay would be extended for years.

Last week, however, Rand Paul declared that he opposed repeal without a ready substitute. "I think it's imperative that Republicans do a replacement simultaneous to repeal," he said on MSNBC.

Paul now seems to have support for his position from none other than President-elect Donald Trump. Paul said today that he received a call from Trump indicating that the incoming president supported a simultaneous repeal and replacement. "[Trump] called after seeing an interview that I had done [talking about] that we should vote on Obamacare replacement at the same time," Paul told Politico.

Paul isn't the only GOP senator to express wariness about the repeal and delay plan. As Politico's Dan Diamond noted this morning, Sens. Lamar Alexander, Susan Collins, Bob Corker, and Tom Cotton have all warned of the perils of repealing the law without a replacement. Given how slim the GOP's majority is in the Senate, that's potentially enough votes to put the brakes on any repeal and delay legislation. Trump siding with Rand Paul on the necessity of a simultaneous replacement makes McConnell's original strategy even more difficult.

That's presuming, of course, that this is what Trump actually believes, and that his administration would actually oppose repeal and delay legislation. Senior Trump aides Kellyanne Conway and Reince Preibus hedged on that point when asked on CNN, declining to commit to any particular course of action.

So it's still not entirely clear where the Trump administration stands on the repeal process. And even if they did back Paul in insisting on a simultaneous replacement, it's not clear how that would work out either. Republicans in congress have had years to unify around a replacement plan, but have never been able to do so. When pushed on the question, Mitch McConnell's office is being tellingly vague about what a replacement might entail.

Rand Paul is right to worry about the political and policy problems with the repeal and delay strategy, and one hopes that his stance will force other congressional Republicans to finally do what they have so far refused—and actually commit to wrestling with difficult questions about what their health policy goals are and what sort of tradeoffs they are willing to accept.

NEXT: Not All Interests Are Conflicts

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  1. I’m going to have to disagree with Rand on this one. Nothing is definitely a large improvement over the ACA. And anything that the government does will be just as bad or worse. Get government out of healthcare.

    1. Yes, Rand is fucked in the head. Government should have NO health insurance laws. What is he thinking?

      1. That they arent getting rid of ALL of the ACA, and it doesn’t go away for 2-4 years anyway. So, that is worse than

        1. A replacement
        2. Actually getting rid of it.

        1. What he said — the repeal plan isn’t even going to repeal everything, only the parts they can do with reconciliation. Obamacare is fucked up enough without repealing some bizarro half of it and leaving a different bizarro half in place.

          If repeal without replacement were in the works, ie just get the government entirely out of it, or at the most make personal health insurance (not assurance, John) as tax deductible as it is for employers — that would be fine. But repealing half alone is a worse disaster than what it is now.

          1. still going on this crap? Again google the damn definition. We have insurance here not assurance

            in?sur?ance
            in?SHo?or?ns/Submit
            noun
            1.
            a practice or arrangement by which a company or government agency provides a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium.
            “many new borrowers take out insurance against unemployment or sickness”
            synonyms: indemnity, indemnification, assurance, (financial) protection, security, coverage
            “insurance for his new car”
            2.
            a thing providing protection against a possible eventuality.
            “adherence to high personal standards of conduct is excellent insurance against personal problems”
            synonyms: protection, defense, safeguard, security, hedge, precaution, provision, surety; More

            as?sur?ance
            ??SHo?or?ns/Submit
            noun
            1.
            a positive declaration intended to give confidence; a promise.
            “he gave an assurance that work would not recommence until Wednesday”
            synonyms: word of honor, word, promise, pledge, vow, avowal, oath, bond, undertaking, guarantee, commitment
            “you have my assurance”
            2.
            confidence or certainty in one’s own abilities.
            “she drove with assurance”
            synonyms: self-confidence, confidence, self-assurance, self-possession, nerve, poise, aplomb, levelheadedness; More

        2. yea i dont get how having parts of it is better than not having it….a bad regulation is worse than no regulation -_- dear lord i hate humanity

      2. Nice jumping to conclusions. Better HSA accounts are one thing that could happen (tax free). Yeah that’s “fucked in the head” .

    2. It’s not “nothing.” It’s removing a chunk of law, leaving the rest in place, with promises that some new law will be implemented soon. That may still be preferable to allowing PPACA to go on for another year or two, but it’s not a simple scenario.

      1. The problem as I see it is that in American politics you have a short window after a new President is elected to make major policy moves. There’s a reason Obama did OCare first thing. If it isn’t attacked now in the opening days of the Trump administration, it will go nowhere. We have a window of opportunity that will close soon. If we fritter that window away trying to come up with the thousand page replacement for OCare, we’ll have OCare forever.

        Why the Repubs are so feeble they can’t pass a one-page law, repealing the entire thing effective, say, January 1, 2019, I don’t know. Failing that, a partial repeal is better than no repeal, even if they are keeping the stupidest parts.

