Dealmaking in a land of no compromise

The travails of the House and Senate dealing with Obamacare show the weakness in President Trump's way of governing.
You can't make deal with people who won't compromise.
Democrats won't compromise - Obamacare's good ideas are ours and problems due to Republicans.
Republicans won't compromise - at least enough won't to prevent a deal.
Why?
For both sides, no compromise benefits them.
Trumps used to deals where both sides benefit from getting a deal done.
Democrats think they'll benefit if they don't deal with Trump on anything.
Thus stalemate.
That costs all of us.

Step one

The House barely passed an Obamacare repeal and replace law Thursday.
Worthy of celebration, as the first step back from eight years of bad decisions on healthcare.

A sick system

President Trump and Republicans are trying to find a better way through healthcare and insurance.
Obamacare helps a few, but costs more for many people.
Can a better system be put in place without drawing major opposition?
They are trying.

Obligated to pay more

Obamacare fans point to the people they say the law has helped.
What about those the law forced to pay more for worse coverage?
To me, that’s the essence of Obamacare: coerce certain people into paying for more health insurance than they need in order to subsidize health insurance for other people.
My wife’s situation is anomalous. I assume that only a small number of people in America have a primary insurance policy like hers.
But there may be millions of Americans who would like to buy the kind of policy we got for my wife — a lowish cost one with a high deductible that will protect us against the cost of medical catastrophes. (Indeed, it’s one of the principles of normal insurance purchasing to insure only against events you can’t afford the cost of bearing. That’s why I want to buy insurance for my home but not for my television or cell phone).

Read and learn

Time to learn about the American Health Care Act.
Repeal and replace the Democratic rhetoric.

Bye bye mandate

It's been slow going for the Obamacare repeal in Congress, but it looks like a plan is coming together.
A draft Republican bill replacing President Barack Obama’s health care law would end its Medicaid expansion, scrap fines on people not buying insurance and eliminate taxes on the medical industry and higher earners.
Instead, it would create tax credits worth up to $4,000, allow bigger contributions to personal health savings accounts and impose a new levy on expensive health coverage some employees get at work.
Let's see how the push works.

Eviscerate and replace

The New York Times' profile of cabinet pick Tom Price includes this lovely phrase - eviscerate and replace.
But it takes a while for them to get back to reality.
He has also written a fairly detailed plan for replacing the Affordable Care Act. It would repeal the law’s expansion of Medicaid and provide tax credits to help with the cost of coverage based on age instead of income, with older people getting higher credits.
Shouldn't that be higher in the story?
It's not just repeal in 2017.
Replace is there, waiting for review.

You can't keep your money

Just in time for election season, states are announcing the increases in Obamacare premiums.
Illinois is seeking big numbers.
Will you blame the insurances companies, or the government that made the rules that those companies must follow?

Starting the death spiral

HotAir shares the good news - the looming death spiral for Obamacare gets closer thanks to Marco Rubio.
Two years ago, Marco Rubio won a fight during the budget battles to include a requirement for HHS to maintain budget neutrality in its risk-corridor programs. Rubio had pushed back against this program for months, claiming — as it happens, accurately — that it was a back-door bailout of the insurance companies that had cooperated in the effort to pass ObamaCare. Instead of allowing HHS to dip into general funds for risk-corridor payments, Rubio’s rider restricted those payouts to funds collected from taxes on insurers.
The move forced HHS to cut expected risk corridor payments to pennies on the dollar, and prompted the closure of more than half of the co-ops launched by HHS to provide supposedly low-cost coverage. Now that United Healthcare has signaled that it may cut its losses and get out of the ObamaCare market, The Hill credits Rubio with starting the death spiral many predicted when Democrats first passed ObamaCare in March 2010.

Crash the Cadillac tax

Happy October.
If you have insurance through Obamacare, time to find out how much more you will pay in 2016.
Almost time for the Cadillac tax to take effect.
The tax that would fund the increased coverage.
Except Hillary Clinton may need to crash the Cadillac.
Hillary Clinton will speak out against the so-called Cadillac tax on high-coverage health care plans, as early as this week, according to The New York Times. The politics on this are complicated, and not entirely focused on health care; in fact, this has more to do with the health of Clinton’s struggling and scandal-plagued campaign. Even so, the Cadillac tax on high-coverage plans is a key to Obamacare, both fiscally and philosophically, and Clinton’s coming attack on it shows just how much of an albatross the entire system has become for her party.

Documenting the disaster

Megan McArdle uses her tech background to remind us how the exchanges websites were designed for failure.
There was no other option.
This system had to be built in three years, and moreover, it could not be built the way Silicon Valley would do it: start small, roll something out, see what works and what doesn’t, then iterate, experiment, and scale until you finally arrive at the site you wanted to build. No, this site had to work on Day One, in every state in the nation that declined to build its own exchange. That was a very tall order, and no one seems to have given it much thought. Even when a manager in CMS tried to get the administration to scale things back, officials refused, and apparently simply failed to consider the possibility that trying to do too much would mean they ended up with nothing at all.

