Monday, June 26, 2017

The Republicans Are Not in a Lose Lose Situation With ObamaCare

If ObamaCare goes under during the Republican Administration and Congress, they will be blamed for it by the Democrats and media If Medicaid fails under the Trump Administration and Republican Congress, they will be blamed by the Democrats and Media for the failure If they repeal ObamaCare or tinker with it, they will be roundly condemned. No matter what they do, they will face opposition in the primaries or general election So just do the right thing – whatever you believe is the right approach. Americans are divided on ObamaCare. Polls, often wrong these days, consistently showed Americans opposed to it, but a recent poll shows only 16% favor the Congressional proposals. Americans did not want it in 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016. I doubt the majority of Americans want it in 2017. Some Republican members of Congress don’t think the House or Senate Bills go far enough in repealing ObamaCare. They call it ObamaLight. Senator Rand Paul will apparently be satisfied with nothing less than total repeal of Obamacare. That will not happen. Of course the republican proposals are ObamaLight; the Republicans face two major quandaries in “repealing” ObamaCare. The first is keeping the current provision on pre-existing conditions, probably the biggest source of economic distress in Obamcare and healthcare in general. Insurers did not cover pre-existing conditions in individual policies for economic reasons. That limitation, along with lifetime coverage limits and pre approvals were the major problems with existing health insurance. ObamaCare eliminates the pre-existing condition requirement. Many of the people rushing into the exchanges are those with expensive pre-existing conditions, which makes eminent sense and is highly foreseeable. It’s politically impossible to terminate an entitlement program upon which millions have become dependent. Pre-existing coverage is a political given, but expensive. The second issue is the expansion of Medicaid. ObamaCare greatly expanded Medicaid by raising the eligibility limit to 400% of the poverty level. Medicaid is an example of a politically popular program headed to economic disaster. It covers about half of all births and nursing home admissions in the United States and is the primary source of coverage of those with disabilities. States control costs by squeezing providers, such that an ever shrinking number of healthcare providers accept Medicaid patients. Escalating demand while restricting supply is a disaster. The only question is when it will implode. Millions of Americans enrolled in Medicaid pursuant to ObamaCare. Once again, these Americans cannot be thrown out of Medicaid without health coverage. Both the House and Senate bills will retain pre-existing conditions coverage and reduce Medicaid over a number of years, but not immediately. In other words, the Republicans are kicking Medicaid down the road. Critical provisions that will provide a boost to the American economy are the elimination of the individual mandate, the repeal of the scores of Obamacare tax increases, and the relaxation of coverage mandates. Medicaid is a drain on state budgets, often the largest expenditure and growing. The initial increase in Medicaid enrollment was covered 100% by the federal government, but it's share is dropping, placing a greater financial burden on the states. The Republican proposals will convert Medicaid into block grants with great discretion in the states in deciding how to allocate the funds. States currently have little discretion, except in squeezing providers. Of course, the demagogues in the Democratic Party are attacking the Republican proposals, echoed by the media. House Minority Leady Nancy Pelosi, with her usual hyperbole, said “We do know that many more people – millions, hundreds of thousands – of people will die if this bill passes.” ‘Millions, if not hundreds of thousands,” of America died before ObamaCare was enacted, during the past 8 years of ObamaCare, and in the future with or without ObamaCare. She also called it “mean and heartless.” Senate Minority Leader Chuck Schumer said it was “heartless” and a “wolf in sheep’s clothing.” “Heartless” must be the focus group word of the week. California State Treasurer and aspirant Governor John Chiang said the Senate bill will result in 200,000 in California losing their jobs. Hillary Clinton asserted the Republicans will become the “Death Party” if they enact the Senate bill. Senator Elizabeth Warren called the Senate proposal “Blood money.” She claimed we would pay for the tax cuts with human lives. Her soulmate, Senator Bernie Sanders, called it a “barbaric and immoral piece of legislation.” He was more restrained than Representative Pelosi in estimating the casualty rate from the republican proposals, only asserting “thousands will die.” They are calling the proposals a tax break for the wealthy, such that the sick will subsidize the rich, such that Senator Richard Durbin labeled it a “tax cut for the wealthy.” He compared the Senate draft to the previous House proposal: “Put a lace collar on a pit bull and it’s still a mean dog.” Senator Sanders said the Republican proposals constitute a “massive transfer of wealth from working families to the very rich.” The reality, of course, is that the young and workers are subsidizing the ill and elderly. It’s called the individual mandate. The unsubsidized insured under ObamaCare face escalating premiums, high deductibles, and a limited pool of doctors. The Republicans need to understand that these are dangerous times for politicians; it is not politics as normal. The Republican landslides of 2010, 2014 and 2016 were caused by popular opposition to ObamaCare. Brexit and the election of President Trump further illustrate the vagaries of today’s body politic. 2017 is their chance to slow down, if not prevent, the collapse of the current American medical system. The voters who elected them can just as easily vote them out of office. ObamaCare is the defining legacy of President Obama and the Democratic Congress of 2008-2010. The act was viewed as a step on the path to single payer. The Democratic presumption was that if ObamaCare failed, which it would, then the next step would be single payer. ObamaCare is in a death spiral. The Republicans have two choices: 1) They can suck it up and vote for an ObamaCare replacement; or 2) Be voted out of office in 2018 and await the enactment of a single payer plan, in which case President Obama has won and the American people have lost.

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