    3. Shorter full agreement version:

      REPLACE IT WITH NOTHING YOU TARD!

    4. Get government out of healthcare.

      Nice slogan but its meaningless until you can actually come up with both a)an alternative to Medicare and b)financing any transition to the tune of tens of trillions.

      Because there is no such thing as a solution unless everyone agrees to get screwed in the short-term

      1. Alternative to Medicare? Uh, no. Medicare needs to die.

    5. Nothing is definitely a large improvement over the ACA

      It would be. But “nothing” is not what we’re talking about. What the GOP is talking about is stripping out the funding and some of the mandates, while leaving most of the rest of ACA in place, and that’s probably even worse than the ACA.

      The sooner they can get rid of the ACA turd the better. But they should take a few months at least to work out a feasible alternative.

      If the alternative is “turn it into a fully free market”, they also need to come up with some transition, because a fully free market in health care (I have lived in some and they do work) requires decades-long, binding contracts in order to cover the elderly and the sick, which simply don’t exist right now.

  2. The Reps had 6 years to work out an alternative to Obamacare. They didn’t because that would involve hard choices, and if they believed in making hard choices they wouldn’t be squishy RINOs.

    1. Once you start laying out specifics you’ll lose support. Like almost all politicians they’re gutless.

      1. I get the political reasoning behind not laying out specifics publicly during campaigns, but you can’t draw something specific up behind the scenes and have it ready?

        1. Based on what Republicans have been doing since talk on the ACA was first started in 2009? Nope, you can’t.

    2. They didn’t because that would involve hard choices

      Well, and there was no need to since it didn’t look like they were going to win. Now they’re in charge and they have to deal with it. And kicking it along to the next election isn’t an option because they’d get punished harshly. So they better come up with something decent quickly.

      That’s a good situation for the country, in case you were wondering, because for the first time in a long time, someone actually has the incentive and power to deal with health care.

    3. They didn’t because that would involve hard choices

      Well, and there was no need to since it didn’t look like they were going to win. Now they’re in charge and they have to deal with it. And kicking it along to the next election isn’t an option because they’d get punished harshly. So they better come up with something decent quickly.

      That’s a good situation for the country, in case you were wondering, because for the first time in a long time, someone actually has the incentive and power to deal with health care.

  3. Just repeal it and then write this on a piece of paper: FREE MARKET. Done.

    1. I’m exceedingly disheartened that the one GOPer that I would expect to step up and say “It is broken. So, maybe there are parts that we aren’t gonna replace.” seems to be all in for any fix that can be found.

      1. Once the government has their nose in something, they never get out. Too much power and cronyism in it for all of them. Same reason the drug war will never end no matter how much of a disaster it is.

        1. ^This. [weeps]

    2. There will never been a free market in healthcare as long as Medicare is the 800lb gorilla.

      1. There CAN never be a free market in healthcare because

        a)there can be no competition at the true point-of-purchase
        b)there is massive information asymmetry
        c)any attempt to control costs requires YOU giving someone else control over your own life/death decisions

        There is a reason that there has never been a true free market in healthcare – in any country on Earth.

        1. There CAN never be a free market in healthcare because

          Lots of places in the world have free markets in healthcare. Usually, it’s a combination of fee-for-service and catastrophic free market insurance. It’s no harder than a free market in anything else.

          1. Lots of places in the world have free markets in healthcare.

            Should be easy for you to name one then.

        2. What’s the fallacy for defining the opposition out of existence? Because you just committed it.

          You can have a free market without total information. When you buy a car, you don’t know if it’s a lemon.

          You do currently have competition at the point of purchase, though perhaps not through insurance. Some people do purchase care without insurance, or in some sort of non-insurance agreement.

          Costs don’t need to be “controlled”, as the free market is better at that than literally anything at all.

          For goodness’ sake, go read some Hayek or Mises!

          1. When you buy a car, you don’t know if it’s a lemon.

            Nevertheless, you still know you are buying a car and what to expect from a ‘non-lemon’ car. A patient doesn’t even know what they have until they have purchased a medical diagnosis. and they can’t really know what they want (re course of treatment) even after they have paid for a diagnosis.

            You do currently have competition at the point of purchase

            Yeah sure. Next time you are bleeding profusely or unconscious or have Alzheimer’s (or have ANY of the symptoms that constitute ‘hmmm maybe I need to go to hospital’), try going shopping for medical care.

            Costs don’t need to be “controlled”, as the free market is better at that than literally anything at all

            You are now just assuming the conclusion. There is no example of a free market in healthcare ANYWHERE IN THE WORLD. There never has been. You are just assuming it into existence – and then assuming that it will work because – slogan. And no cosmetic surgery is not comparable to medical care precisely because its easy to walk away from cosmetic surgery and be a non-consumer of it.

