Saturday, January 17, 2015

ObamaCare Progress Report

The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.

Franklin Delano Roosevelt (1882-1945), 1938 speech

It ‘s time for an ACA progress report.

• Marilyn Travenner, CMS head, announced she is retiring in February after 5 years in office. She is noted or blamed for 3 things. She oversaw: 1) the disastrous first launch of health exchanges; 2) double counting 400,000 people in federal dental plans to reach an enrollment goal of 7 million in that launch; 3) the historic expansion to Medicaid, now covering nearly 70 million Americans. Travenner's successor will have to be prepared to adapt to a disastrou Supreme Court decision on federal exchanges which would cause millions to drop or cancel plans and disrupt the entire insurance market.

All told, today there are 10 million more insured Americans, 5 million or more who are receiving federal subsidies.

• There is much chatter among the political classes about what will happen if the Supreme Court rules against subsidies in federal exchanges in June. A few words about background. Obamacare proposed to expand coverage by two mechanisms: 1) expanding Medicaid, which is a mission accomplished; 2) creating regulated insurance exchanges, in which lower income people would be subsidized, which remains up in the air until the Court acts. The ACA wording restricts subsidies through exchanges “established by the states.” King v. Burwell plaintiffs claim that wording makes federal exchange subsidies illegal. Only 14 states have health exchanges; 36 do not. If the Court ruels against federal subsidies, that might leave 10 million out in the insured cold. There are 4 options to address the problem:

1) Let ObamaCare burn, i.e. collapse of its weight and let 10 million now subsidized suffer consequences of being uninsured.

2) Fix the wording of the law so that 10 million will continue to uninsured and ACA will go forward as is.

3) Wait for 36 states to build their own exchanges to their citizens can become eligible for exchanges.

4) Repeal , replace, or change ObamaCare with a GOP plan covering the 10 million while expanding coverage for other uninsured, presumably with universal tax credits. The GOP has yet to formalize and advance such a plan, and Congress would have to pass it under the threat of a Presidential veto.

That the progress report. Perhaps limbo report would be more appropriate.

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