The GOP's Obamacare Repeal Bill Is Here. Is This Just Obamacare Lite?

The House bill trades one set of tax credits for another.


Jeff Malet Photography/Newscom

After months of confusion and secrecy, House Republicans have finally revealed their Obamacare repeal legislation. While it's useful to have House Republicans on the record with a legislative plan, the plan doesn't offer any estimate for how much it would cost, or how many people it would (or wouldn't) cover. In general, it's not clear what problems this particular bill would actually solve.

The bill would replace Obamacare's subsidies with a system of tax credits and halt the law's Medicaid expansion at the end of the decade while grandfathering in many beneficiaries over the long term and giving states $100 billion in funding to work with to care for hard case patients. All in all, it's a fairly conventional Republican plan, modified in ways designed to mitigate recent political objections.

The tax credit is, for the moment, the most controversial component of the legislation. As in previous drafts of the bill, the credits are refundable, meaning that individuals will be eligible for them even if their total tax liability is lower than the amount of the credit. The federal government would pay people, even if their federal tax bill was zero. It's a subsidy, basically, rather like the one in Obamacare. Conservative legislators have argued that such a system would be little more than Obamacare lite. Sen. Rand Paul (R-Kentucky) has complained that any refundable credit is tantamount to "a new entitlement program."

Unlike Obamacare, which bases its credits on income, the GOP bills we've seen so far are based on age. That creates another set of political headaches, because it means that wealthier folks get tax credits, and because it means that older people would get less help than under Obamacare, in hopes of creating a scheme that lures more young and health people into the system.

The bill released tonight attempts to mitigate these problems by capping the refundable credit so that households earning more than $150,000 would be reduced, and individuals making more than $215,000 would get nothing at all. But that still leaves a credit that is refundable for most people, and adds a bit of additional administrative work: Under Obamacare, judging an individual's employment and income has proven more than a little difficult, and the same would continue to be true here.

So Republicans would be replacing one set of insurance subsidies with another set of insurance subsidies, while killing the individual mandate but leaving many of the law's insurance regulations intact (with a penalty for insurance gaps). There's a reason that legislators like Michigan Rep. Justin Amash are already referring to it as "Obamacare 2.0."

On the other hand, the bill would probably result in the disruption of current health insurance for millions (although it's hard to say with confidence how many, for reasons I'll explain in a moment), and we don't yet have an estimate as to what effect it would have on the budget.

Beyond that, the bill would provide a hefty payment to states, about $100 billion over 10 years, for states to use to fund safety nets of their own design. And then there's the bill's Medicaid rollback, another awkward balancing act. It keeps the state-level optionality granted by the Supreme Court in 2012, and allows states to keep the law's expanded funding for Medicaid beneficiaries up through the end of 2019, and for those who maintain continuous coverage after. So the enhanced Medicaid matching funds provided by Obamacare would dwindle away over time. This is as much a political compromise as an actual policy measure. Will it appease the four Republican Senators who pledged today to oppose the repeal of the law's Medicaid expansion? No one knows.

Indeed, there's an awful lot we still don't know about the bill, in part because Republicans have rolled it out in such a way as to prevent clear analysis.

With any major health care policy reform, the big questions are: How much will it cost? And how many people will it cover, and in what manner? Typically these questions are answered by the Congressional Budget Office (CBO), which provides the official estimates, and perhaps supplemented by outside organizations with various rooting interests.

But there's no CBO score of the Republican bill. And reports indicate that Republicans intend to proceed moving the bill through the committee process without any CBO score to guide them. That means that neither the public nor congressional legislators will have any real idea of what the likely effects of the bill are even as they are debating its merits.

Of course the CBO has been wrong before—in particular about health care. And of course there are reasonable issues with the CBO process, which is built to produce authoritative single point estimates rather than ranges that might better express the level of uncertainty in the estimates.

But the CBO does serve one incredibly valuable function, which is to provide an official estimate for the budgetary effects of a law, and (more or less) force everyone to stick with it, or at least make a clear argument as to why they aren't.

We don't have that here, and the result is that even though the bill is now public after a period of unusual secrecy—members of the House were allowed to read it only in a tightly controlled setting last week, while Senators were prohibited from looking at it—there's a lot we still don't know about how it is likely to work.

More broadly, it's not clear what constituency this bill is designed to satisfy, aside from Republican congressional leadership. It doesn't go far enough for conservatives, but may not be generous enough to appease more moderate Republicans either. (Democrats are, at this point, virtually certain to uniformly oppose the bill.) It's a muddled version of the House GOP plan, which was itself a muddled vision of what a political compromise might look like, in some hypothetical world where Republicans actually agreed about health policy.

The GOP's real problem, in terms of passing legislation, isn't that the party can't agree on specifics, or that legislators need to bargain their way toward a compromise that gives everyone something they want. It's that they don't agree on, or in some cases even have, basic goals when it comes to health policy. This bill, and the aura of secrecy surrounding it, seems more like a wish and a hope that this essential problem goes away rather than an attempt to truly solve it.

So what we have at this point is a bill, but not a lot of context. It's a start, and it's better than nothing. But it's not enough.

NEXT: Trump's New Travel Ban, Just as Mean and Useless as the Old One

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  1. But there's no CBO score of the Republican bill. And reports indicate that Republicans intend to proceed moving the bill through the committee process without any CBO score to guide them.

    The "fiscally responsible" GOP. What a fucking joke. With all the faults of Obamacare at least Dems paid for it.

    1. The Dems "paid for it" by shortening the timeline on which it would be scored. They didn't really pay for the long-term costs, just like no one has paid for SS and Medicare. Charge it!

      1. I recall Romney and Ryan complaining about the $400 billion in Medicare cuts in the ACA during the 2012 campaign.

        That is the fiscally responsible GOP for you!