    3. problem is repealing Obamacare does not repeal the dozens of other Federal laws or the hundreds of State and Local laws that prevent anything remotely resembling a Free Market in Health Care from arising and honestly it is not hard to argue that a simple repeal of Obamacare, especially a partial one would make the situation worse not better.

    4. Just repeal it and then write this on a piece of paper: FREE MARKET. Done.

      Golly. And libertarians wonder why no one takes them seriously. You even forgot the magic fairy dust to scatter over the paper

    5. Doesn’t work. The government made long term commitments to people for providing health insurance and maintenance. Generally, once you break a free market, it takes decades to recreate it again.

      For healthcare, what they roughly need to do is:

      – transition from employer tax breaks to individual tax breaks
      – create standard legal frameworks for long term private insurance contracts
      – reduce licensing/regulatory hurdles for medical providers
      – transition Medicare/Medicaid to a purely means-tested system of last resort that provides only the most basic services/drugs
      – move everybody who falls through the other cracks (due to preexisting conditions, poverty) onto Medicare/Medicaid

      Probably the most important delusion the government needs to dispel is the view that medical decisions are independent of money. If you don’t have an expensive insurance plan, expect long wait times, limited choice of drugs, and having costly and risky procedures denied.

      1. Probably the most important delusion the government needs to dispel is the view that medical decisions are independent of money.

        It isn’t govt that needs to dispel that. You do. And good luck with that

  4. They should have a plan already. Rand Paul 2020 or 2024.

    1. Rand Paul 2020 or 2024.

      Paul/Weld 2020 – We know where Aleppo is.

      1. Maybe we should just shower up a hobo and run him.

        1. that was johnson’s problem…..he didn’t take a shower first.

        2. Didn’t we try that twice already?

        3. Wait, I’m runnig in 2020?

      2. The best the Libertarian Party will ever do in a Presidential race is be a spoiler.

  5. RE: Rand Paul May Disrupt the GOP’s Terrible Plan to Repeal and Delay Obamacare
    The Kentucky senator says he doesn’t support a rollback of the health law without a replacement in place.

    Welcome to the GOP Senator Paul now that you approve of government healthcare.
    What are you going to wish for next?
    More money for the Pentagon, more leeway for the government in asset seizure laws, more licensing approval for the state?
    The more the politicians stay in DC, the more they become one in mind, heart and soul.

    1. If you think Rand has been corrupted by DC or the Republicans, you need to watch the speech he gave on the Senate floor on the 4th of this month.

  6. The problem with this plan was that it was bound to create uncertainty and disruption in the individual insurance market.

    Overstated. Policies are set a year in advance, and change every single year, as to both benefits, providers, and premiums. The regs change constantly, at both the state and federal level. OCare as it is, is a source of uncertainty and disruption. Telling the industry that the rules will change again in a few years is like telling them the sun will come up in the morning.

    I think “repeal now, replace later” is the only way to get it done. Trying to do it simultaneously will lead to it getting bogged down and dying, year after year. Repeal, effective in two years, gives a hard(ish) deadline to replace – if the Repubs are afraid of their replacement plan being unpopular, they will be more afraid of extending OCare.

    1. Clicked too soon.

      And, who knows? With repeal out of the way, people may realize there’s no need to replace.

      1. Why would there be a need to replace? It was much better before. And there’s no way I’m going to believe that anything the government does will improve anything, regardless of which side of Team Purple does it. Anything they do will be an unmitigated disaster, just like the unmitigated disaster we already have.

        1. Why would there be a need to replace? It was much better before.

          And everybody knows it. We don’t have the same up-to-the-minute polling that we had coming into Nov. but it’s generally less popular than Trump.

          Maybe they’re waiting for the people who gained coverage to die so that they aren’t actually taking anything away from anyone?

    2. If it was actual a full repeal now (even with a delay) that might be okay. But partial eventual repeal is a horrible procedure.

    3. Except it does no such thing.

      You are talking about a Republican Congress that routinely votes to raise the debt limit rather than tackling the hard questions of entitlement reform and fixing our structural deficit If you think for one second that a “deadline” of 2 years would spur McConnell and the rest of the Republicans into actually dealing with health care you must be living in Colorado because you’re higher than a fucking kite.

      That deadline will come up, it will get pushed out a year, and then it will get pushed out another 2 years so it doesn’t interfere with the election and then the repeal bill quietly gets killed by a Democratic majority.

      No the only way to actually get rid of Obamacare is to not even repeal it. repealing it is utterly unnecessary, you simply superseded it with a new law that does as much as it can to fix all of the other problems introduced into our health care system by government interference. Yes, that law would have provisions within it that repealed specific sections of Obamacare but a separate vote on repeal is a waste of time that accomplishes nothing whatsoever.

      Paul is right, we need to stop coddling the Republicans and letting them take meaningless half measures for political gain and force them to actually take a stand and accomplish something or else suffer the fate they so richly deserve

      1. You are talking about a Republican Congress that routinely votes to raise the debt limit

        And not just a little bit. It’s not “we’ll let you spend $200 billion more than revenues this year, but we won’t revisit the issue again until 12 months from now”, it’s “we’re not going to attempt even a semblance of discipline whatsoever about keeping debt growth restrained”.

