Wednesday, October 05, 2016

Still Crazy After All These Years

An ObamaCare October surprise.

October 4, 2016

Image result for bill clinton flint
Bill Clinton in Flint.

Five weeks before the presidential election, a campaign surrogate is declaring war on ObamaCare, as the Washington Times reports.
“You’ve got this crazy system where all of a sudden 25 million more people have health care and then the people are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half,” the surrogate said in Flint, Mich., Monday. “It’s the craziest thing in the world.” Also: “The people that are getting killed in this deal are small businesspeople and individuals who make just a little too much to get any of these subsidies.”
Having said all this, why aren’t Donald Trump ahead by 50 points? you might ask. Maybe because the quote above doesn’t come from one of Trump’s surrogates but from one of Hillary Clinton’s—and not just any surrogate but Bill Clinton, to whom Mrs. Clinton is officially married.
It’s something of an October surprise, and Mr. Clinton isn’t the only unlikely critic of ObamaCare to emerge in recent days. In yesterday’s New York Times, reporter Robert Pear described ObamaCare as a failure while studiously avoiding the F-word: “[President] Obama’s signature domestic achievement will almost certainly have to change to survive.”
Since ObamaCare is not a living organism, the “survival” metaphor obscures more than it illuminates. Just how much change could the law take and still be deemed to have “survived,” as opposed to having been replaced by a new scheme? We’re not sure how to answer that other than purely subjectively. There are more maddening metaphors, too:
Dr. John W. Rowe, who was the chief executive of Aetna from 2000 to 2006 and the president of Mount Sinai Medical Center in New York before that, predicted that “the insurance market will stabilize in two or three years.”
“We are not in a death spiral,” Dr. Rowe said. “If this were a patient, I would say that he’s not in intensive care, but he’s still in the hospital and requires careful monitoring.”
But that does not mean the act will heal on its own, said Sara Rosenbaum, a professor of health law and policy at George Washington University.
It doesn’t help that Rowe and Rosenbaum are describing a problem with health-care financing using medical metaphors—though perhaps it’s revealing that the one thing they don’t discuss about the ObamaCare “patient” is whether he has insurance, the proliferation of which, we are supposed to believe, is ObamaCare’s great accomplishment.
But actually ObamaCare does have insurance. “The Obama administration is maneuvering to pay health insurers billions of dollars the government owes under the Affordable Care Act, through a move that could circumvent Congress and help shore up the president’s signature legislative achievement before he leaves office,” the Washington Post reported last week:
Justice Department officials have privately told several health plans suing over the unpaid money that they are eager to negotiate a broad settlement, which could end up offering payments to about 175 health plans selling coverage on ACA marketplaces, according to insurance executives and lawyers familiar with the talks. . . .
The money in question involves one of three strategies to help coax insurers into the marketplaces by promising to cushion them from unexpectedly high expenses for their new customers. This particular strategy, known as “risk corridors,” was for the marketplaces’ first three years, when it was unclear how many people would sign up and how much medical care they would use. . . .
The risk corridors started in 2014. The crunch became apparent last fall, when federal health officials announced that they faced an enormous gap because so many more health plans incurred high expenses for their ACA customers than low ones. For that reason, HHS [the Department of Health and Human Services] made less than $400 million in 2014 risk-corridor payments—just 12.6 percent of $2.9 billion it owed overall.
That is, ObamaCare’s insurance scheme was so badly designed that its reinsurance scheme broke down and the administration is madly searching for tax money it can use to bail out insurance companies—the same insurance companies Obama relentlessly vilified when he was attempting to sell the public on ObamaCare.
In an interview with New York magazine, Obama sounds a familiar theme about Republicans’ failure to cooperate:
[GOP lawmakers made] a calculation based on what turned out to be pretty smart politics but really bad for the country: If they cooperated with me, then that would validate our efforts. If they were able to maintain uniform opposition to whatever I proposed, that would send a signal to the public of gridlock, dysfunction, and that would help them win seats in the midterms. It was that second strategy that they pursued with great discipline. It established the dynamic for not just my presidency but for a much sharper party-line approach to managing both the House and the Senate that I think is going to have consequences for years to come.
Obama himself made a similar calculation, also really bad for the country, though one could argue either way if it was “smart politics.” With Democratic majorities in both congressional chambers, he worked with his party’s leaders to bully through the law despite uniform Republican opposition and public opposition strong enough to elect a GOP senator from Massachusetts, of all places.
Now, as the Hill reported last month, “Democrats are beginning to talk about changing ObamaCare to fix what they acknowledge are growing problems in the law’s insurance marketplaces,” and they “are also expressing hope that Republicans will work with them to make fixes to the law when the new Congress convenes in 2017.”
Which could get interesting. With Obama gone, his veto—and ego—would no longer be a barrier to legislation undoing ObamaCare, or at least its worst aspects. If Trump is elected, one would expect congressional Republicans to take the lead. As for Mrs. Clinton, who knows? She has described herself as a supporter of ObamaCare, but that is probably just another way of saying she’s a supporter of Obama, who is much more popular than she is.
The Times’s Pear reports that many Democrats favor a “public option” (a government-run medical-insurance company) or even “single payer” (a government-run medical-insurance monopoly). But neither of those ideas seems likely to go anywhere in a Republican-controlled House or Senate.
Maybe Mr. Clinton’s anti-ObamaCare musings were meant to signal to Republicans that Mrs. Clinton would be flexible enough to go along with some reforms they would find acceptable. Or maybe Mr. Clinton just wishes Mrs. Clinton were flexible.

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