On December 12, 2016, NPR's Alison Kodjak gave us our next warning article of what MIGHT happen ("Obamacare's Demise Could Be Quicker Than Republicans Intend") if Republicans pursue the idea of repealing Obamacare but delaying the effective date of the repeal for two years while they come up with a replacement plan.
First, reality, Obamacare for 2017 is the same as its been with the non-Republican changes that there are fewer insurance companies participating on exchanges because the reality of the temporary payoff provisions to insurers under risk reinsurance and risk corridor payments expired for this year AND with the reality that insurance policy prices increased for consumers at an average of about 22 percent. Still, with the payoff by government of subsidies, the impact of those increases are disguised somewhat for the at most 11.1 million exchange users, a courtesy unavailable to the rest of the population that's been enduring the brutal increases with DECREASING assistance.
Second, like Alison Kodjak, I believe there should be no timing game played by Republicans which would mimic the timing game played by Democrats with Obamacare with both planned timing manipulations such as delaying the most consumer unfriendly policies of the 2010 Act from kicking in until 2014, with consumers finally understanding how bad the law was at the end of 2013 when we had the keep-your-plan fiasco and other lies surface AFTER Obama rode Obamacare and the lies he told about it into a second term in 2012. Then there were the unplanned timing delays, everything from the procedural enrollment times to the substantive application of the employer mandate to the stepped slashes to Medicare that are still occurring. No, timing games work against consumers.
Naturally, Ms. Kodjak dislikes delay for another reason--she wants Obamacare.
But let's get to her fears. First, she worries for insurers and the end of Obamacare's creation of a "market for health insurance that didn't exist before," naturally removing a law that forces people to purchase the consumer financial product of health insurance of pay a penalty creates a new "market," much like forcing people to study Greek Mythology will up the sales and the cost of the new textbooks for the required cost.
From this loss of forcing us all to purchase insurance, Ms. Kodjak continues to worry that insurers who know that repealed Obamacare will not be around after a certain date will not be motivated to participate on exchanges and will pull out--Ms. Kodjak seems unbothered by the exodus of insurers THIS YEAR, during Obama's presidency after the Act's intended end of temporary payoffs to insurers under risk corridors and risk reinsurance provisions and that those remaining raised their prices on the average of 22 percent.
Then NPR goes back to the 20 million number of people who gained health insurance, some on exchanges, some because of expanded Medicaid, and some because parents can insure their grown children up to age 26.
Here's what logic should tell us--if you give people a choice then some people will likely CHOOSE not to have health insurance, so the "20 million" which is a guesstimate number that not only has fluctuated wildly because it omits significant factors such as those who had health insurance options that disappeared under Obamacare forcing them to go into the counted roles of "exchange folk," or Medicaid folk, will go down.
Then there's expanded Medicaid, which today 31 states and DC have adopted and 19 have not according to KFF.ORG shows in an October 2016 map, "Current Status of State Medicaid Expansion Decisions." More importantly, (see Status of State Action on Medicaid Expansion, 10/14/2016, KFF.ORG), those states did not have expanded Medicaid available for their citizens until 2014, four years after the Act's passage with some states lagging behind into 2015 and even 2016. Medicaid expansion was PHASED in and what can be PHASED in can be PHASED out.
Further, as one of the disgraced "architects" of Obamacare has revealed, millions of those who got Medicaid in the past two years WERE ALREADY ELIGIBLE FOR MEDICAID, in what Jonathan Gruber referred to as "coming out of the woodwork."
Then there's the very shaky part about the swelling in enrollment via expanded Medicaid which is that that expansion, in stark contrast to the lower enrollment than anticipated in exchange plans year after year, was higher than anticipated which means that under the grotesque amount of authority given to HHS (Department of Health and Human Services) that includes CMS (Centers for Medicare and Medicaid), there would be changes since the government changes how much it spends--even as recently with not honoring what they owed to insurers under the risk corridor payment to insurer provisions ("Feds short insurers $2.5 billion on exchange plan losses," Bob Herman, 10/1/2015).
Finally as to Ms. Kodjak's third concern, about the up to 26-year-old coverage, let's remember there were 20 states that had such insurance law and options to their residents BEFORE Obamacare. Let's also remember that insurers win when they offer this coverage by getting younger people whose parents are purchasing plans for them to join in the risk pool AND get the better health insurance their parents purchase--Two persistent problems with Obamacare and its phony "single risk pool" idea.
And then Ms. Kodjak proves the point, citing the new threatening "memo" from the insurance lobby that naturally supports continuing the individual mandate, supports government payments to cover people's premium and cost-sharing bills and supports elimination of taxes on insurers, hardly an argument from the consumer side. Said bluntly, "The big problem is that through Obamacare, the government plays a huge role in helping people pay for insurance on the individual market. Many insurance companies are already losing money on those policies, so if they think the government won't keep offering subsidies, insurers may just stop selling individual policies altogether." And so we get the next threat. If they don't get government money they won't play ball and we know it's true because look what happened with the termination of the government's temporary payoff programs of risk reinsurance and risk corridors.
But instead of looking at this logically, that feeding the monster and giving in every time it has said, "MORE," is NOT going to prevent continued threats, which is what Obamacare created in its partnership with insurers, Ms. Kodjak should focus on the positives--OK, don't offer the plans. The uninsured rate swells. Medical care is unaffordable. If no one can afford medical services except for a minority, then providers will lose their customers and raise prices for their remaining customers until those customers can't afford their product either.
Any way you look at it an Obamacare approach fails, as much and more so than what we had before, because insurance companies have had years to craft ways to offer less coverage for needed medical services and charge more for their plans with the assurance that people HAVE TO buy them during the Obamacare years.
The law needs repealing and I agree, it shouldn't be either the real slow death of what's been going on this year with Obamacare or the manufactured slow death by Republican Obamas like Paul Ryan, whose ignorant ideological stances from their entrenched governmentally-protected lives makes them the smug deaf ears upon which the perpetrators of the US healthcare crisis have relied upon for decades.
Look at what Ms. Kodjak is warning: If healthy people aren't forced to purchase policies health insurers won't write individual policies. If the government doesn't keep paying insurance companies to insure people on exchanges, insurance companies won't participate on exchanges. Those are threats and giving into them has not prevented insurers from making new threats to walk away.
Perhaps we should be looking at what's really going on with the bully pulpit of the heatlhcare conglomerate's partnership with our government, which in my opinion is arising to domestic government-sanctioned terrorism against consumers, especially those facing health issues (defined as "Acts that appear to intimidate or coerce a civilian population; (ii) to influence the policy of a government by intimidation or coercion," by Wikipedia). THAT's the consumer starting point.