      2. You may be right, Rasilio. I think you are overestimating the willingness of Repubs to “save” OCare by extending the repeal, which would be electoral suicide for many of them. But I think its highly unlikely that the Repubs would pass a new law comprehensively addressing the “problems” in health care financing in the window of opportunity that they have. Meaning, its more likely that OCare will continue ad infinitum if we hold out for a comprehensive fix, than if we take an axe to it at the first opportunity, which is now.

      3. Previously House Republicans had the excuses of a Senate that could filibuster anything, a President who would veto anything they wouldn’t, and a media/public freakout (Hi Peter!) should any sort of “shutdown” be even contemplated.

        Which tended to make laying one’s cards on the table an exercise in futility.

        Will they find some other excuse now that those issues will largely be reduced if not outright eliminated?

        Time will tell.

        1. That’s one thing about getting rid of the filibuster. It can’t be used as an excuse anymore.

    4. That only works if you’re repealing the whole ugly monster. This piecemeal bullshit guarantees that nothing actually gets resolved.

    5. RC Dean has it right.

  7. What the hell’s wrong with repealing it and replacing it with whatever it was we had before? If you’ve got problems with what we had before, fix those problems. You’re taping paper wings on a monkey and when it don’t fly, trying to figure out if you need a different kind of tape.

    But, of course, this just shows that Obamacare did work splendidly as intended – the primary purpose of it wasn’t necessarily to “fix” the healthcare delivery system, it was to create a government-run system to fix the healthcare delivery system and a widespread acceptance of the idea of a government-run system.. As Pelosi said, “We have to pass the bill in order to see what’s in it”. That’s because what was in it didn’t matter, as long as you’ve established the idea that it’s the government’s job to Do Something, you’ve already won the war.

    1. “You’re taping paper wings on a monkey and when it don’t fly, trying to figure out if you need a different kind of tape.”

      This is what government does best.

    2. OCare *was* the fix to the problems with what we had before.

      Now imagine what the fix to OCare will be like.

    3. You’re taping paper wings on a monkey and when it don’t fly, trying to figure out if you need a different kind of tape.

      The best analogy I’ve heard is “like trying to fix the cracks in your piggy bank with a hammer”.

    4. What the hell’s wrong with repealing it and replacing it with whatever it was we had before?

      Because what we had before relied on plans and providers that don’t exist anymore because ACA killed them. That is, if you just get rid of ACA now, many people who had insurance before ACA might not be able to get insurance again. Worse yet, providers probably aren’t going to believe that the current situation would last for more than a few years, because Democrats will likely mess with this again down the road, so they wouldn’t invest in this market again.

  8. Very disappointing. He’s as pathetic as this alt-text.

  9. 1. Since when does Rand Paul have enough support from the rest of the GOP to effect jack?
    2. Get rid of this monstrosity right now. It’s probably the major reason the GOP won control of Congress.
    3. Government interference is what’s wrong with healthcare in the US. You don’t fix that problem by tinkering with the shape of the interference, you fix it by getting rid of the interference.

    1. Since when does Rand Paul have enough support from the rest of the GOP to effect jack?

      The Repubs have a two vote margin. Rand is half that margin. That gives him a lot of leverage. One other Repub rolls over, and OCare is safe from repeal.

      1. Fair enough, assuming zero Dem votes, which I think is unrealistic. Dem senators up for reelection in two years have no incentive to block popular will on Obamacare, now that Obama is gone. Not one is going to risk losing reelection to preserve Obama’s “legacy”.

        1. If Paul and another Senator flip on this, saving OCare becomes “bipartisan”, and the law is thereby further insulated from any attack.

          1. Eesch, that’s a scary way of looking at it. I hope you’re wrong, that the bipartisan mandate is to fix the law. Do all that i prescribe, but keep the name ACA or Obamacare. Let the Dems keep credit, if it actually makes things better.

      2. I trust Rand Paul more than most members of Congress to actually get something good (for other than himself) in exchange for his vote, so this is not necessarily a bad thing.

  10. Rand Paul: another example of why The Deplorables rejected Republicans.

  11. If anybody other than Rand Paul was saying what he’s saying Reason would attack him for it. If what we have under the law is worse than what we had before then what’s so terrible about repeal? If we need a law to replace the repealed ACA (we don’t in my view) it can be hammered out and voted on later.

    Also, what’s up with the Republicans bitching about this law for the past 6 years and having nothing ready to replace it with? Goddamn are they incompetent.

    1. Not really, Suderman has been pretty consistent about this (and is often criticized by commenters here for it).

      Full-on repeal and delay is one thing. But the proposed law repeals parts of it, leaves other parts in place (some of which would be much more damaging in isolation compared to being part of the law as a whole) and then the GOP, as you allude to, apparently have nothing to offer up as the replacement that they’re promising to implement at some point in the future. That’s just a bad combination.