        1. When did this happen? 400 billion per year? Weren't the dems saying the pubs want to push granny off a cliff

          1. It was $400 billion over 10 years - the CBO scoring horizon back when the CBO mattered.

            1. So the dems wanted to push granny off a cliff

            2. Did it actually cut 40 billion per year or just go somewhere else?

              1. Regarding that CBO 'estimate', Reason did a very good article on it at the time.
                The CBO has no option but to base projections on the data handed it. In this case, but those who were pushing O-care. Lies on the level of Gruber's 'you can keep your doctor!' bullshit.
                Now, either turd knows this and he's flat-out lying, or he's conveniently 'forgotten' it (he was posting here at the time), but regardless, it's a lie. Turd once again caught lying; what a surprise!

                1. Well we will see if the big Cheeto can pull off "Healthcare for everyone". This bill the have now certainly will not...

          2. Romney's right: Obamacare cuts Medicare by $716 billion. Here's how.


            Whoops. It was $716 billion.

            1. Ok but did that actually happen?

              1. Yes. It is one of the big reasons the deficit has fallen since 2008/09.

                1. If he reaped the medicare savings and spent it on barrycare, then by definition it can't have reduced the deficit. But you're and idiot who thinks you can spend the same money twice. And medicaid per capita spending on barrycare is running 50% higher than projections. The only reason that barrycare hasn't already burst at the seams is because all thise rednecks in the 19 states ehich did NOT expand medicaid and replicate that disaster over the entire population.

                  1. You're wrong again.

                    Obamacare Is (Still) Fiscally Responsible

                    Congress' scorekeeper confirms that the health care law will reduce deficits

                    Those costs are more than offset, however, by budget savings in Medicare, Medicaid and other programs, as well as revenues from taxes and fees. The resulting deficit reduction will be modest over the first 10 years, CBO projects, but larger in the ensuing decade.


                    1. You didn't even address my point, dumbass.you conflated everything from medicare cuts (there are no medicaid cuts as all of the insured gains came as a result of expanding medicaid) to tax increases. And what did cbo say about the longterm viability of providers with the reduced reimbursement? Something to the effect that many would not be reimbursed even at cost within a few years. That ring a bell? Of course not, but then you're the moron that thinks that hydrocarbon production on federal lands under barry increased, so facts aren't really your strong suit.

                    2. You're a TEAM RED ! idiot.

                      Oil production of federal land was 1.955 million bpd - higher than any of the last three years of the Bush administration.


                    3. What is the going rate from moveon.org these days? $1/post?

                      Unlike you I realize that hydrocarbons come in many forms and not just crude oil.

                      Overall fossil fuel production from federal lands generally declined between FY 2003 and FY 2014, down 21% in FY 2014 compared with FY 2003 (Table 1). This trend is primarily the result of a steady decline in federal offshore natural gas production between FY 2003 and FY 2014 and the 9% drop in coal production from federal lands from FY 2012 to FY 2013.

                      Looking specifically at federal oil we see it was essentially flat in spite of horizontal drilling and frac'ing advances which more than doubled output on non-federal lands. Quite the accomplishment. Better ask your mom for some more pop tarts, I think you're in for a rough night.

                    4. Better ask your mom for some more pop tarts, I think you're in for a rough night.

                      Now that is funny.

                    5. Turd's post:
                      "as well as revenues from taxes and fees."

                      See? If we raise taxes enough, it'll reduce deficits!
                      What a fucking ignoramus. You lying pile of shit, if taxes are raised enough, you can cut ANY deficit.
                      Go fuck your daddy.

                    6. "if taxes are raised enough, you can cut ANY deficit."

                      Technically not true although soros jr. would love to try in order to fund his new soviet man.

                      Hey, did you see tesla shit the bed on profits AGAIN? And it looks like they need to do another capital raise. I'm sure anal blockage will be right there begging them to take his mom's money.

                    7. "Technically not true although soros jr. would love to try in order to fund his new soviet man."
                      You are correct; that curve will bite you in the ass at some level.

                      "Hey, did you see tesla shit the bed on profits AGAIN? And it looks like they need to do another capital raise. I'm sure anal blockage will be right there begging them to take his mom's money."
                      Yep, saw that.
                      They also did hit the ship numbers, and the profits are down even with the gov't 'certs' they still pedal, and (AFAIK) with the fake 'refuel in 5 minutes' scam payments.
                      I really do hope Trumps EPA-boss pulls all *my* money out of Tesla and makes Musk try to run a real business. I'm tired of supporting lefty SV swells coasting to work on dead batteries.

                    8. Did you notice how much they made in ZEV credits the previous quarter (think it was quarter and not year). $200MM. And that dropped to $30MM or so this past quarter when their loss widened. Could the two be correlated. Let's apply buttplug math to find out!

                    9. "Could the two be correlated. Let's apply buttplug math to find out!"

                      I'm sure turd's 'bubba-balanced-budget' theories have enough elasticity to accommodate that sort of disparity.
                      Let's hear it, turd!

                    10. Correction:
                      - did *NOT* hit the ship numbers -

                    11. You do know the CBO stopped scoring the ACA because Obama had punted on so many parts of his own law?

                      I repeat: the CBO decided they could no longer score it. So you have no idea what it actually costs.

                      For example, the Cadillac Tax....never implemented.

                      So, the democrats never "paid" for anything except in lost seats.

                2. Oh bullshit. The only reason the deficit has dropped in recent years were due to upticks in revenue.

                3. Yes. It is one of the big reasons the deficit has fallen since 2008/09

                  Bullshit. Here are the actual costs of Medicare and Medicaid services since FY08:

                  FY08: $862 billion
                  FY16 : $1.41 trillion

                  You see a drop in cost there, dummy?

            2. Was this the doc fix?

            3. The Democrats paid for it alright: by imposing ludicrous price controls in medicare well below the actual increase in healthcare costs.

              Here's the Brookings Institute report

              "Before the ACA, payments were to be updated each year by an amount equal to the growth of input costs (hospital wages, etc.); after the ACA, the payment update equals the growth of input costs less the rate of increase in economy-wide productivity."

              In other words, per standard leftist economics, they declare "prices shall no longer rise faster than this!" and expect it will actually be so.

