Sunday, February 8, 2015

The ObamaCare Olympics! (Repeal / Replace)

In June the Supreme Court is going to rule on a case (King vs. Burwell) that has serious potential to greatly weaken Obamacare by using the language in the bill itself to declare some of the federal government subsidies illegal (specifically, in cases where the state has not set up its own exchange). If this happens, the people in those states will still be on the hook for insurance but it will be far more expensive--probably fatally so.

The merits of the case (or not) are out of scope for The Omnivore (he reads analysis as well as anyone else but is not a lawyer nor an expert in medical-care law)--but the ramifications of the event are clear: this is the probably the best shot Republicans have ever had--and if they do not win the presidency in 2016 while keeping the House and Senate, the best they will ever get, for repealing Obamacare.

The path, however, is fraught with danger. The GOP will have to thread a delicate needle to capitalize on the opportunity, move quickly to attain, keep, and deliver on significant voter faith, and act with some degree of bi-partisan support to enact changes.

This is the Olympic-Feat level of governance. If the GOP proves up to it, their various missteps may be forgiven. If they bungle it, symbolically it should be the end of the party*.

What Must The GOP Do?
The window of opportunity opens immediately when / if SCOTUS rules that the subsidies are illegal. At that point there will be a blizzard of options on the table and there will be a crisis: 13.4 million people, largely in red states will lose their subsidies and be in danger of losing insurance. Click the link for an interactive map. There will, immediately, be a simple option on the table: pass a bill to amend the existing law by about 4 words.

This will be a "familiar" showdown: The Senate Democrats--a minority party--declare, as bloc, they will filibuster anything but a clean bill to amend the law. Obama declares he will veto anything but a direct legislative fix. The heat level for millions of people means this is ALL OVER the news. At this point, the familiar fault-lines will appear. This is the nightmare scenario--and, if you are honest--a reasonably likely one:

  1. The ideological House can (may) declare they will only present the Senate with full-repeal bills or some other go-for-broke (full illegal immigrant deportation?) rider.
  2. Senate Republicans--especially in afflicted states--watch their positives fall since the media-messaging is very clear that this "could just be fixed."
  3. Major insurance carriers, who currently profit from Obamacare and are institutionally afraid of tectonic legislative change, add their voices to the fray. This helps create a sense of "impartiality" that many marginal observers will believe.
  4. The GOP proposes an alternative but--in this scenario--infighting between the Let-It-Burn caucus and the We've Got To Help Our People (GOP Senators) caucus leads to a broken-glass mess of fractured and contradictory messaging, amplified by the media (who don't just 'smell blood in the water' but are doused with it, Carrie-style) convinces people that the alternative may never launch.
  5. What should be a concerted attempt to both present a viable alternative and pin the blame for the failure on Obama and the Democrats (no GOP person voted for Obamacare and the language was written by Democrats) collapses in an avalanche of falling poll numbers.
  6. The Stand Firm caucus (led in the Senate by Ted Cruz) tries to hold on--but afflicted states, with help from Insurance Carriers (the WellPoint company stepped in to help with the failing O-Care roll-out), enact a "work-around" that uses a cheap, quickly created 'front-end' over the existing Federal Exchange, claiming they have solved the problem (several states already do this). Republican threats to bring THAT up with a lawsuit look petulant and the clock--the clock is running out.
  7. Eventually everyone collapses and passes a fix with further legal action pending. The base defects.
If you--presumably a GOP voter--think this couldn't happen? GIVE THE OMNIVORE YOUR DEALER'S NUMBER. Seriously: this is the recurring pattern we've seen before. On the other hand: things ARE different this time.

What's Different Now?
Two things are different here than have been true before in similar show-downs. These are:
  1. The mess is NOT bi-partisan. Wrangling over government funding and the debt ceiling targets the nation as a whole. In this case, no matter what Team Obama says, the problem was created by their own hand (assuming SCOTUS finds a problem in the first case, of course). In this case it's the Republicans arguing for the "status quo" for once.
  2. The Republicans actually do have a viable-looking alternative that, while it hasn't gotten homecoming queen-level fanfare, could, if carefully rolled out and shepherded make a case for changes.
The two of these combined make an wide-scale reasonable case for Republican governance if they can be sold correctly and can convince a small number of Senate Democrats. If they can do that, then Obama has an insurrection on his hands and very well might take the blame for a veto.

What's That Plan?
 Here's a pretty good look at it. A few key points:
  1. It doesn't subsidize the middle class as much as Obamacare but it does give an Earned Income Tax Credit to lower incomes (for them to go buy insurance wherever). It won't insure as many people as O-Care but it doesn't just cast the poor out on the streets either. It's meant to be cheaper and more sustainable.
  2. It keeps many of the popular protections of Obamacare (but see below) like the kids-on-insurance-until-26 provision.
  3. It ends the Medicaid expansion (but, again, tries to make it more affordable to buy insurance in general).
  4. It removes a lot of the policy-requirements (like free birth-control) from the insurances. 
While some of these are marginal differences (no Medicaid expansion--but EICs--which mean you can get back more money than you paid in--meaning it's effectively the government sending money to the poor to buy insurance with) there are a few points you should be aware of:
  • The lack of restrictions on plans mean "junk plans" might arise--plans that are sold to suckers that appear to cover things  . . . but really don't.
  • The proposal grandfathers you in--but then, if you do lapse, you get hit with the pre-existing condition. This has potential to be a killer: if you are dead-ass broke and unemployed, you probably can't keep coverage (maybe there is some kind of "carry me for 10-cents a month plan?" The Omnivore doesn't know)--but if that happens or if scenarios are realistically posited, they'll draw sympathy.
Still, this is a reasonable looking plan. It seems like it could draw bi-partisan support. Even more important: it can be sold as a serious GOP-driven reform that is in the best interests of millions of non-rich, demographically diverse Americans.