    2. They actually do have plans for replacement. What’s his ass nominated for HHS had a pretty good plan, IIRC.
      But the media has found their story, and neither heaven nor hell will get them to change it.

      1. If it doesn’t meet their criteria it’s not a “plan.”

  12. What’s the point of *replacing* it with something? That something will be just as bad as what’s there now, if not worse.

    The problems with healthcare financing lead back to market distortions from government intervention back in the *1930’s*. Just get rid of the interventions and let things sort themselves out.

    1. Yes but getting rid of those interventions going all the way back to the 30’s would be the definition of replacing it.

    2. What’s the point of *replacing* it with something?

      Well, you have to replace it with something even if that something is “nothing” or a “free market” or “ACA-without-X”, where “X” is some random collection of provisions.

      What Paul and Trump are saying is that “ACA-without-X” is not a feasible replacement for ACA, we need something different.

      The best thing we can hope for is a replacement of ACA by “free market-with-well-defined-transition”.

  13. Repeal it, replace it?! Now?! But good god, man – you’ve got to give them time to get their investment portfolios re-organized first!

  14. WTF doesn’t Rand and his ilk have the guts to say:

    Repeal, yes.
    Replace? Unnecessary.

    Healthcare is not a right, therefore the government has no business coming up with any kind of plan. It’s similar to coming up with a plan to ensure you pay your weekly grocery bill.

    1. But what they call “repeal” right now retains most of ACA, pre-ACA regulations, and Medicare/Medicaid; it’s not actually a repeal or a free market.

      1. And currently the repeal is part of a budget continuation bill that would increase the federal deficit by another $10T dollars……the real reason Rand is opposed. See his speech last week.

  15. Rand is right. The ACA destroyed whatever freemarket system we used to have. People lost their former plans and now are forced into the crappy ACA plans. Many have insurance now for the first time ever. Repealing the law with no replacement would cause some people to lose their insueance and could quite possibly destroy the insurance industry. This is, of course, what the Democrats wanted in the first place. They created the law to fail, and fail so badly that the only way to fix it is with a full, single payer replacement.

    1. The insurance industry would survive a repeal; its not repealing it that’s going to kill them, because the insurance company cross-subsidies expire soon.

    2. Nonsense. Repeal Obamacare completely, then get rid of regulations keeping people from buying across state lines, and expand Medicaid/Medicare to cover anyone who cannot get private insurance- which is all that ever needed to be done to gain Obama’s stated goals.
      Then, change the health insurance tax credit to apply to individuals instead of employers.
      Those few actions alone would usher in an era of lowering costs and improved access.

      1. Nonsense. Repeal Obamacare completely, then get rid of regulations keeping people from buying across state lines, and expand Medicaid/Medicare to cover anyone who cannot get private insurance- which is all that ever needed to be done to gain Obama’s stated goals.

        Sounds good. I think that’s what people mean by having a plan for “replace”.

    3. Many have insurance now for the first time ever.

      Well, they have Medicaid, anyway.

      Repealing the Medicaid expansion would put millions of people without Medicaid. Whether that’s substantial for them or not is more of a case-by-case matter. Many went without Medicaid before because they saw no benefit to it. Many had private insurance but lost it due to all the other ACA provisions. Some, probably a nontrivial percentage, neither qualified for Medicaid before the ACA nor had private insurance (or their coverage was spotty). The question remains, though, how many of them are actually using it. The ER doesn’t require Medicaid or insurance and no public ER has been able to demand payment upfront since the 1980s when EMTALA was passed.

      Soon enough though the bill for the Medicaid expansion will fall mostly to the states (at least, those who decided to adopt it). That means it’s not really necessary to gut it at the Federal level. Maybe just let it wither and die on the vine as states realize they can’t afford it. Keeping the Medicaid expansion might not qualify the resulting situation as a “full repeal” technically, but is probably the most politically feasible option.

      1. Let’s not forget that all subsidized plans are a form of welfare too.

        So none of them have “insurance.”

        1. Well, it’s still insurance (inasmuch as any of it is), they’re just not paying for their own coverage. But you’re right, the subsidies are as much welfare as Medicaid is.

  16. Useful idiots are useful to progressives.

  17. Go on now?! But dahling, I cahn’t go on now!

    These rustlings of discontent you hear are the sounds of the GOP changing into their Washington Generals uniforms.

    The road goes on forever and the Party never ends!

  18. Hey Peter!

    Please describe what parts of the would effectively survive repeal through reconciliation? The key world here is effectively. I will await your next article. Thanks!

    1. What Senate Republicans have taken this to mean is that they can repeal Obamacare’s tax and spending provisions?namely its insurance subsidies and the individual mandate, which the Supreme Court ruled was a tax?but not its insurance regulations. Those regulations include provisions requiring insurers to sell to all interested parties and restricting them from charging more to individuals with preexisting conditions.