              There are only two ways these price controls can be offset: 1) Doctors start avoiding medicare patients (or more practices shut down or don't open because of declining revenue relative to cost), negatively impacting the supply of healthcare, while doctors charge more from their non-medicare patients to offset the price controls - much like what happens to non-rent controlled apartments in cities with extensive rent controls. This is part of why premiums and deductibles keep going up. Or, 2) These price controls get repealed, which is what is generally expected.

              Either way, you are a moron. Price controls don't work buttplug. Only way to cut prices without cutting demand: increase supply.

      2. Actually, unless you've never been employed, you'll find that FICA at the bottom of your paystub....That amount is matched by your employer. In fact, Social Security and Medicare are the only programs that actually are paid for by a separate earmarked taxation. You'll notice there is no deduction on your pay for 'Military' or 'The Wall'.....In this day and age, we are bombarded with 'cut the entitlements'! Check out the real state of Social Security: http://www.michcitizenaction.o.....2_orig.jpg

    2. When you say they paid for it...what do you mean?

      1. The same way that clinton had a surplus while raiding all those trust funds, i.e. just ignore incurred liabilities and look at immediate cash flows. Try that with your mortgage company and see how far it gets you.

          1. Such a fact filled rebuttal. Now scurry back to get your soros talking points. We'll wait.

          2. "Another wingnut lie."

            Yes, that accounts for every statement your dishonest progtard ass has ever made PB.

        1. Hey, moonbeam paid the $25 minimum credit card due, searched all the over-stuffed furniture and found some spare change and announced CA had a "balanced budget!"; turd's been posting the same bullshit regarding bubba for years.
          I'm pretty sure he really is stupid enough to believe it, and maybe stupid enough to presume the rest of us are stupid enough to believe it.
          Hey, turd! Go fuck your daddy!

          1. I just stopped by to see if Servo called someone a turd and commanded him to go fuck his daddy.
            Yup, he did that.

    3. "With all the faults of Obamacare at least Dems paid for it."

      You lying sack of shit, the TAXPAYERS and RATEPAYERS paid for it.
      Oh, and fuck off.

      1. he really is a liar and it is disingenuous to say that it was "paid" for even with the additional taxes

    4. No, the taxpayers paid for it.

      Tax+spend is always better than Borrow+spend.

      HUGE difference between the two parties. Both are bad in terms of the "spend." One is more responsible, in that generation that spends is more responsible for it.

      1. Um, no. "Generations" aren't responsible for shit. Individuals are. The fact that one lives in the same time period as another person doesn't make them more responsible for them than some distant descendant.

        Also, the long run economic consequences of tax-and-spend are similar: private investment funds diverted (one from taxation, the other through credit market being crowded out) to the state. Only in the short run are the impacts much different (if you're a Keynesian, then you should prefer borrow-and-spend when the economy is weak. But then again all progressives stop being Keynesians the moment a Republican takes office and does it).

  2. This bill, and the aura of secrecy surrounding it

    They have to pass it so we can find out whats in it!

    1. What goes around...

      1. Talking to yourself again Weigel?

        Yes, I know that "DanO" is your latest troll account, now that you seem to have retired "dajjal".

    2. Palin's Buttplug|3.6.17 @ 8:44PM|#
      "They have to pass it so we can find out whats in it!"

      Turd, only one congress critter (and one lying commenter) said thata.

  3. That means that neither the public nor congressional legislators will have any real idea of what the likely effects of the bill are even as they are debating its merits.

    Oh, that's only on the budget, and no one really cares about that. The primary goal here is to both placate the working class screwed over by the ACA and not totally screw over those currently kind of benefiting from the ACA. The latter group isn't voting GOP so that's a fool's errand, but whatever. My problem is that they've had almost seven years for their lobbyists to come up with a replacement and they still seem to have been caught off guard.

    1. They were pretty sure Trump would lose...

      1. Seven years ago?

      2. AdamJ nailed it. They thought trump would lose, it was all talk. And then trump won which caught them off guard

        1. You might be the dumbest one here.

          1. Check "Sevo" out. The stupid is painted all over that one.

            1. Make sure you don't confuse these two accounts. That would be embarrassing.

            2. Palin's Buttplug|3.6.17 @ 9:07PM|#
              "Check "Sevo" out. The stupid is painted all over that one."

              Poor, poor turd; called on bullshit on a regular basis and the best the lying pile of shit can do is say 'poopyhead!'
              Now, turd, go back up-thread and dispute (with FACTS) where I've called you on your bullshit.
              Or just fuck off.

            3. Servo is like one of those 5"-tall ankle-biting dogs that yap-yap-yap while hopping backwards.

          2. Uh did you think trump was going to win?


    2. In fact, I wouldn't be surprised to find that most Republicans wanted HRC to win so they would continue to have a foil so they could rally their base.

      1. yep because if they controlled congress they wouldnt have to do much of anything.

      2. Yep. Failure Theater.

      3. Yep. Failure Theater.

  4. What do you mean by disruption Suderman? A tweet is not evidence. Explain and defend this assertion please.

  5. "Mend it, don't end it." That chant started about 5 seconds after Obamacare passed and the usual suspects in the GOP were already going from promises to repeal to promises to fix. The Dems knew what they were doing ramming through Obamacare no matter what promises they had to make, lies they had to tell, arms they had to twist, bribes they had to pay. All they were after was getting the camel's nose inside the tent and universal socialized medicine was a done deal, only the details remained to be worked out. And here we are, there's nobody with the balls to take all the free candy back from the baby.

    1. Once upon a time Republicans were against Medicare too. Now they defend it to the death.

      1. Defend it? Hell, they added a big new section for prescription drugs to it in 2002 they like it so much. Not a dime of revenue was raised to pay for it too.

        Because Big Spending and tax cuts reduce the deficit if you believe in some bullshit called "dynamic scoring".

        1. How about tax cuts and massive spending cuts?

          1. How about tax cuts and massive spending cuts?

            Neither party has ever tried that combo.

