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Monday, September 25, 2017

Forgetting the Lessons of Obamacare: Not ready for Prime Time

There were many who warned that Obamacare, the Affordable Care Act, was not ready for prime time. Amidst the bickering it emerged that this was largely true and has remained true up to and including now.

There might be disagreement as to why the rush to passage of the law. For me, it's obvious that Obama's Administration rushed to pass before the real focus of the law, a partnership between insurance companies and the federal government to save both money on insurance costs per person, was discerned and revealed and that the rush represented the ego of the "I" President, (criticized often for his overuse of the pronoun "I") to pass something.

Nevertheless, few would argue that the law was a sloppy mess that baffled with bullsh*t and as its more draconian provisions unfolded added credibility to the statements revealed of Obama's key man Jonathan Gruber, described as an "architect" of Obamacare that the law relied on "the stupidity of the American voter."

So what makes a bill not ready for prime time using the lessons of Obamacare? First, one that uses timing mechanisms for its more draconian provisions, especially when those deadlines are coincidentally post election, such as the individual mandate provision that didn't take effect until after Obama's re-election (January, 2014).

Second, missing statutorily provided effective dates and picking and choosing which provisions would take effect, such as the employee verification that was supposed to be done prior to federal dollar entitlement payouts to Obamacare participants, that did not happen. Such as the Cadillac Tax, set to come into play for 2018, now from its original statutorily provided date.

Third, inability to track costs where after one year the CBO stated they would only count insurance only expenses to government because they were UNABLE to calculate other government costs such as public employees, their benefits, new staffing, new infrastructure that the government spent and we paid for in connection with Obamacare. The ONLY numbers that Obamacare touted were the savings on what was paid out per person on behalf of individuals in entitlement programs such as Veterans benefits, Medicare.

Fourth, immediate lawsuits necessary in order to clarify language such as the Medicaid expansion provisions stricken down by the Supreme Court in 2012, or the King v. Burwell, 2015 decision where the government argued and won the right to pay out more money in entitlements desperately afraid that with the failure of state exchange establishments that Obamacare would disappear without this payout to individuals.

Fifth, the immediate worsening of health insurance conditions for the majority of Americans. At its best, Obamacare worsened health insurance choices for over 300 million Americans. At its best pie in the sky guesstimates of enrollment, only about 11 million Americans enrolled in Obamacare entitlement policies and expanded Medicaid, also is an uncertain number.

Further, for those outside the Medicaid and Obamacare circle, MOST Americans, ended up paying more, a lot more for health insurance benefits and getting less as all insurance policies sunk to the bare minimum levels of Obamacare basic requirements and provided the low-hanging fruit of checkups, etc. by raising individual costs for copays, coinsurance and deductibles. Further, the unaffordability of dependent coverage accounted for the loss of health insurance by about five million American family dependents.

Sixth, the restatement of the problem in order to make it look like the law was "working." Remember the initial problems that were supposed to be addressed? Saving families $2500 a year, keeping their own doctors, having health insurance like the President's family, coverage of pre-existing conditions and all while getting more of those without health insurance covered? That didn't happen, so it became a phony numbers game of how many enrolled in the entitlement program of Obamacare and the "Yea! We're covering those with pre-existing conditions," rant that IGNORED the abject failure of Obamacare for the majority of Americans as stated in its original goals.

Seventh, the misuse of language. From the misuse of the term group insurance, (yes, Obamacare handouts were available to a group, no it isn't group insurance), universal risk group (no, the law itself singled out people for surcharges based on age and tobacco use from the get-go), to bizarre claims that it represented universal health coverage (too dumb to even address), President Obama persisted in his false claims about the law until the very end of his term. This fake terminology not only is misleading but prevents addressing the problems.

Eighth, how great is a law whose passers immediately explain why they don't have to be subject to it? That's what happened with Democratic Congressmen and their ilk who IMMEDIATELY excluded themselves from compliance by successfully claiming that they had employer coverage and therefore Obamacare did not apply, ignoring the fact that we pay upwards of 72 percent of their premiums for their superior benefits that they get from public employment in the federal government. Hardly an "atta-boy" achievement.

Republicans, again excluding themselves from having to comply with whatever law they conjure, again, presenting last minute tweaks and adjustments, again vague on the details, again, talking timing, are continuing President Obama's legacy of trickery and bad law. It's THE reason that first the law must apply to public employees.