      At least that’s the senate leadership’s plan.

      However, Michael Cannon of the Cato Institute and Paul Winfree of the Heritage Foundation have made a strong argument that the insurance regulations could be repealed through reconciliation as well, because, as the Obama administration has argued in court, those regulations are inextricably linked to the rest of the law. So far, though, Republicans in Congress have shown no interest in pursuing this argument.

      Seems to me they should at least try a wholesale repeal first. If it gets shot down they’re no worse off for having tried it. Can’t they also tie the repeal to the budget? Let the Democrats shut down the government if they really want to save Obamacare.

      1. And I know some people say the community-rating provisions are way too popular to be repealed, but they’re only popular in the most abstract sense. The concrete effect of raising plan costs for 90% of insureds is the main reason Obamacare is on the chopping block at all.

        Killing these provisions now will piss off those who directly benefited from them, but they’re way outnumbered by people who’d see their premiums go down.

  19. You’d think Rand Paul of all people opposing the current repeal proposals would cause the commentariat around here to realize that, hey, maybe creating a free market health care system in a way that doesn’t immediately immiserate millions of people (which would generate a corresponding massive backlash against free market solutions) is a little more difficult than just pushing a button that says, “Repeal Obamacare,” but apparently that was too much introspection to hope for….

    1. We can’t throw out the British! Who would replace the monarchy?

      1. *Sigh* Can you really not see how causing millions of people to lose access to health care in the short run on any terms that they can afford would generate a little bit of backlash that pretty much guarantees the whole thing would be reversed in the next electoral cycle? Creating a free market health care system on terms that the majority of the electorate will accept is going to require a multi-year transition process. Otherwise you’re going to have a massive wave of personal bankruptcies, photogenic children and other sympathetic-looking people dying horribly, elderly people forced to move in with their families, etc. While we can debate the moral acceptability of those consequences relative to continuing the present system, the vast majority of voters most certainly aren’t going to give a shit about that and will instead slaughter at the earliest opportunity whatever political party they deem responsible for creating the situation.

        1. Makes sense, JGalt1975 … but they have no idea how to do a phase-in, and they’ve already sold out to vote-pandering by promising to repeal ONE mandate but continue the OTHER mandate on pre-existing condtions — thus confirming their fucking stupidity on health insurance. That would OBVIOUSLY skyrocket premiums even worse that Obamacare! duh.

          Look how Dibya fucked up Medicare even worse, also pandering for votes, created trillions of more middle-class subsidies … then lost the White House and entire Congress. So they need MORE looting!

          And how refreshing that my cousin realizes that this is still a Constitutional Republic, instead of Rule by Bellowing.

    2. Partial repeal is being opposed due to it not removing the insurance regulations while getting rid of the parts of the law that subsidise the insurance companies, speeding up the death spiral in PPACA-compliant plans. And it delays all those changes by a few years, just because.

      A partial repeal (especially if it leaves those provisions in place) isn’t much of a “Repeal Obamacare” plan except in name..

      1. Partial repeal would have to be honest, so no hope. For example, switch the pre-existing mandate to high-risk pools .. so politicians take the cost to taxpayers, instead of forcing everyone else to pay higher premiums in the exchanges … which are subsidized by taxpayers! duh. Taxpayers pay either way, but get the costs honest.

        The biggest saving by far is to throw out the Medicare vouchers promoted by phony free-marketers Ryan and Cato, which increase competition in the wrong market! Insurance isn’t healthcare, so they’re both a crazy as progs. We’ve always had competition in Medicare, but seniors have no skin in the game. Give seniors the tools and information, pay them a percentage of what they save.

        Cato and Ryan are crony capitalists to goobers on the right. Insurance companies LOOK like privatizing, but — ask even a high school accounting sudent — they add a costly middleman between the government and providers … and enrich the insurance industry! The moral and intellectual bankruptcy of fiscal conservatism. And libertarianism.

    3. While your heart is in the right libertarian place, you underscore why the strategy of the left is so successful. All you need to do is slime some/any little government wet dream into the regulatory zeitgeist and it never, and I mean never, shall be undone. There ain’t nothing so permanent as a temporary government program.
      “Hell, we can’t go backwards now! Think of the disruption and the backlash! So maybe, uhh, maybe we can just reform it, improve it, modify it….”
      And the left laughs all the way to the next committee session.
      It has and always shall be a bullet-proof, long term, political strategy.