            1. Which party combo tried your mom?

  6. Yet another expected butcher job by Washington. They don't want to actually solve any problems. Focusing only on healthcare insurance while not even discussing the healthcare industry, rising costs and lack of transparency is putting lipstick on a pig.

    1. Yep. You would say the incentive is to cause more problems which means more power

      1. Have ANY of them discussed tort reform?

  7. My expectation that the craven gaggle of power-lusting fucks that is Congress would deliver a greasy turd of an Ocare repeal has been, to my disappointment, met.

  8. "In general, it's not clear what problems this particular bill would actually solve.

    The bill would replace Obamacare's subsidies with a system of tax credits and halt the law's Medicaid expansion at the end of the decade"

    1. . . . squirrels cut off everything I wrote.

      The fact is that Medicaid is the ultimate cause of the problem, and any solution that stop the expansion of Medicaid would necessarily be avoiding the problem.

      Medicaid reimburse providers for a fraction of the cost of care and leaves them to gouge private pay patients and insurance companies to make up for the difference. If the GOP plan is crimping the expansion of Medicaid, then it is most certainly addressing the cause of the problem.

      1. Sounds more like cauterizing the wound after you've lost half your blood. We need far more than that.

        1. At least they're rolling back the expansion of Medicaid.

          Medicaid is the cause of the problem, and they're addressing it.

          They aren't solving the problem completely, but then the political will to repeal Medicaid isn't there.

          The market of ideas is like other markets. Manufacturers don't dictate products to the market. If the market won't buy those products, then making them for sale is self-defeating. You have to make products that the market will buy.

          If this is the best the market will buy right now, then let's take what we can get. We'll work on our advertising and maybe get them to buy something even better in the future--but eliminating the Medicaid expansion is a necessary step on the road to solving the problem.

          There can be no long term solution that doesn't involve minimizing Medicaid (except maybe the singularity? Jesus coming back?), and eliminating the expansion of Medicaid is a good start.

          1. Unfortunately it doesn't do that:

            It keeps the state-level optionality granted by the Supreme Court in 2012, and allows states to keep the law's expanded funding for Medicaid beneficiaries up through the end of 2019, and for those who maintain continuous coverage after.

            (emphasis mine)

            Basically it looks like it grandfathers in the increased medicaid spending. And I can guarantee that those state legislatures will never let their spending drop.

            1. They're killing it in 2019. That's a great step.

              If they're giving subsidies to poor people to buy insurance on the open market--rather than Medicaid--then, once again, that is a step in the right direction.

              The insurance companies don't pay a fraction of the cost of care like Medicaid does.

              It's like a store where half the merchandise is stolen through shoplifting. The honest customers have to pay twice as much to make up for the losses. The more we migrate people from being shoplifters through Medicaid, the less of a problem that will be. Again, subsidizing the poor for their private health insurance isn't the perfect solution.

              But getting them off of Medicaid is a necessary part of the solution, and if we're talking about kicking those people off of Medicaid within the next three years, then--even if they're still getting health insurance subsidies at taxpayer expense--they aren't distorting the market as much by way of Medicaid anymore.

              Some forms of welfare really are worse than others, and Medicaid is the worst of them all because it doesn't only cost the taxpayers. it destroys the healthcare market, too. Paying for other people without distorting the market is certainly better than being forced to pay for other people--and distorting the market.

              1. If that's what they were doing, I would agree with you. Based on that wording (and I'd much rather read an analysis from McCardle instead of the beard) it sounds like they are not getting rid of it (Medicaid expansion) unless states allow their spending to lapse. I can guarantee the states will not let their spending of "free money" lapse.

                1. My reading is that once those people are no longer on Medicaid, they can receive subsidies so long as they maintain continuous coverage.

                  I believe this is meant to combat people only going on insurance when they get sick and then dropping off again.

                  And so long as they aren't on Medicaid anymore, I think that's better than what we have now.

      2. What is the solution, though? Charity will not pay the medical bills of the elderly (poor elderly are dual coverage of Medicare and Medicaid), the disabled and of poor children. With more medications, more medical treatments/surgeries and people living longer (and less healthy), it's a very complex issue. I'm not a statist, and I don't like entitlements, but I have yet to hear of a good option of how to keep at least basic healthcare somewhat accessible, and without increasing the amount of people living in abject poverty or dying on the streets. At the very least, we need basic services like vaccination to keep all of us healthy and free of preventable diseases such as polio and measles. Who pays for that? If we don't pay for vaccinations for poor children, then we risk the health of many more people, which is more expensive in the long run. Preventative care is more affordable than sick care.

        1. The elderly could pay most of their bills themselves (and their retirements) if they actually saved for it. We've created a dependency trap that will require decades to escape once we finally decide to do so. As to the very small fraction of the population that is truly disabled (no, not headaches and back aches or work "stress"), they could get a refundable credit also placed in a private savings account invested and growing for their entire lives. For the tiny fraction that are disabled at birth the country could afford a much, much smaller medical assistance program.

          As soon as the Medicaid roles increased the first thing that happened is that ER usage went up. The myth that people will get preventive care if you offer it is just a myth. There needs to be an incentive for the patient to behave responsibly. Dying in the streets would be a good one but we won't allow that. Like any other finite good, care will be rationed. If we are to have government redistribution to pay for the compassion of others, then we will have to have the government also deciding when to pull the plug. But no one wants to kill grandma 2 wks early. So barring that we need to create a financial incentive to behave properly. There are schemes out there that actually pay people to be healthy and schemes that reward them for shopping around for services. That seems to me the only way that we will ever truly bend the cost curve down.

          1. NotAnotherSkippy|3.6.17 @ 10:45PM|#
            "The elderly could pay most of their bills themselves (and their retirements) if they actually saved for it
            We've created a dependency trap that will require decades to escape once we finally decide to do so...."

            That "trap" is compounded by the assumption that 'the elderly' should carry the total burden.
            'The elderly' (in most cases) spent some large amount of money raising their offspring until (in my case) age 18. When my (and my wife's) parents became unable to provide for themselves through income, it became our responsibility to return the favor.
            As it happens, most all needs were covered by their savings and investments; the most we had to do was fend off those who were grasping for part of what was there but still needed.
            But had the numbers gone "red", well, that's the other end of that deal. Before you ask strangers to take care of you, call the family.

