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Three-legged horses can’t run

If you cut a leg off your horse, it’s not going to run far or fast.  If you cut two legs off, it’s going to fall over.  And if someone else cut your horse’s legs off, you wouldn’t help them fix their horse.

Common sense, right?

So why is Paul Ryan et al complaining about ACA?

He and his fellow Republicans chopped not one, but two legs off that horse, and now they scream loud and long that that horse won’t run, so they need to shoot it and replace it with…what?

I bring this to your attention because it explains why there’s so much reluctance on the part of Democrats to work with their Republican colleagues on an ACA replacement. Put bluntly, Congressional Dems believe they got screwed and are really pissed off about that. So pissed off that they are more than happy to let the Republicans shoot themselves in the head all by themselves.

Here’s a quick summary of steps Republicans took that harmed ACA. (more here; a LOT more here)

  • Removed funding for risk corridors which kept co-ops and other plans alive
  • Didn’t expand Medicaid in 17 states
  • Hobbled ACA marketing efforts in multiple states
  • Sued the Obama Administration to block premium supports

I’ll leave aside the things the GOP could have done to help fix ACA, common sense stuff such as:

  • increasing the penalty for not carrying insurance to levels originally recommended by the Heritage Foundation,
  • fixing the “family glitch”
  • require insurers to operate in broad areas so they don’t cherry-pick only the most profitable locations, and
  • requiring full transparency from all medical providers.

If they had, ACA would be operating a lot better today, but Sen McConnell, Speaker Ryan et al weren’t interested in fixing ACA.  (In contrast, Democrats helped fix G W Bush and the GOP’s Medicare Part D plan when it was cratering)

The result of the Republicans’ successful efforts to hamstring ACA were made public earlier this week when President Trump did a photo op with several “Obamacare victims” including a Colorado woman who claimed her health insurance costs had tripled under ACA (note there’s no independent corroboration of her claim). Ms Couey said she’d had to switch insurers multiple times – while there’s no detail on this, it is likely more than one of her previous insurers went belly-up for one of several reasons.

(Warning, this gets pretty wonky) A big reason for Ms Couey’s issues – ACA had provisions specifically designed to help new insurers develop, grow, and become viable competitors – in local markets – in an industry dominated by behemoths. These provisions included “risk corridors”; financial vehicles designed to help health insurers entering markets by offsetting initial losses by transferring profits from their wealthier competitors.

The idea was to force competition into and help sustain that competition in a market where size is all that matters, where it is all but impossible for new, entrepreneurial competitors to start, much less succeed.

Those provisions disappeared, killed off by a Congress ostensibly interested in the competition and the free market.  Specifically, Sen Marco Rubio inserted the clause in the Cromnibus bill that prevented the Feds from moving money around to cover the Co-Ops’ losses in 2014.

Let’s remember that the risk corridor payments were to be budget neutral over the three year lifespan of the program.  The Rubio amendment (Section 227) forced CMS to shift that to a “pay as you go” model.

What does this mean for you?

If someone had chopped the legs off your horse, would you be eager to help them fix their’s? 


7 thoughts on “Three-legged horses can’t run”

  1. I’d like to answer your first question Joe. The GOP killed our horse and didn’t intend to replace it at all. They wanted to kill the horse because they didn’t like its color, and they want us to be happy now that the horse is dead. It’s that simple.

  2. Joe, the basic reason the GOP has cut off the horse’s legs, is that the horse was once their horse, but they moved too far to the right ideologically and now are against anyone having health care unless they can buy it outright. Their “repeal and replace” bill is proof of that. Number 45’s budget is a reflection of that party’s disdain for people not like them. It is interesting to note that Sen. Sanders did a town hall in WV recently and everyone there voted for #45, but agreed with Sanders for the need for universal health care. The GOP does not care about the people, only the Koch Brothers and now, as we have just learned this morning, the Family Mercer. We are no longer a democracy, but an oligarchy. And this is the price we are paying for ignorance and stupidity among the masses.

  3. So true….both parties are to blame for where we are today. They forget or choose to disregard they are in their jobs to serve the people. Healthcare is something we all need, for prevention as well as to be diagnosed when we get sick and for treatment when needed. It is not an option. Health insurance is the gateway to get healthcare. If you don’t have it or have inadequate insurance you can get ED care, but not much else unless you can pay for it. I was dx with a Brain Tumor in 2014 and got excellent care as I had a good health care plan from my employer. Since then, I have been on Cobra, at ($1100.00 a month) and my employer did not take me back to work, so I remain on the Cobra policy. When that runs out, I will be in trouble as an individual policy will cost me $2550.00 per month, or at least this was the quote when I checked it out in October before the COBRA was extended.
    I would like to see both parties come together and take a look at this whole thing and figure it out. Health care/insurance is important to the entire country and every person in our nation. It should not be a partisan issue. Our legislative leaders need to work together and figure it out.

  4. Healthcare consumer advocates I’ve spoken with at the Colorado Health Foundation acknowledge there is a coverage pricing disparity between the mountain communities and lower-lying areas. People living in the ski areas pay higher premiums under the ACA for their policies. The woman the White House trotted out as a “victim” of the ACA could be paying more because of her zip code, which is the same issues consumers face with car insurance. So, I guess I’m a “victim” of my state’s mandatory auto-coverage law, too.

  5. It is not the Republicans horse, it is the American peoples horse. The Dems have a right to be mad at the republicans, but they should not take it out on the American people.

    1. Hi JG – I agree in general. Allow me to make this observation. Dems believe Republicans’ health plans are going to harm Americans, and moreover, the new budget and priorities of the Rs will do so as well. One could make an argument that the best strategy for the Dems would be to ensure the Rs fail, so the Dems can win the next elections and thereby help American people.

      If they help Rs now, Dems will likely get only a fraction of what is needed, and they will perpetuate the damage they believe the majority party is doing to the country. So, better some short term pain now than a lot longer and deeper pain later. My sense is that’s what’s driving a lot of Dem positions in DC these days.

  6. Then the cycle starts all over again. The most important thing in any elected officials mind is their reelection and their party staying in power.

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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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