      1. And the left laughs all the way to the next committee session.

        And because you have no alternative. Ridicule is not a viable option

  20. “The problem with this plan was that it was bound to create uncertainty and disruption in the individual insurance market……”

    An unconscionable statement and reflective of the statist-compromising mindset that this site has become. But it is welcome, so that the commentariat and true libertarians can see what they’re up against, Such na?vet? and government-expanding promotion is deserving of the publisher’s boot. But the whole damn staff has caved and regressed into moderate, New Democrats or establishment, secular Republicans. Suderman and his ilk are the best friends of big government and clumsily prove the success of progressive strategy. Incremental expansion of power, small or large, seduces every damn one of these so-called right-of-center pragmatists. He and the rest of Reason are easy game for the statist. Just squeeze in a simple regulation or two (never mind the unconstitutional ACA grandiosity) and once codified into law, these sheep won’t dare challenge the precedent nor espouse any faith in a laissez-faire institutional environment.
    Suderman does not believe in markets. No, the managed market under the grip of every ego driven regulator is not a market, so he can stuff his apologetic rationalizations for leviathan. He does not believe in liberty. He does not believe in diminishing the size of government. He is, and generally always was, a dupe for the establishment. He’s scared to death of freedom.
    At least he’s outed himself once and for all.

    1. Reflective of the statist-compromising mindset that this site has become

      Easy to say when you have no understanding of the issue … and not even the hint of an alternative.

      Such na?vet?

      Can you get beyond rock throwing and state a viable alternative?

      At least he’s outed himself once and for all.

      Which outs your own much larger failure.
      My patents raised me to never criticize anything or anyone without offering a better alternative. It’s called personal accountability.

      What do YOU suggest? Be specific.

      1. “Easy to say when you have no understanding of the issue ….”
        Heh, heh… we’ll just leave my profession out of the discussion for now.

        Do you have any comprehension of my post? Do you even get the point?
        The precedents over a hundred years of physician-patient relationships, and the regulatory contortions provoking the perversion of this once noble market, have ended “alternatives.” And it goes for the underwriting industry as well. This is the statist strategy. Set the precedent for control and any further modification is yet another layer of control.
        Can you even fathom the observation that there is no appetite for a market, including associated, evolving, informal and formal institutions that can oversee that market? Spare me dire warnings on what will happen in an open economy when freedom is attempted.

        1. “Easy to say when you have no understanding of the issue ….”

          Heh, heh… we’ll just leave my profession out of the discussion for now.

          To avoid further humiliation?

          Do you have any comprehension of my post? Do you even get the point?

          You had no point. Still don’t.

          The precedents over a hundred years of physician-patient relationships, and the regulatory contortions provoking the perversion of this once noble market, have ended “alternatives.”

          Totally hopeless? You claim no alternative is possible, as I thought.

          And it goes for the underwriting industry as well. This is the statist strategy. Set the precedent for control and any further modification is yet another layer of control.

          More rock-throwing?

          Spare me dire warnings on what will happen in an open economy when freedom is attempted.

          So you confirm having no clue, believe NOBODY wants a market (which already exists) … and you believe an “open society” is somehow different from a free society. You agree that you have no alternative at all because, you say, it’s totally hopeless anyhow. You’ve thrown in the towel.

          But you fail to address, or even mention what I challenged . Your claim of a “statist-compromising mindset that this site has become” So you can’t defend that either.

  21. Replace it with a decoupling of healthcare insurance from employment. Then completely deregulate healthcare insurance altogether. Then get rid of certificates of need.

    1. Isn’t it bad enough that progressives confuse coverage with treatment? Why do so many, both left and right, confuse the health insurance market with the provider market? The very worst example is Medicare vouchers.

      The first requirement of a free market is to know what one is.

  22. Pretty sweet of the government to fuck over the insurance companies and Americans with ACA and then fuck them over again by ripping it out from under them after they put in infrastructure and planning for it. Some “libertarians” aren’t all that smart to just assume killing it all at once is a smart move. If the Republicans don’t put in some sort of replacement effort they will be totally ripped a new one in 2 years.

    1. Pretty sweet of the government to fuck over the insurance companies and Americans with ACA

      It was the insurance industry that demanded the mandate to buy from them, in exchange for guaranteed coverage of pre-existing conditions.. So government mandated that we all had to purchase from the insurance companies.

      Republicans (and libertarians) are even crazier, by promoting Medicare vouchers. That LOOKS like privatization — to their goobers who know NOTHING about markets. But it increases competition in the WRONG market, insurance is not healthcare. And insurance companies would add a costly middleman between the government and providers.

      David Nolan said that left and right are obsolete. Did he realize that the libertarian establishment would become equally obsolete — by pandering to the same interests?

  23. Oy vey, this has brought out some of the dumber Reason comments.

    Paul is right. Those older than 8 will remember the pre Obama status quo was enormously unpopular and healthcare costs were already skyrocketing. Next to the Iraq war this was the biggest reason for Obama’a win in 08. The ACA exacerbated but did not create the worst problems. “Just repealing” is a recipe for both economic and electoral failure. Other reforms (like the market reforms people are suggesting) have to be simultaneous with repeal and have to be billed as a replacement to distance it from the unpopular Bush era status quo.