          2. I completely agree with patient/personable responsibility, and the fact that we cannot keep letting this system continue. I like some of the solutions that you have suggested, but the estimates on poor children and permanently disabled are off somewhat. I try to look at the entire situation as logically/economically as possible, hence why I brought up the vaccination issue.

            The problem with social security and other entitlements for the older/elderly is that without true education, we cannot just say that people can save for their own retirement. The education curriculum that I was taught included a year of trigonometry and a year of algebra, and yet there was not one required high school class on basic economics/finance. No one I graduated with was taught by schools to balance a checkbook, understand how to buy a car or a house, or what interest rates and principal are. That they left up to the parents. Where does that leave poor and uneducated people who do not understand what that all means in the first place? Or people who have no fiscal responsibility.

            As someone who was raised by financialy ignorant parents and had to self-teach almost everything I know, I can attest that far too many people don't have a clue about investments/savings/retirements, and their parents don't either. Without a major public education plan, I don't know how we could just eliminate all entitlement programs without having a major impact or further increasing income equality.

            1. Many people who did have retirement plans were financially damaged after the market crash in 2008, or having their money scammed by people like Madoff. Since this is a libertarian site, most here are against regulations, but what protects people from predatory banking/investment practices? No one was protected from predatory lending that led to the housing market crash, and no major repercussions were taken. No one went to jail. I knew people personally (not by choice) who were using White Out to forge mortgage applications. Yes, people need to have personal responsibility and not sign loans they can't afford, no matter what some goomba from NY promises you on the phone, but there were also people who were deceived and genuinely screwed through no fault of their own.

              Without any social/security net, and with a reduction or elimination in regulations, seriously, what protects any of us? What if our bank accounts were completely wiped out one day? With cyber warfare and identity theft, this is not some far-fetched fear or conspiracy theory.

              I'm not arguing at all for social safety nets, I'm just trying to figure out most people can take responsibility for their lives and their choices without fear of having it all taken away, and without further increasing the income inequality.

              1. *Nor am I suggesting by any means that the government does a very good job of protection from cyberthreats, hacking, predatory lending practice or most other things, for that matter*

              2. "No one was protected from predatory lending that led to the housing market crash, and no major repercussions were taken."

                Care to define "predatory lending"?

              3. If you sat tight through the crash in 2008 your retirement came through just fine. In fact that is true for any significant period (10-20 years) the market has trended up. Don't mistake the occasional dips for disaster if you are patient.

                And those predatory loans were financed with government money. Why is it that everyone forgets this? Without Fannie and Freddie the housing bubble never reaches the level it did. Without CRA the housing bubble never reaches the level it did. You assume that government protects you from the bad guys without even realizing that the worst bad guys are invariably the government.

                But let's say that we don't trust ppl to plan for themselves. OK. Take the FICA contributions and put them into a stable basket of low cost index funds: stocks, bonds, REITs. The formula would change only slowly over time. Fees won't eat up your gains. And the money will for the first time actually be an entitlement because it will literally be your money. Hell, it will even be inheritable. Singapore already does something similar to this for health savings accounts. So instead of being the ponzi scheme we have currently the money will actually be used productively. It also has the added benefit of not sluicing nearly as much through the government with all of the corruption that entails.

              4. In almost every scam the victim was greedy.

            2. "As someone who was raised by financialy ignorant parents and had to self-teach almost everything I know, I can attest that far too many people don't have a clue about investments/savings/retirements, and their parents don't either."

              We now have a gov't education system which teaches not a whole hell of a lot regarding finance. Are you suggesting we have to bankrupt the country waiting for someone to alter the curriculum to include such instruction?
              I'd say you and I have a very long wait; where I live the major change in the curriculum has been instructing kids on ways to 'resist Trump'.

              1. To your first comment - predatory lending was the banks and mortgage companies purposely targeting sub-prime mortgages. I witnessed it first hand. They would brag about putting the yield spread on the back end to make their interest and fees up front. Like I mentioned before, they literally forged documentation and preyed upon the lower class and uninformed.

                To your second comment - I agree, and that's why I brought up the fact that we are not even educating children, let alone adults, on basic finance. I don't want to bankrupt the country, but if we just pull the plug on entitlement services with no education or financial advisement for people, it will likely not end well.


                1. I read post after post on financial groups from people in their 30's and 40's whose parents are retiring or close to retirement with no savings whatsoever, or not close to enough to retire on. Theirs (my parent's) generation was the one where many people worked for the same company their entire lives, plan to live off of their pension and social security, and never grew up having to worry about their finances other than just paying their bills on time. My in laws notoriously get screwed with high interest rates on cars even though they have stellar credit, all because they have no clue. They (the baby boomers) were the generation born into (or shortly thereafter) the entitlement programs, and this is our dire outlook. They did not teach their children any better, and we have only become a completely consumer society with credit cards and no concept of financial management or how economics or finance works. I'm genuinely concerned for our future, and we as a society need to figure out how to wean ourselves off of entitlement programs and to create a sense of urgency to change values and focus on personal responsibility. We can't just go cold turkey, because most people are poorly unprepared to stand on their own.

                2. Because moral hazard is a joke. If someone will bail you out, of course, it will become some people's business strategy to be short-sided and get the quick buck.

          3. This is part of why I'm kind of on board with forced healthcare savings accounts. Not very libertarian of me, but the fact is, we all are going to pay for other people's heathcare. They're going to force us to in the voting booth. It's only fair that we force them to save in order to contribute to it.

            I'm partial right now to John (C) Goodman's ideas about a fixed tax credit that people can use to buy into medicaid that is set equal to the marginal cost of medicaid enrollment, but everyone else can use in addition to their own money to purchase better care.

            Aside from that, deregulate the actual heathcare industry as much as possible to drive down the *actual* cost of provision of care.

