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AHCA and the circular firing squad

Senate Republicans are not going to pass the AHCA.

Here’s why.

credit NYTimes

23 million Americans would lose their healthcare over the next decade.

14 million of those lose their coverage next year – an election year.

Anyone who’s been elected to the Senate is smart enough to know that taking benefits away from your core supporters is political suicide – and make no mistake, AHCA does precisely that.

Core Republican voters are those most hurt by AHCA; lower-income seniors would see their health insurance premiums explode, jumping almost ten times to $16,100.

But it’s not just about coverage – it’s about employment; healthcare systems, doctors offices, insurers and other businesses would shed 1.8 million jobs by 2022. These are well-paid positions, averaging well over $55,000.

That’s $99 billion in wages alone sucked out of the economy.

Here’s what I see happening.

Senate Republicans know they’re screwed if they pass AHCA as is. So, they may claim they’ve delivered on campaign promises to repeal-and-replace “Obamacare” by passing  some legislation – any legislation – that lets Republicans claim they tried to repeal “Obamacare”.

Then, when the House rejects their bill, the Republican Senate can blame it on House Republicans.

Doesn’t matter if you’re a Trump Republican or a Bernie backer, the cold hard political reality is there’s no way to lower premiums, cut budgets, and improve coverage. Anyone with any experience knew that, and knows that.

What does this mean for you?

The circular firing squad is forming.


4 thoughts on “AHCA and the circular firing squad”

  1. Hi Joe. Thanks for the info. Sorry I missed you at the New Mexico Conference. I couldn’t attend this year. Jessica Dahrling works for the same company I work for (Orchard Medical) and she said she had a chance to speak with you and that she really appreciated your presentation. She also shared your PowerPoint presentation with me. Great info. Thank you!

    My thoughts on this article…

    It’s political suicide whether they pass AHCA or not. Passing it obviously has its downfall but not passing it also makes millions of people upset. They lose either way. Very smart move by the Democratic. Giving people free or cheap health insurance through a socialistic program locks them in for future vote. Once something is free or cheap then all hell breaks lose if taken away. It is a no win situation for the Republicans. Well played Obama.

    So now what’s the solution? What do we do? Leaving Obamacare as it is definitely isn’t the solution. The train is still wrecking. How do we solve the problem of Obamacare? There are millions and millions of people that would like to know.

    Are we at a point of no return? Is there any way to solve the massive costs of insurance premiums thrown on the successful hard working wealthy people and successful hard working middle class?

    1. thanks for the thoughtful comment Spencer.

      couple observations. I wouldn’t describe ACA as “socialist”. Systems such as those in France, Great Britain, Switzerland and Denmark fit that label, but ours does not as it relies exclusively on private and not for profit insurers to provide insurance and non-governmental providers to deliver care.
      In terms of solutions, this depends on what you want.
      If you want lower-cost insurance with broad benefits, then Medicaid for all is the solution.
      If you want the free market, then that’s what we have today.
      When one closely examines which plans are winning in the individual market, it is those with deep experience in Medicaid.

      There is no free lunch; fee for service drives cost, and higher medical costs drive higher share prices for insurers. If you want lower cost and better care in the current system, then you have to control cost via narrow networks or rely on increasingly high deductibles.

      Those successful wealthy and middle class folks you mentioned want choice, low cost, and flexibility. As costs escalate, that’s become unrealistic. You can’t have your cake, eat it too, and not get fat.

      That’s just reality.

  2. Spencer, I echo your sentiments.

    Joe, forgive me if I’m understanding you wrong. No free lunch? Those successful wealthy and middle class people you refer to are footing the bill for a lot of unnecessary and elective medical bills (such the rampant millions upon millions of dollars in medical fraud, abortion, and the sex change operation for an inmate) and for a lot of people who could pay their own way if they chose to. Yes there are needy US citizens who legitimately need help, but wasn’t that what Medicare was and continues to be all about? Putting the blame on wealthy and middle class people seems an awful lot like California’s Governor, Jerry Brown, calling the tax-paying citizens “freeloaders.” There’s no doubt the system is broken, but really – let’s put the blame where it belongs and not on people paying their own way AND the way of others.

    1. Hi Sue – thanks for joining us.

      Couple observations.

      First, we all live in this country, and all of us get to contribute. Sometimes that means our taxes pay for things we don’t like; I don’t like paying for a lot of things like Iraqi wars, ethanol subsidies and supermax prisons or healthcare for motorcycle riders who don’t ride with helmets and crash, but that’s part of the deal. If someone doesn’t like abortions or sex change operations, then they can go to the courts or their legislators. You may think certain procedures are “unnecessary or elective”, but that’s your opinion. I’d suggest others may think some things you value are also unnecessary or elective; I recall an employer I worked with who did not want to pay for HIV medication or mental health services.

      One other example – addiction treatment. It’s been remarkable how opinions have shifted on this over the last few years.

      Second, I believe you are referring to Medicaid when you describe needy citizens. Medicaid is at significant risk due to AHCA and Mr Trump’s budget outline.

      Third, I don’t believe I blamed middle class and wealthy people for the political mess – this isn’t about blame, but rather bringing clarity to the discussion. Politicians have been telling these people they can have it all, and they can’t. It’s crystal clear that we will never return to the cheap health insurance and broad networks of the seventies. The sooner we all recognize this the better.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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