The cost of free healthcare

Ace provides the list of woes for states trying to have their own insurance exchanges.
figure.
My favorite.
2. Magical thinking.

Twelve states and the District of Columbia fully control their markets. Experts estimate about half face financial difficulties. Federal taxpayers invested nearly $5 billion in startup grants to the states, expecting that state markets would become self-sustaining. Most of the federal money has been spent, and states have to face the consequences.

Self-sustaining? How was "more services" and "fewer costs" ever going to be self-sustaining? It was magical thinking, as Vermont discovered:

In Vermont, a debate has been raging about whether to abandon the state exchange. Democratic Gov. Peter Shumlin originally wanted a single state-run system for all residents, along the lines of Canada. Shumlin backed off because it would have meant prohibitively high taxes.

Do you really want to live?

Wyblog finds the looming regulations, encouraging doctors to talk to patients about the costs of end of life care.
The doctors can get paid for bringing up the subject.
Probably not enough for the abuse they and their staff will get for this.

Whiff

A comic that perfectly sums up the latest Supreme Court decision on Obamacare.

I intended to be a millionaire. Will Justice Roberts help me with my quest?

Leaning on the court

While we await the verdict on King v. Burwell, the White House wants things to go their way.
In a matter of days, we will know what the court has decided and whether the president's strategy has worked a second time. However the court ultimately rules, the politics of division — which affect America's institutions as well as its people, and of which this president is and continues to be an avid and reckless practitioner — will have lasting effects that will take years of serious and concerted effort by a less partisan president to correct.

How much will you pay to keep Obamacare

The media worries about people who might lose subsidies when the Supreme Court rules on King v. Burwell.
Instead of worrying about those who pay more in taxes because of the law - and its implementation by the Obama administration.
For example, an estimated 15 million Americans are paying more for coverage on the individual market under Obamacare and not getting subsidies. That’s far more than the 6.4 million now receiving taxpayer help on the federal exchanges. Insurance regulations imposed by the healthcare law—age-rating rules, actuarial-value restrictions, and benefit mandates—have made insurance more expensive, and repealing them would dramatically lower the cost of coverage for everyone, subsidized and unsubsidized alike. Likely, millions of Americans now getting subsidized coverage could afford it on their own if these regulations were repealed.

We must maintain the mistake

The big week in Washington continues with oral arguments on King v. Burwell.
The question before the court - does the law means what it says it means.
And can government agencies change rules without Congressional approval.
How did this loophole - no subsidies if you use the federal exchange - happen?
Democrats pushed through the complex bill with tricks - due to Scott Brown winning the Massachusetts Senate race in early 2010.
They didn't have the votes to bring the House and Senate bills in tune, so they pushed it through as it was.
If you're complaining about millions losing their subsidies, it's millions of people who shouldn't have had subsidies in the first place.
The plantiffs didn't make the decision to give subsidies - the IRS did.
You may want to blame Republicans for this possible Obamacare loss, but Democrats created the mess.
And bureaucrats made it obvious.

Theory vs. practice

The New York Times tells of troubles at Harvard - hikes in their insurance due to Obamacare.

Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care. The university says the increases are in part a result of the Obama administration’s Affordable Care Act, which many Harvard professors championed.

The faculty vote came too late to stop the cost increases from taking effect this month, and the anger on campus remains focused on questions that are agitating many workplaces: How should the burden of health costs be shared by employers and employees? If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both?

Your theory sounds nice.

How does it work in practice?

When you have to pay more, not just the theoretical rich guys you want to soak.

Obamacare before the death panel

2015 should provide significant problems for Obamacare.
Tevi identifies three reforms that conceivably could command enough support from Democrats to pass the Senate. They are: (1) repeal of the “medical-device tax,” (2) raising the definition of the full-time work week from 30 hours, so as to end the incentive for employers to cut employee hours below 30 per week, and (3) repeal of the so-called Cadillac tax on high-value employer health-care plans, which encourages employers to reduce the value of their health-care plans, lest they be subjected to the tax.
President Obama would be free, of course, to veto any of these changes, and might do so. But, as Tevi argues, the fact that these matters, and others like them, will be on the legislative agenda will keep Obamacare on the defensive. And the next president, from whichever party, will likely be far more open to significant alterations.

The numbers don't work out

Megan McArdle looks at Vermont's decision to stop its path a single-payer medical system.
Because people involved in the system have livelihoods that depend on it.
Cutting spending means that a number of people are going to lose income and employment. They will have trouble paying their mortgages, car loans and little Johnny's bill for travel soccer. Then they are going to get organized and march on Washington and vote against the politicians who cut their jobs.