ObamaCare Challenges Ahead

(Civilizations) break down and go to pieces if when challenges confront them which they fail to meet.

Arnold Toynbee (1889-1975), Civilizations on Trial (1948)

The new frontier of which I speak in not a set of promises – it is a set of challenges.

John Fitzgerald Kennedy (1917-1963), Speech accepting Democratic Presidential Nomination, 1960

Despite the 7 million health exchange enrollment figures, challenges loom. or perhaps I should say "lurk,"  ahead for ObamaCare.

·       

•        The principle challenge is figuring out what,  if anything, the 7 million numbers mean.   The government has been tight lipped about the mix – how many paid, how many were previously uninsured,  how many were young,  how many were healthy or  sick, and how these numbers affect adverse selection and premium levels, and what the numbers were in key states.

• ·         A second challenge  will be  how  to respond  if the premiums  and deductible announced in May engender an angry public reaction.

• ·         A third challenge will be what to do if the enrollment figures fail to lower the number of uninsured – the original goal of ObamaCare.

• ·         A fourth challenge will be simplifying the online enrollment process and taking the mystery out of it for the next enrollment period  on November 15, 2014.

• ·         A fifth challenge will be how to deal with  significant  increases in  Medicaid numbers.   Who will care for them? Less than 50% of physicians now accept Medicaid patients, primary care physician shortages mount by the day, 10% of primary care doctors are abandoning independent practice and entering  3^rd party-free, cash-only practices, and more than 50% are already working for hospitals, where they have shorter hours..    Is the answer more community clinics,  more mid level practitioners,  or higher pay for primary   care practitioner.

• ·         A sixth challenge will be what to do if Republicans take on the Senate of November 4. 2014.  The current odds are they have a 60% to 80% chance of capturing the Senate.

If a GOP Senate victory should occur, President Obama will be a health reform lame duck.  He will have veto power, of course, but he and Democrats will have to decide between stalemate, salvaging ObamaCare,  and compromising.   For example what will they do about proposed cuts for Medicare Advantage plans,  to which 30% of seniors belong.  Seniors will  bean indispensable and reliable voting bloc in the 2016 Presidential elections.

Republicans, on the other hand, if they are to win over the independents, the young, women,  and Hispanics,  must decide how to proceed with repeal or replacement, and offer must, in my opinion, offer a  positive, attractive, and clearly understandable alternative health plan to attract support for their candidate.  Among other things, the plan should probably include malpractice reform, more health savings accounts,  shopping across state lines,  tax credits for individuals as well as employers, risk pools for the sick to keep premiums low, discounts for seniors falling into the donut hole,  limits of lifetime spending, and coverage for those with pre-existing illness and for young adults on their parents plans.

·         A sixth challenge,  for Democrats and Republicans alike, will be what to do if the Republicans take  the Senate on November 4.   If that should occur,  President Obama will be a health reform lame duck, if not a dead duck, and Democrats will have to decide how to salvage ObamaCare and what compromises to make.   For example,  what will they do about proposed cuts for Medical Advantage plans, cuts that will anger seniors, the most reliable voting bloc.  

Republicans, on the other hand,  will have decide how to proceed on repeal or replacement, or what alternative reform plan to offer.  The GOP will need  to present a united , positive, clean, and attractive  alternative plan to attract public support.   That plan might include malpractice reform,  more health savings accounts, unbundling of primary care from specialty care,  universal tax credits to include those in individual markets,   risk pools to keep premiums low for those with pre-existing disease.  and retention of popular ObamaCare features, coverage of those with pre-existing conditions,  young adults under their parents plans,  and discounts for seniors falling into the donut whole.

Tweet:  Significant political challenges are ahead for Democrats and Republicans  as midterm elections approach.