What's The Problem?
The end-state: the GOP getting to roll-back, replace, and (arguably) improve Obamacare without having to overcome electoral hurdles and done in a way that leaves their hands clean (it was SCOTUS and the Democrats that killed Obamacare!) seems like a goal everyone on the Red Team would be driving for. Alas, The Omnivore isn't overly optimistic.

Firstly, the plan does provide a fair amount of "free stuff"--there are going to be ideological partisans--and maybe a lot of them--who won't go for that.

Secondly, this proposal does NOT require the actual repeal of Obamacare. This reality alone, that a hybrid solution might move forward, could feel like a loss or betrayal to much of the base. Already some Republicans are suggesting that a major change should wait until 2017--that is: if SCOTUS strikes down the exchanges, pass a legislative fix that lets them continue business-as-usual until 2017 (when both bills can be "on the ballot"). This is the kind of thing that sounds like a dream-come-true to the base who may believe that with O-Care on the ballot they can't lose! This isn't the case: millions of people who like being covered will resent being used as a political football. If the GOP loses the ours-is-better messaging war, the battle's over.

How much would bet on the GOP's SEAL-Team-Level Elite Messaging Machine?

Yeah: me neither.

So the GOP has its work cut out for it. It needs to consolidate around a plan that hits the center of the electorate (very hard), make its case to the electorate (hard), contain the no-compromises caucus (maybe impossible), and then move as one when the opportunity presents itself to act in a bi-partisan fashion and convince Obama that, in good faith, this is best for the country (unicorn-level).

We'll see.

* To be clear about that: bungling the chance to repeal or reform O-Care will not necessarily be the end of the party--The Omnivore isn't saying that. However, this event is pretty much core to the Tea Party's reason for existence. It represents the GOP's current ideological engine. If the Republicans can't manage to come together on this--with some degree intra and inter-party compromise and all that entails (meaning: governing a nation that is polarized and in danger of fraying) then, simply put, The Omnivore doesn't see how you make a case that it isn't time to give someone else--some other party--a chance.


  1. The Republicans' problem: Occam's Razor. Change the four words, simple. This will be the crux of the argument from the Dem's, and don't see how any argument that relies on wonk-speak could beat it.

    1. This is true--shutting down the simple-fix is going to be tough. They have several months to get out in front of this though and they need to make their case quickly and efficiently. This is Olympic-Level governance (or they could get lucky and the populace could decide this all really IS Team Obama's fault).

      It's a test.

      -The Omnivore

  2. The second problem is the requirement for "Olympic-Level governance" when the R's have shown, time and time again, to be incapable of Junior-High level governance. Especially with an election season coming up, there are just too many people vying to 'out conservative' each other who will be front-of-line to represent the "Let It Burn" caucus.

  3. There is so much about our private-sector health-care insurance solution that makes no sense.

    It makes no sense to fracture health-care policies between haves and have-nots, where the haves can afford reasonably good insurance while the have-nots can only afford crappy and evasive policies that offer little in quality care. All citizens should be offered the same, quality base level of health-care.

    It makes no sense to fracture health-care such that if patient-Bob needs to go to fully qualified doctor-Jerry, he can't because doctor-Jerry is not on Bob's insurance-company "providers list". All qualified doctors should be 'allowed providers'.

    It makes no sense to argue that single-payer health-care insurance "puts government bureaucrats" between doctors and patients, when we've had private-sector bureaucrats interfering in medical decisions for decades. I'll trust a government bureaucrat before I trust a for profit health insurance industry. Both may want and take profit at my expense. But at least the government entity does not have fiduciary responsibility to stock-holders to do so.

    It makes no sense to ague that the government can't be trusted to be financially capable of managing health-insurance, and instead trust it to a for-profit insurance industry whose profit-motive is intrinsically opposed to patients getting health-care.

    There are so many arguments that point to single-payer, tax-based health-care (or insurance if you prefer) as the wisest path to take. There are many arguments in opposition to this, but while a few hold merit, most of them fall apart in comparison to their single-payer corollary.

    The solution we have in this country for health-care insurance/cost-coverage is pretty awful. I mean, the mere fact alone that we overwhelmingly tie affordable health-care coverage to employment should be motivation enough to say "uh, no no. This has GOT to be tax-based, dude!" I mean, that just makes no sense. None. Nobody should be forced to either give up health-insurance for his/her family, pay an extortionistic increase in premiums to keep it, or move to a cheap but barely-existent plan; just because, or hell with it - especially when - they've lost their job.

    Many things belong and do best in the private sector. Health-care insurance/cost-coverage is not one of those things. Private sector competition in the automotive industry makes car companies build better cars for better prices. Private sector competition in the health-care insurance leads to ever evolving cutting of costs - too often by reducing care for patients. Denial of service, delay of payments, obfuscation of coverage, bureaucratic run-around between departments; these are all tools employed liberally by the private, for-profit health-care insurance industry.

    I don't delude myself into thinking that a single-payer, tax-based solution will be trouble free. But this private-sector answer we have now, and all the efforts to 'reform' it - including the Affordable Care Act ... it's just perfume on shit, man. It still stinks something awful. Only the Medicaid-Expansion aspect of the ACA shows some glimmer of hope of evolving towards something better. It should be expanded more. It should be expanded to everyone in the country.