        2. So, the problem isn't the market, the problem is government interference in the market. It all started long long ago during WWII when business started offering health insurance to get around wage freezes put in place by, you guessed it, the federal government.
          Then the States started getting involved, dictating what had to be included in insurance plans.
          The amount of distortion in the market place is now Dali-like in its surrealism. For instance, I've still got a box of my late wife's bills. Guess how much they charged the insurance company for a bag of saline. Go ahead, guess. Now, remember, this basically salt and water. Did you guess $90? No? Why? Is it because that's an insane amount of money to pay for salt water?
          Did you know that the health insurance companies and hospitals collude on prices? Yup. The insurance company gets billed less than the actual cost for things like childbirth, but then agrees to pay way more for things like heart surgery.
          You know what's cheap? Lazic. You know why? Insurance doesn't cover it. Publish price lists and watch costs tumble.

          1. "The amount of distortion in the [medical] market place is now Dali-like in its surrealism"

            I'm sure you know that the RE market collapsed in 2008 because 'free market', right?

            1. Well, nat! Everyone knows that!

          2. Spot on.

            No one ever discusses the the many causes of the out-of-control costs or the mostly-unregulated healthcare system (yes, there are some regulations, but clearly they are not effective and are more red tape, admin and increase costs). I rarely see anyone mention that there are hundreds of pharma companies, plenty of competition, many different options for the most popular drug classes, billions spent in R&D and marketing, and yet we have very few drugs or products that cure anything, cancer survival rates for most types of cancer have barely budged in 50 years, Drug safety, testing and product claims is highly regulated, but actual business practices, off-label promotions and unethical transactions still occur every day.

            Hospitals keep their billing practices secrete, superbills are almost impossible to obtain, and they almost never disclose their contracted rates with insurers. The hospitals charge patients OOP 3x-5x what they collect from insurance companies, and maybe if you are lucky they will reduce your bills slightly or negotiate a payment plan before sending your accounts to collections.

            The list goes on, but lets ignore the facts and focus on the broken ACA that does little to address any of these problems, and the broken "replacement" that congress wants to pass.

            1. I have a procedure scheduled.

              Insurance rate is $7k. I pay $1k.

              Cash price is $3k.

              Either the insurance company is getting screwed, or they jack up the list price so that my copay is higher. And then they get a rebate on the back end. Which is more likely?

          3. Publish price lists and watch costs tumble.

            I've hammered on this repeatedly as long as I've commented on here. This is a regulation that libertarians should get behind, because it forces medical providers to be honest about the cost of their services and opens up competition.

        3. "Charity will not pay the medical bills of the elderly (poor elderly are dual coverage of Medicare and Medicaid), the disabled and of poor children. "

          And neither will any sort of entitlement program. The costs simply exceeding the available revenue.

          But more importantly, and all your protestations to the contrary, fuck off slaver.

          Because don't think your bait and switch argument "medical bills of the elderly ..., the disabled and of poor children" vs. "basic healthcare", vs. "vaccinations for poor children" is not noted.

      3. Or it will just lead to more gouging of private payers.

  9. older people would get less help ..., in hopes of creating a scheme that lures more young and health people into the system.

    Sounds legit.

    1. Sounds perfect.

    2. But if you are paying their premiums, it doesn't actually help.

  10. Quote: "But there's no CBO score of the Republican bill." Various news articles have made the situation clear. This is quite deliberate.

    Quote: "On the other hand, the bill would probably result in the disruption of current health insurance for millions." Assuming this includes the eventual phase out of Medicaid matching funds the number probably should be in the "low 10's of millions."

    Quote: "there's an awful lot we still don't know about the bill." So many questions. Is the tax credit indexed for inflation to prevent it from dwindling to nothing? Are the states required to, in some way, 'match' the grants to keep them from diverting their health care dollars to build football stadiums or other goodies?

    Regarding the CBO's "authoritative single point estimates" This gives everyone (a non statistician like myself) a starting point to build their own estimate range. Kudos to the author.

    1. We'll use 7 years of costs for 10 years of revenue, to match apples to apples.

      We'll add in Cadillac taxes that will never see the light of day.

      CBO scoring is a joke.

      1. And the doc fix...

  11. it's better than nothing
    said the libertarian publication's author. Guess libertarian does not mean what I used to think it meant, either.

    1. Libertarians are statist cucks who love government first but want to see it as somewhat smaller and more efficient second.


    2. No, libertarian means what it always did.

      reason.com is simply rightwing Republican politics pretending to be libertarian. neocons, "bothsiditis"..

      I mean look at this

      The tax credit is, for the moment, the most controversial component of the legislation

      Which is laughable given that there is NO COST EVEN ESTIMATED YET for the dropping of the mandate, for example.

      It's better than nothing

      We had something. Not nothing. Now we have something that we have no idea what it is.

      1. Tax credits are better than subsidies going directly to companies.

        Consumers have more choice how to spend them. And at the very least their personal data won't be on the exchange websites.

        1. And you won't have people getting s subsidy and then having to pay it back.

      2. Peter Suderman is " rightwing Republican politics pretending to be libertarian"?????


  12. No, it is Obamacare Lite in terms of coverage: fewer people, and likely not as many benefits
    It is Obamacare+huge debt in terms of costs

  13. Wait.
    This is their big plan? Really?

    Wow. How pathetic. It really is Obamacare 2.0. It is just a "mean" version of ObamaCare (where "mean" is defined as "not spending enough money", natch). Where are all the big ideas and market reforms?

    These people have truly learned nothing from the Obamacare wars. Dems staked everything in order to get their healthcare vision passed. Reps are unwilling to do the same. And the Reps have even less reason NOT to take big risks, because the electoral calendar for 2018 is still heavily in their favor. And OF COURSE the 2020 election would be a referendum on whatever they did on health care regardless (barring some other unforeseen event), so why not push some big visionary plan? And ESPECIALLY in the House, where they can just ram anything through without having to worry about filibusters? Oh no, they are just fiddling around the edges while trying to talk out of both sides of their mouths that they are doing "market-based health care" while keeping the subsidies and the "good parts" of ObamaCare intact. Yeah right.

