Tuesday, December 16, 2014

Can GOP Fix ObamaCare?

What’s done is done and cannot be undone.


I belong to the school that says things will never be the same after ObamaCare.

What’s done is done and cannot be undone completely. No, but it can be partially redone.

As the New Year approaches and the GOP takes control of Congress, there’s a lot of talk of how Republicans might undo ObamaCare.

Much of this talk centers around the Supreme Court decision due in June on whether the health law’s wording allowed the Obama administration to offer subsidies through 36 federal health exchanges. What happens if the Court negates these federal subsidies?
What happens if these subsidies continue in state exchanges?

One, the federal government could talk back subsidies from some 7 million people (the exact number will not be known until after the February 15, 2015 deadline of the second launch ends). This seems political untenable, unstable, and unsustainable) since it would result in skyrocketing premiums, the death spiral of health insurance markets, and a deafening political uproar about unfairness between liberal and conservative states. Blue states – like California, New York, Maryland, and Connecticut – which have their own exchanges could continue to offer subsidies.

Two, the Court could simply edit the law to include all states offering exchanges, whether federal or state run, causing the law to remain essentially intact.

Three, the GOP could pass alternative legislature that would repeal ObamaCare and end subsidies for all and replace the subsidies with tax credits for all and allowing buying of plans across state lines, presumably lowering premiums through competition, or lowering costs by permitting patients the freedom to choose their own plans, free of comprehensive cost-raising regulations, coupled with such market-based changes as health savings accounts and catastrophic ceilings on costs.

Four, the GOP could repeal ObamaCare, make changes such as changing the definition of full time work from 30 to 40 hours, ending the excise tax on medical innovation companies, and ending penalties associated with the individual and employer mandate.

Whatever happens, the GOP must get its act together and put together a coherent, unified, pragmatic alternative to ObamaCare that makes sense to the American people and does not destabilize or cancel existing health plans, while at the same time, lowering premiums, deductibles and co-payments; decreasing the number of uninsured. And Republicans must do so with the knowledge they cannot redo the entire system and undo what has already been done. They can redo without completely undoing.

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