Friday, April 7, 2017

Trump’s Plan to Make Sure Obama Care Implodes

Trump has recently made the point that, instead of his recent “repeal and replace” effort, he simply should have let the Affordable Care Act (aka the “ACA” or “Obamacare”) continue and fail on its own. Then he could get the undefined, ambiguous and under-thought RyanCare (Trumpcare?) plan slide through Congress, because there would be nothing else in place.  But Donald Trump seems to be hell-bent to make sure the ACA fails. Let’s look at how that he expects to bet that done.
First, every piece of seminal social legislation enacted in the modern era has routinely been amended numerous times. It is literally impossible for legislators to enact a “perfect” piece of such major policy changes the first time around. Nobody expected it with ACA either. For example, the 1935 Social Security Act was seriously amended and refined 1939, 1950, 1952, 1954, 1956, 1958, 1960, 1961, 1965, 1966, 1967, 1969, 1971, 1972, 1973, 1977, 1980, 1981, 1982, 1983, 1984, 1985, 1986, 1987, 1989, 1990, 1993, 1994, 1996 and 2000. And while there were precursor statutes as early as 1956, the modern version of Medicare was formally enacted in 1965, but, in addition to several lesser amendments, the law experienced major overhauls in 1972, 1987, 2003 and 2006.
President Obama himself wanted to make some major changes in the ACA, especially after the Supreme Court ruling that partially sustained and partially limited that statute. For example, in order to get the law passed in 2010, Obama reluctantly agreed to let the pharmaceutical industry to charge their full retail prices for prescription drugs without giving the newly-authorized massive healthcare exchanges the power to use their bargaining strength to negotiate for reduced prices. With prescription drugs placing a staggering pressure on rising healthcare premiums, this provision needed to be revised. But a GOP Congress would only entertain total repeal but no amendments. So a refusal to fix the statute has contributed to its obvious flaws.
But Donald Trump’s plans are more directly aimed at making sure that the ACA will implode. How? “The stealth battle began on Inauguration Day, when Mr. Trump signed an executive order giving his agencies wide latitude to weaken the law… Almost immediately, the Department of Health and Human Services scaled back advertising aimed at encouraging people to enroll in a health insurance plan by the Jan. 31 deadline for 2017… No surprise, then, that sign-ups for this year came in a bit short of expectations.
“Next, the Internal Revenue Service announced that it would continue to allow taxpayers to file their returns without indicating whether they had complied with the mandate to have insurance. Assertions to the contrary notwithstanding, this was quickly interpreted to mean that those failing to comply with the health care act’s insurance requirement would not be assessed penalties.
These may sound like small potatoes, but the requirement that all Americans have insurance is at the heart of Obamacare. Without maximum participation of healthy, young Americans in the insurance exchanges, insurers cannot afford the cost of covering older, less healthy individuals…  That’s the essence of why companies have been dropping out of the marketplace, creating the risk that counties in states like Tennessee and Arizona may have no insurers participating.
“Much more seems on the horizon. This month [March], Tom Price, the secretary of the Health and Human Services Department, tweeted: ‘There are 1,442 citations in the #ACA where it says. ‘The secretary shall …’ or ‘The secretary may …’ @HHSGov, we’ll look at every single one.’” Wall Streeter, Steve Rattner, writing in New York Times, March 28th. So the head if HHSD, charged with implementing the ACA, has pretty much told us he won’t support that law or actively enforce its requirements. And the money necessary to fund the ACA was being sucked out of the system by a government unwilling to collect what is legally mandated. Without funding, of course Obamacare would fail.
Not everything that Trump has been completely negative, but his overall vectors to date, unless reversed, will inevitably lead to the collapse of the ACA. “To be fair, the administration’s actions to date have not been completely one-sided. In February, to provide more certainty to insurers, H.H.S. set stricter limits on sign-ups outside the defined enrollment periods. The Republicans even incorporated one good idea in their failed bill: a $100 billion pool that states could use to help cover the cost of insuring very sick people, thereby shoring up weak exchanges. There seems little chance of that happening now.
“But the White House has been silent on a major issue: whether it will continue to fight a lawsuit by House Republicans intended to eliminate subsidies to low-income Americans to help cover their deductibles and co-payments.
“If the effectiveness of the A.C.A. is diminished — whether by affirmative moves by the Trump administration or passive resistance to needed improvements — rest assured that the Republicans will try to blame Obamacare’s supporters. Mr. Trump may not know how to govern, but he’s proven his ability to conduct Twitter wars.” Rattner.
Donald Trump is figuring on his followers’ willingness to believe his ultimate assertion that Obamacare was destined to collapse… even if it is his sabotage of that statute that is likely to be the real reason for any failure. Like a fox lying in wait, Donald has laid the trap that he expects Obamacare to fall into… and then his impoverished constituency will be grateful for even the most minimal of healthcare coverage. Oh did you hear, the GOP is thinking about resurrecting their “repeal and replace” mantra. Oy!
I’m Peter Dekom, and Mr. Trump will be able to say, “you should have passed what was proposed the first time before Obamacare collapsed”… and blame the Democrats accordingly.

1 comment:

Anonymous said...

New York Times April 7:
"In contrast to the dire pronouncements from President Trump and other Republicans, the demise of the individual insurance market seems greatly exaggerated, according to a new financial analysis released Friday.
"The analysis, by Standard & Poor’s, looked at the performance of many Blue Cross plans in nearly three dozen states since President Barack Obama’s health care law took effect three years ago. It shows the insurers significantly reduced their losses last year, are likely to break even this year and that most could profit — albeit some in the single-digits — in 2018. The insurers cover more than five million people in the individual market.
"After years in which many insurers lost money, then lost even more in 2015, “we are seeing the first signs in 2016 that this market could be manageable for most health insurers,” the Standard & Poor’s analysts said. The 'market is not in a ‘death spiral,’ ' they said."