    At this point I don't know why any genuine fiscal conservative would vote for a Republican.

    1. Neither party is fiscally conservative, sadly. Why can't libertarians stop bickering about weed and become a real movement?

      1. Mm, you're right, we should stop being such sticklers about locking people in rape cages over a dumb plant and focus on important things

    2. The GOP is not really fiscal conservatives but who should they vote for? Democrats who are worse?

      Unfortunately people like their goodies.

  14. The best thing about his "Obamacare 2.0" - it KILLS the individual mandate. It's the most unpopular and arguably the most unconstitutional aspect of the law. The majority of Americans did not agree with the government forcing them to purchase a product while taking away existing options. If enrollment was smooth and premiums never went up, we would still oppose it for this very reason.

    Trump and the GOP were never going to dramatically reduce or take away medicaid coverage or subsidies. It's politically infeasible and would have met with widespread public disapproval. The purists will scream "F you, cut spending" but for me, I'm down with Obamacare 2.0 with NO individual mandate. Without the individual mandate, the law is basically voluntary medicaid expansion and a voucher for qualified applicants. It's far from perfect. but it's a start.

    I seem to recall polls that have consistently shown how unpopular the individual mandate is. A recent poll showed that plurality of Americans would prefer to keep most of the law WITHOUT the individual mandate. Rand Paul is taking a principled stance, but it would be foolish for him to ignore an opportunity to scale back or eliminate the individual mandate. He can oppose the weak subsidy proposal, but he has to kill the mandate.

    1. The problem is that the mandate is basically what pays for health care.

      There is nothing to actually reduce cost. So what pays for not denying insurance to the sick and dying and the poor is forcing people who don't need health insurance to buy it, thus paying for the people who are using it a lot.

      1. Eh the mandate wasn't strong enough to actually make people pay for it as opposed to just buying if they needed it later on. The mandate was relatively small such that it was a bit meaningless

        1. True, enforcement of the mandate was nearly nonexistent, as Ocare never would've passed or survived if the mandate were enforced as severely as it would need to be in order to be truly functional.

      2. The market can function fine without a mandate. The young don't need to subsidize the old. Stretching out premiums between young and old to 5x instead of 3x eliminates cross age subsidies.

        The real problem is moral hazard. If a society provides free medical care to people without insurance, people of all ages will game the system. Eliminating moral hazard requires closing loopholes that let people wait to buy insurance until they're sick. The dems chose the mandate because it fit into their value system, but a mandate is just one of many ways to fix the problem.

        Other countries eliminate moral hazard by requiring the uninsured to pay a huge fine plus all back-premiums if they need care and don't have insurance. To make the penalty stick, folks in those countries can't get out of paying the penalties with bankruptcy.

        A complementary approach is to allow waiting periods and temporary pre-existing condition exclusions so if you have a lapse in insurance, you have to wait 6-12 months for pre-existing coverage. IMO, this works best if bankruptcy laws are changes so folks can't discharge medical bills incurred while not covered.

        These approaches would easily be enough to stop gaming. Since Republicans tend to value individual responsibility more highly than dems, and don't mind punishing people for the poor choices they make, they're more consistent with republican values than a mandate.

      3. If the mandate was actually paying for health care (whatever you think that means) then insurers would be rushing into the marketplaces.

        Instead we are talking about the signs of the beginning of a death spiral.

        1. There's a lot of healthcare wonks who think the individual mandate is not strong enough. It might exist currently, but if it's under-powered it's not going to have to desired result. That's an issue of implementation, and not one of unsound theory.

          1. It remains an issue of untested theory at best.

            And, given that there was never any political will to actually make the mandate onerous enough, it's also entirely academic. To the point where your point is not even germane to the topic anymore.

            1. Well it's tested in that Switzerland uses a mandate system, and it works decently well for them.

              Your point about political will is the real issue though, isn't it? Any way I look at it, it seems that the drawbacks of any healthcare delivery system are politically intolerable, which puts American healthcare in a really shitty and impossible place.

              -We don't want to pay the taxes necessary for single-payer, ruling out single payer
              -We bristle at being forced to buy insurance, ruling out comprehensive private care
              -We don't like insurance companies refusing people care, ruling out a more market-based system

              I honestly don't see a path forward. I guess when costs or whatever get bad enough some stop-gap measure will squeak by, but I expect it to be sub-optimal, whatever it is.

            2. If the mandate were severe enough it would work, but if it were severe enough the law would be enormously unpopular; indeed, it may not have survived the courts if it weren't so lax.

              Germany is far more punitive, for example, when it comes to enforcing compliance.

              I would prefer magellannh's solution to a stronger mandate myself.

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  16. The game was lost years ago. Clearly most people - politicians and voters - agree with the fundamental principle of Obamacare: government run and regulated health insurance, largely paid for by the people. All this law making activity is just bickering over small details.

    1. Correct. Republicans have conceded the righteousness of government-policed medicine. Democrats lost the most recent election but they have won the war. And the celebrating Trumpkins are too dumb to notice. Repeal and Replace?! But Don't Touch My Medicare?!

    2. "government run and regulated health insurance"

      No, there is no actual insurance here.

      What people really want is government run and regulated health care rationing.

      They just don't want to be the one denied, or the one who truly pays.

      We are out of money and cuts will happen, the only question is how.

      1. Good point Thomas, good point. With mandated coverages and the disallowance of charging based on identified individual claim risk, it ceased being insurance.

  17. No national market for insurance?

    Well, this is stupid. One of the quickest and easiest ways to lower costs by increasing risk pools is ignored, as usual.

