Repealing & Replacing The ACA – A Realistic View

It is mind-boggling to me how already-complicated systems and processes become even more complicated — by orders of magnitude — when government gets involved. The “repeal and replace Obamacare” mantra used to describe the process that is needed to keep “Obamacare”  [the Affordable Care Act, or ACA] from collapsing under its own weight [which it certainly will in its current form] is a classic example.

In December 2016, I posted a four-part series to this blog entitled A Realistic View Of The ACA. In Part 1 of that series [Part 1], I introduced the series and covered the first part, Repeal.  In Part 2 [Part 2], Transition, I focused on a relatively simple transition plan for people currently covered under the ACA, including some of the financial math that would be associated with such a plan. In Part 3 [Part 3], Replace, I focused on essential elements that would need to be included in a system to permanently replace the ACA.  In Part 4 [Part 4], Looking Forward, I got into 1) how repeal and replacement of the ACA could potentially be the main determinant of the outcome of the 2018 mid-term elections and/or the 2020 presidential election, and 2) what the future will probably look like under the replacement law if it is successful.

In this post, I’ll get into what has transpired so far, what seems to be underway this week, and how all of that validates my point as expressed above — government seems to have a knack for making complicated things much more complicated.

Recent And Current “Goings On”

Repeal/Replace “Plan A” was pulled from consideration on March 24 when it became clear that not even enough Republicans supported it to overcome a 100%-certain Democrat bloc vote against it. Why? Simple politics. The Republican leadership and Secretary of HHS Price created it in a vacuum, making two stupid assumptions: 1) that any plan they developed would have the support of all moderate or “mainstream” Republicans; and 2) that they had the “muscle” to overcome resistance they surely must have known would come from Freedom Caucus Republicans.  As they tried to “tune” the bill to satisfy both factions within their own party, they got into a quagmire — adding or taking away items that would have brought in more Freedom Caucus support caused them to lose support among moderates, and vice versa.  Had the leadership not made those two assumptions, there is not a doubt in my mind that something would have passed in March [that doesn’t mean it would have been good — it just means that Republicans would have been able to say they kept their repeal/replace promise and could now move on to tax reform, immigration reform, etc.].

“Plan B” [in its current form], announced on April 20 as being very near completion and having the support needed to pass the House, will “evolve” into what will no doubt be a Senate/House-compromise version of it. If that version gets passed by both houses and signed into law by the President, I predict that the resulting healthcare system will ultimately fail just as the ACA is failing, for one simple reason — the same reason that is one of the roots of the ACA’s failure [the “tap root” of the ACA’s failure, though, was a fundamental design that was financially unsustainable]. That reason is that nobody in the legislature is starting from the philosophical base I suggested in Part 2 of the above-referenced series [and still strongly believe] must be the starting point — determining first what guiding principles can be agreed upon up front before hashing out of the details even begins [see the full Some Basics First section near the beginning of that post at this link: Part 2].

Déjà vu?

Without getting into more detail here than I feel is appropriate in the space I allocate to these posts, I can offer a simple explanation of why comprehensive laws like the ACA and whatever it is replaced with, absent up-front agreement on guiding principles before negotiations over details even begin, ultimately either fail or force us into watering them down so we an afford them — i.e., this axiom: over time, politicians will find ways to get rid of the unpleasant parts of a law [generally, those parts that their constituents don’t like and/or cost their constituents more money] and add more benefits [“goodies” that their constituents want]. All you have to do is look at the history of Social Security and Medicare to see plain demonstrations of that simple fact.

This axiom is already manifesting itself in the current repeal/replace effort. The ACA requirement that insurers must allow children to maintain their coverage on their parents’ policies through age 26 [a “goodie”] is extremely popular, and appears to be among features that will surely make it into whatever version of the repeal/replace bill gets passed into law. While I’d be the last person to argue against the desirability of that feature or even its merits, the truth is that it is “on the table” for the wrong reason [many people like it].

In fact, operation of this axiom is exactly why the ACA is collapsing under its own weight. Poorly designed as it was, it did have some elements that at least in concept, theoretically might have worked, but several of those elements were very unpopular and were “tuned out” over the past few years [with bipartisan support, I might add].

New Healthcare Page At; Other Changes Coming

Simultaneously with this blog post, I am inserting a new page at this web site.  The purpose of that page is to outline what I honestly believe must be the framework of a new healthcare system to replace the ACA. Initially, it is the main content of Part 3 [Replace] of the four-part post mentioned above, with some additions and modifications I’ve made since that post.  If future developments suggest a need for additional changes to that page over time, I’ll make those changes and announce them in one of my Blog posts. This new page can be accessed through the new regular menu at this site, but this link will take you directly to it: Repealing And Replacing The ACA.

The static pages of this site were originally designed to focus visitors’ attention on the 2016 election that was still a few months away when the site was first launched, and Blog posts up to Election Day [11/8/16] were in that same vein. To transform the site’s original static page structure into one that reflects the new post-election environment [which I am certain is continuing confirmation that a New Paradigm is rapidly solidifying itself] and set the stage for content focused on the future, the following changes to the menu structure are being published simultaneously with this Blog post, just over three months into the new administration that began 1/20/17:

    • The list of original pages in the sidebar menu, originally entitled WHAT THE HECK IS GOING ON?, was renamed to BACKDROP – SITE CONTENT LEADING UP TO 11/8/16 ELECTION.
    • A new menu section entitled NEW PARADIGM “GOINGS ON” was added just above this renamed section.  The first “installment” in that section is the above-mentioned page entitled Repeal And Replace The ACA. As new static pages are published, links to them will appear in this section, and they will be announced in concomitant Blog posts.

By the way, I mentioned in Part 1 of the above-referenced series why I believe my educational and experiential background have given me some unique qualifications to write on this subject. I’ve included that paragraph in the footnote below*.


img_7026 Charles M Jones

Charles M. Jones

* My Qualifications For Writing On This Subject

You can review my background in depth at the page at this site.  I’ve summarized here the content on that page that is most significant vis-a-vis my blog posts on this subject. … I was a “C-Suite” Healthcare executive for most of three decades, and after that I was a Healthcare consultant for about seven years. Among my executive oversight responsibilities for several of the “C-Suite” years was a centralized business office for a ten-hospital, seventy-clinic integrated healthcare delivery system that also included an insurance subsidiary. I say that to say that I have direct knowledge and experience that I believe enable me to write with at least some degree of authority on this subject.

Author: Charles M. Jones, PE, CPA

[retired — neither license active]

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