    Lastly, there’s almost certainly going to have to be some kind of entitlement to replace Obamacare, like a voucher program, and that’s just the way it is. Most voters won’t countenance someone starving, even if it’s their own fault for gambling away their paycheck. So we accept taxpayer funded food stamps as necessary to convince people not to do something really dumb like put the government in charge of the food business.

  24. Given that libertarians want market solutions to healthcare, “repeal and then do nothing” shouldn’t be so upsetting to them. Would you rather that they do nothing or propose some GOP version of Obamacare?

    In fact, all they need to do (for now) is repeal the individual and employer mandate, and revive plans that were cancelled under Obamacare. The subsidies and medicaid coverage can stay for now, given that the free stuff part of ACA is still somewhat popular. When states start running out of money there will more chances to change the law.

    Let’s not forget the REAL reason why we were against this law – the government FORCED us to purchase products against our will, while taking away other options. There already was a single payer healthcare in America, and the government was managing other parts of our lives before healthcare. America still has a lot of that “live and let die” spirit and the ACA crossed a line.

    1. Given that libertarians want market solutions to healthcare, “repeal and then do nothing” shouldn’t be so upsetting to them. Would you rather that they do nothing or propose some GOP version of Obamacare?

      “Libertarians want market solutions, so should they do nothing or propose a non-market solution?”
      Obviously they should REPLACE Obamacare with a more marker-based solution. But they’ve never known how to.

      In fact, all they need to do (for now) is repeal the individual and employer mandate, and revive plans that were cancelled under Obamacare.

      That’s one of their proposals, would be a massive disaster — far worse than Obamacare on skyrocketing premiums. The mandate, demanded by the insurance industry between Obama’s election and inauguration, is intended to offset the massive risk of “guaranteed issue” (pre-existing conditions). So repealing the mandate would escalate rates even faster — or see the insurance publicly castrate the GOP by refusing — which would get us back to mandates. You ignored that entirely, but it’s MAJOR.

      Let’s not forget the REAL reason why we were against this law

      Mostly ignorance and no alternative. Essentially helpless..

      There already was a single payer healthcare in America,

      Virtually all the uninsured are in single-payer and Medicaid. Rates VERY high in most non-group coverage.

  25. They haven’t come close to a replacement in seven years. And want to fuck-up Medicare even worse than Dubya did. If Rand forces the Congressional GOP to complete its implosion that would even offset his humiiating Presidential campaign. GO RAND!

  26. Rand has the right idea. You can clearly tell who is young and inexperienced. There is more to governing than blindly slashing with self-righteous mindlessness.

    1. Firstly, your faulty and iironic assumptions on age and profession discredit your argument.

      “There is more to governing….”
      And herein lies the paradigm, and mindset that has crushed any semblance of a free economy. Because, don’t tell me, we in the ‘healthcare field are different’….

    2. Rand has the right idea

      He MAY have seen the light … and walked away from his wacky father (and anti-gummint libertarianism)

  27. up to I saw the paycheck which had said $8845 , I have faith that my friends brother woz like actualy erning money part-time on their apple labtop. . there aunt had bean doing this 4 only 7 months and resently took care of the morgage on there mini mansion and bought themselves a Lancia . view it now….

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  28. yea health costs in US are fucked. I was visiting a friend in Seoul in October and I went to international clinic expecting to get ass raped and found out my bill was 35 dollars and the meds were 15 dollars….out of pocket.

    I pay like 150 to just go to doctor and whatever the hell meds would cost here.

    I remember seeing a mckesson distribution center and see why everything is so expensive and thats just the distribution side.

    So many requirements for laws it makes so much overhead.

  29. Personally, this is what i always thought the government should do.

    If they can invest 10 dollars and save 15 dollars in economic grow than its a good idea.

    If government was to do anything in health care it would simply provide or pay for basic survives,

    Vacines, resetting bones, meds, and so on.

    Basically, just to keep people working and nothing more. Have cancer? Too fucking bad….it is life. Now if we can cure/threat cancer for 1000 bucks and keep a person working for another 5 years awesome! But we aren’t there yet and not worth tax payers money.

    1. Haha, the cancer line is hilarious.

      Related to this principle of investment, I’ve toyed with ideas like this before. Like, what if when we’re born, along with a social security number, a government account was created with X amount of dollars in it. Each person could then spend that money as they wanted and needed on healthcare. Once it ran out, you’re on your own. The starting amount would be some significant percentage of “average health care used over a lifetime.”

  30. I don’t understand – there should be no federal government regulation or funding of the medical industry, therefore it should be replaced by NOTHING. What is Paul thinking?

    1. He may have finally see the total wackiness of his father. If he rejects the death spiral of anti-gummint libertarians and switches to the pro-liberty side, then he may have learned from his massive screwups on the Presidential primaries. He actually thought that Berkeley liberals could be in the same coalition as extreme socons holding religious tent revivals against marriage equality — a core principle of Ron Paul’s misnamed “liberty coalition.” Instead, Rand proved the futility of it. But does HE know that?

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