    1. Risk pools are one thing I know about, and I don't think such a plan would work for medical insurance. First, risk pools only work where insurance is required. Drivers have to have liability; businesses of a certain size have to have comp. In car insurance, two groups of people get stuck in high risk pools: those with lots of tickets and those with lots of damage claims. The Venn diagram of the two groups mostly overlaps, but there are a few people who have lots of tickets who never have a claim or whose claims are really small. Those people subsidize everyone else. (Risk pool premiums are quite high.) In Worker's Comp, companies that have lots of claims get stuck in the risk pool, but if they go for a certain amount of time without a claim they can leave, so the ones who straighten up before they qualify for lower premiums, again, subsidize the rest. (Also, certain high risk occupations where the employer is extremely careful subsidize others here.). Also, most states kick in some $$ into the comp pool,

      With health insurance, there really isn't anyone who won't have claims to pay for everyone else other than smokers, and without the individual mandate there's no one in this group at all. Insurance companies learn that a person is a bad risk when that person makes claims, which means in this context, being sick already.

  18. "capping the refundable credit so that households earning more than $150,000 would be reduced, and individuals making more than $215,000 would get nothing at all."

    That feature alone makes ObamaCare Lite preferable to 100-400% of poverty line limits of original ObamaCare.

    The disincentives -- i.e., effective marginal income tax rates -- to additional work and earning in the 100-401% of poverty line range can be astronomical. A phase-out of credits in the $150-215K range is much, much more reasonable.

    Even so, for a 60-year-old couple making $150-$215K/year AGI, the ObamaCare Lite phaseout amounts to a boost in effective marginal income tax rate of about 15%. Back of the envelop calculation: $10K tax credit/$65K phase-out range = about 15%.

    Combined with the existing 28% marginal rate, and you still have a European socialist marginal rate of 43% on upper middle class households.

    ObamaCare Lite still very crappy to a libertarian, but it is vastly superior to the insanely high marginal rates that people in the 100% to 400% of poverty line face.

    1. Don't those people have employer insurance?

      And therefore nothing to subsidize?

  19. It should also be said that getting rid of the individual mandate is a solution to the libertarian problem of the government forcing people to buy something against their will.

  20. Republicans kept voting to repeal Obamacare when they knew it wouldn't happen.

    Now that they have the power, they will etch it in stone.

    Anyone who is surprised by this hasn't been paying attention for the last 100 years.

    1. That's because their real constituency is Washington D.C.

      Sure, they'll do their best to placate the rubes back home, but when push comes to shove it's all about serving the interests of the state.

  21. This is ridiculous. They get control and can't figure out how to change Obamacare. At this rate we will never have a market system that makes sense. One of my former soldiers is a small businessman. In three years his healthcare insurance expense literally tripled for the same number of employees and crappy coverage. It's 40% of his payroll expense!!! The Republicans are a joke. I can't believe I'm writing this, but single payer would almost be better than this nonsense. At least then the system wouldn't be loaded with bad incentives and problems - which essentially favor giant, big business over new business starts. What a sad state of affairs . . .

    1. Friend in Canada is waiting 8 months for a knee replacement.

      1. Better than never.

  22. So taxpayers will still have to pay around $100 billion to states? This goes against the philosophy the GOP believes. Us taxpayers would still be footing the bill for some guy who chooses not to work. This encourages laziness and encourages people to stay home, do drugs, have kids, commit crime...

  23. sounds like crap to me may as well as left the shit bag alone and I'm one who has no insurance thanks to Obama

  24. Not sure if this will fill the grand Cheetos promise of "insurance for everyone"


  25. The real problem is that Obamacare poisoned the well by getting Americans to expect health insurance from a federal system with subsidies.

    There is no way to put in a reasonable bill. None. All the complaining about this being Obamacare lite miss the point that the public won't accept a more rational system.

    Hopefully this can be a path towards a more market oriented system, because there is no way to get there in one step.

    And, if Republicans blow this, they lose their majority and the true statists and social justice warriors gain control of our country, which would ruin things far beyond health care.

    Elections have consequences. Voting for anyone other than a Republican makes them worse, if it results in the communism-light Democrats getting in power.

    1. Wow! All talking points covered in one breathless post.

      "I guess what I would say is if you looked at that person's budget and you looked at their cable bill, their telephone ? cell phone bill, other things that they're spending on, it may turn out that they just haven't prioritized health care because right now everybody is healthy,"

      1. Perhaps one should ask oneself, if someone is dumb enough to buy cable, a cell phone, lease a car, and buy all that other stuff before health insurance, then end up needing health insurance, why should the public be required to bail them out? Maybe such a person deserves to be mired in debt for such idiotic financial priorities?

        And contrary to the leftist canards, most people who went without heath insurance could've afforded it if they'd cut back on unnecessary commodities, not because they were without a penny.

  26. Seven years of Republican promises, and Trump's promise of a better, cheaper and more inclusive Health Care system than that 'disaster' Obamacare...And this is what they give us? A shuffling of the deck and from what i can figure, an awful lot of Americans who will be without coverage. There is nothing in this bill that will 'fix' anything. This does nothing to control the costs of our insurers, hospitals, or drug manufacturers. Why bother? Just so the GOP and Trump can say they lived up to their promise to kill Obamacare? What about the flip side of that promise; cheap, better, and more inclusive? Garbage! Useless garbage!

  27. Under Obamacare's 'individual mandate' a young healthy individual without insurance pays a penalty every year. Under Ryancare's 'individual coverage gap mandate' a young healthy person could skip insurance for 10, 20 or 30 years without penalty. They may even be able to collect a yearly 'tax bonus' while skipping coverage. Did I read this right?

  28. But mummy, all the industrial nations in Europe have universal health care!
    Oh Johnny, if you think that's so sweet, why don't you move there?
    Oh mummy, that would be so scary.!
    Oh Johnny - grow up.

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  32. Hey I have a fucking idea for medical care. Get rid of Nobama care completely, don't tax anything in the health industry, remove all federal regulations on the health industry, get rid of the FDA, let insurance companies sell across state lines etc. in other words, government should get the fuck out if they want affordable and efficient medical care but that isn't going to happen because fucktard Republicans and Democrats love power too much.

  33. sounds like crap to me may as well as left the shit bag alone and I'm one who has no insurance thanks to Obama


  34. older people would get less help ..., in hopes of creating a scheme that lures more young and health people into the system.

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