Tuesday, March 28, 2017

ObamaCare Lives Another Day

In case you somehow hadn't heard the Republican members of the House of Representatives could not come together to support the American Health Care Act (AHCA). The more right wing members of Congress refused to support anything that wasn't a total repeal of President Obama's signature legislation. I don't have a lot to write on this at the moment both because (1) I've already written at length why I think that the law (PPACA or ObamaCare) that the AHCA was designed to replace is destined for a slow ignominious demise and (2) my Day Job supervisor has taken the time to make it crystal clear what my true priorities are during quarter close. And they aren't blogging. But I do just want to say that I think that both the defenders and detractors of ObamaCare are missing some critical points by getting lost in the partisan weeds of denying President Trump a win or trying to ascertain who is up and who is down in the Byzantine politics of Washington D.C.

Numbers don't lie. The PPACA is a bad deal for younger healthier people. It doesn't reflect their expected value or risk. It's mispriced. Younger folks will, all else equal, continue to avoid enrolling in the expected or promised numbers. That's not going to change. The other thing which isn't going to change is that some of the very people who for the past seven years ran around spitting at ObamaCare, waving "Obama is a monkey" signs and voting for people who swore blood oaths to rip up the PPACA root and branch, turned out to have a different feeling about ObamaCare when Uncle Bud was covered for the cancer meds he needed or Cousin Sherri finally got enrolled in a program to help with her opioid addiction. There are relatively few people who will, if push comes to shove, place their ideology over their survival. They won't brag about this. It's not the stuff of heroic stories. But it is human nature. And even a lot of big bad Republicans who wanted to kill ObamaCare still flinched away from taking away popular benefits.

Now that there is Republican control of the executive branch with all of the awesome discretionary prerogatives included with that, Trump and his minions could accidentally on purpose help along ObamaCare to an early grave. And there wouldn't be too much that Democrats could do about it. Or given Trump's desperate need for adulation, he could attempt to reshape the PPACA via executive fiat and administrative rule making into something that keeps coverage for many voters but slows skyrocketing premium and deductible growth. I don't think this will work even if Trump were a detail oriented policy wonk, which he is most assuredly not. So the most likely scenario is that the PPACA continues to limp along until the next midterms and then the one after that and so on. It's never going to be unpopular enough to kill. But it will never be popular enough to fix either. 
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