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ACA Deathwatch: Healthcare and Snow storms

Happy Monday!  Up here in the northeast we’re still digging out from a major snowstorm that’s a long way from being over.

I’ll make a lousy analogy; that’s pretty much what’s happening in DC.  For local governments, getting the snow off the streets is the political test that ensures mayors another term, or ends their political career.

Healthcare is the national equivalent, with a rather important difference.  Unlike snow removal, healthcare is devilishly complicated.  It’s not just coordination of more plows, salt, drivers, and tow trucks.

Premium subsidies are one example.  About $9 billion goes towards helping poorer folks pay their deductibles, copays, and other costs.  Back when Republicans were in the opposition, they sued the Obama Administration to block those payments. If the suit were to succeed today, insurers would suddenly find themselves forced to:

  • come up with the $9 billion out of their own pockets or
  • terminate coverage for millions of members.

Not surprisingly, Republicans have apparently decided to keep paying the premium subsidies for the time being.

Kicking-the-can-down-the-road doesn’t do anything other than prolong the inevitable, which, stated simply, is this: Congressional Republicans are stuck.  It’s not possible to ensure poorer folks keep their coverage while reducing costs and de-regulating the health insurance markets.

Pre-election promises that voters can “Have their cake, Eat it too, and Not get fat” are coming up against the hard reality that healthcare is really complicated; and insurance companies, pharma, doctors, and healthcare systems are in business to make profits.

For insurers to be profitable, they have to:

  • enroll lots of people by charging premiums low enough to
  • get enough healthy people to join so they can pay for sick peoples’ care, yet
  • set premiums high enough to pay pharma and healthcare providers so those industries make a profit;

Without premium subsidies, lots of lower-income people can’t afford insurance, insurance companies can’t afford to insure those people, and more and more healthy people will drop coverage. Republicans’ apparent decision to maintain premium support will keep things calm for now.  The individual market looks pretty stable – rate increases have stabilized and enrollment, despite Republicans’ efforts to hinder sign-ups, is adequate.

Eventually the healthcare “snow” is going to pile up deep enough that Congress is going to have to start plowing.

Either that, or this…

What does this mean for you?

Don’t expect much REAL progress on healthcare legislation in the next month or two.  Or maybe even longer.

Got your shovel ready?


4 thoughts on “ACA Deathwatch: Healthcare and Snow storms”

  1. Joe, here’s another analogy that comes to mind. In a few weeks we have the Houston livestock show and rodeo which produces more than 300,000 pounds of manure. I’ll let you connect the dots of why your comments remind me of shoveling manure! (:
    The Republicans are doing exactly what you screamed for – taking their time to work on a solution (not few months as Price just got in, but most say a plan by the end of 2017 with several years to roll it out?), not repealing without a replacement, and actually working with experts and healthcare companies on what would work best. And I bet you lunch that they will let all of us see their plan for input instead of “we have to pass it so you can see what’s in it”. Also, nobody is talking about removing all subsidies for the poor that need them – they are calling them tax credits instead of subsidies.
    We agree that this is an amazingly complex situation that will take time, but with adults finally in charge of leading this country I have no doubt they will develop something much better than the mess we have now. I know that’s a low standard, but incremental change over the next few years would be a good thing for everyone.
    Enjoy shoveling the snow and I’ll keep shoveling the manure! (:

    1. John – once again you demonstrate your complete lack of knowledge about even the basics of ACA, how it became law, the role of the Gang of Six and industry in its development, and basic functioning of the healthcare system – not to mention your complete mischaracterization of what I said previously.

      Do you even know what premium support is? Were you even aware that the Republicans were the ones who, before the election, tried to end it? But now that they are in power, they’ve decided that it has to stay because of the potential political damage to their party? Do you not understand that this is blatant hypocrisy?

      Rather than just repeat talking points about Pelosi’s statement it would behoove you to understand the context of her words, when they were said, and what she was responding to when those words were uttered.

      As you haven’t seen fit to respond to my previous corrections of your myriad misunderstandings, I’ve given up trying to have an intelligent, fact-based discussion with you. If and when you decide to actually understand the core issues, background, history, and current situation before you form an opinion or attempt to dispute something I’ve written, I’d be happy to hear from you.

      1. Thanks, Joe. I didn\’t mean to get into a proverbial snowball fight with you, just trying to add a little humor to the discussion and offer some alternative ideas. Quite frankly, I don\’t respond to everything as I have a job that takes me out on the road several days a week and can\’t spend the time I would like to writing you love letters (: I just simply ask that we wait and see what they come up with before saying this can\’t be fixed or criticize when they do the right thing (like leaving the premium subsidies for now) until they can work thru this. I\’m not sure what I mis-characterized as that was not my intent and yes, I\’m an idiot about the basics of the ACA but nonetheless would love to get into a fact-based discussion without any fear mongering or saying that nothing can be done to fix the mess we\’re in. However, \”opinions\” are not \”facts\”. Like I said, I\’m an idiot but like a lot of Americans, I do know that the system is broken and the ACA was built on a load of proverbial manure — Americans have NOT \”been able to keep their doctor\”, premiums have not \”decreased by $2,500 per family per year\” BUT instead premiums are INCREASING by 10% to 116% in most of the states and on and on…. These are FACTS — not opinions. Obama said this in his own words and premiums are doing just the opposite — increasing substantially for Americans across the country. Shouldn\’t we all come together for the good of the American people to ensure this is fixed?

        Conversely, there are a lot of OPINIONS like THE HILL article you referenced about that \”individual markets look pretty stable\” yet just 120 short days ago, it was \”Imploding and Beyond Repair\”? THESE ARE OPINIONS, NOT FACTS.

        Also, it is not \”blatant hypocrisy\” if/when anyone changes their mind, especially when it\’s for the good of the American people. That\’s called compromise and something we need more of. You know the situation was MUCH different prior to the election on what limited tools the Repubs had in order to lessen the impact of the ACA imploding on Americans.

        Joe, my push back is simply to ask that we: 1) recognize we have a problem and 2) work together focused on solutions. It will be interesting to see over the next couple of months how many changes to Speaker Ryan\’s plan there will be!

        1. John – if one does not understand an issue in depth, one should not advance opinions about it. And if you don’t have time to read thoughtful responses that reflects a lack of respect on your part that is troubling. I too have a job – in fact I have two, yet I am somehow able to respond.

          What you fail to recognize is Republicans REFUSED to work with the former President and Congressional Democrats to fix ACA. In fact, as I’ve documented here extensively, they actively tried to kill ACA and make it inoperable. This is not “we changed our minds”, this is “oh, shit, now we own it”.

          Nice of you to all of a sudden get all bi-partisan, after 8 years of Republican intransigence and obstructionism. Truth is ACA would be working significantly better today if Republicans had actually worked with Dems. You own that.

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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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