This just in … After failing to pass anything remotely related to repealing and replacing the ACA [as they promised Americans who voted for many of them they would], Republicans have punted on the Healthcare front for the time being — ostensibly to move on to other priorities like tax reform. So on the Healthcare front, here’s what will happen between now and the 2018 elections. …
If the ACA [Obamacare] is simply allowed to continue collapsing
The ACA will collapse [soon if so-called CSRs (Cost Sharing Reductions, which are loss-offset payments from the government to insurance companies) are throttled back — a distinct possibility with Republicans holding the purse strings]. Think of CSRs as the Healthcare equivalent of government subsidies for rail [Amtrak] and mail [United States Postal Service, or USPS] services. These ostensibly “independent” agencies will never be allowed to fail, so whatever losses they incur will always be covered by the government [i.e., by taxpayers]. In the case of the ACA, this essentially means that insurance companies contracting with the ACA exchanges have credit cards with no credit limit and no interest [from the perspective of those companies] on cumulative “purchases” [subsidies].
The ACA is not sustainable without the CSRs, so the CSR funding issue is simply a brake pedal — each congressional action to continue CSR funding presses on the pedal and slows the collapse [the amount of continued funding is analogous to the amount of pressure applied to the brake pedal]. If CSR funding is discontinued completely, the collapse would accelerate rapidly.
We already know that under any collapse scenario, Republicans will say “We told you so!” and Democrats will say “Republicans killed it by cutting funding”, so I won’t bother to pursue that train of thought. Here’s what will happen when the ACA collapses. …
- At least as many Americans will lose their healthcare coverage as would have been the case had a realistic and affordable/sustainable repeal/replace law been passed [that would ultimately have happened anyway, which is why all the rhetoric about how many fewer people would have had coverage under the now-failed repeal/replace laws was meaningless — i.e., ten-year projections of coverage under the proposed laws was being compared with ten-year projections of coverage under an ACA that won’t last that long].
- For the time being, though, a feeling of false euphoria will prevail, and politicians who feel that they have “saved” the ACA will be able to bask in their success for a little while. And, the minority of Americans who are benefitting from the ACA will continue to benefit, and the majority of Americans who are suffering because of the ACA will continue to suffer.
- There will be political fights over CSR funding [and other parts of the ACA], but when push comes to shove, the government will continue to pay “whatever it costs” to keep it afloat for as long as possible [it is impossible to accurately predict what that cost will be]. I anticipate that timeframe to be about two years if Republicans continue their legislative majorities in 2018, or three years if Democrats gain legislative majorities in 2018. If Democrats gain legislative majorities in 2018 and win the White House in 2020, this funding will last the lesser of 1) seven years or 2) the number of years left until our unbridled entitlement programs [now including this one] bring us to the brink of financial collapse [at which time all bets will be off for all government programs, entitlement or otherwise].
If some kind of political compromise is reached to prop up the ACA
Although Mitch McConnell says “It’s time to move on”, a significant number of Republican Senators are saying that it’s not over yet, expressing at least moderate optimism that something can still get passed, through the Conference Committee process, and signed by the President. If these Senators are correct, I still say that whatever finally gets to President Trump under the current poker-game strategy — if it’s even remotely akin to the ridiculous “‘Skinny’ Repeal/Replace“ bill that [thankfully] failed by one vote last week — will ultimately fail just as the ACA has failed [and for the same reasons]. For more depth into my rationale on this, see The AHCA – My Prediction.
We already know that whatever bill gets passed will be heralded as wonderful by Republicans and lambasted as devastating and mean-spirited by Democrats, so I won’t bother to pursue that train of thought. And of course, it will in fact ease some of the short- to intermediate-term problems with the ACA [that’s what politicians do best — develop short-sighted fixes to long-term problems, essentially kicking the can down the road and making the problem appear to be fixed].
So, I’ll just outline what should be communicated in announcing the final solution to the “Repeal/Replace the ACA” dilemma [this, of course, isn’t how it will be communicated]. … This act is called the Simple Healthcare Access For Today act, or the SHAFT act. The minority of citizens who avail themselves of the benefits it provides might say they [and of course, if they are receiving subsidies, the majority of citizens who are footing the bill] are “getting the SHAFT” from the government. Here are the key features of this great new program. …
- The goodies that are most popular among you have been retained [children can remain on parents’ policies until age 26, a person cannot be refused coverage because of preexisting conditions, etc.].
- The mandates that theoretically would be required to make all the goodies you like affordable have been repealed [the employer mandate; the individual mandate; taxes on people who don’t get any coverage; subsidies, both to insurance companies and to citizens who cannot afford mandated coverage; etc].
- The government will pay “whatever it costs” to keep this program afloat for as long as possible [it is impossible to accurately predict what that cost will be]. We anticipate that timeframe to be about two years if Republicans continue their legislative majorities in 2018, or three years if Democrats gain legislative majorities in 2018. If Democrats gain legislative majorities in 2018 and win the White House in 2020, this funding will last the lesser of 1) seven years or 2) the number of years left until our unbridled entitlement programs [now including this one] bring us to the brink of financial collapse [at which time all bets will be off for all government programs, entitlement or otherwise].
If Republicans [including Trump] wake up and actually realize what must be done
Since I’d put the probability of this scenario actually unfolding at almost nil, I won’t take the time to elaborate on it here. I want to be optimistic and hope for the best, though, so I’ll expand on it if/when it seems more probable.
So pick your poison …
The first and second of these scenarios will have the same result in the long term, so pick your poison in choosing between a salvaged ACA and a new law repealing and replacing it. The probability of the third scenario actually unfolding is almost nil, but please join me in hoping it will be the one that unfolds!
Charles M. Jones