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Replacing Obamacare – Beware the sinkholes.

January 6, 2017

Although Democrats would have you believe that Republicans have never even thought about having a plan to replace Obamacare, the truth is that there have been several outlines advanced over the past five years.

The one that received the best press is the 240-plus page  Empowering Patients First Act largely authored by incoming HHS Secretary, Tom Price.

While many of that legislation’s key points are popular, such as retaining the ban on excluding pre-existing conditions from coverage, other points have had problems on both sides of the aisle.

One of the most notable is that the plan would essentially scrap the newly expanded Medicaid coverage for people who simply can’t afford insurance at any price above free, in favor of block grants to the states. The thought is that states could then use the funds to provide coverage in whatever manner they choose.

Maybe that would work, but the first pitfall that comes to mind is whether each state would have the same general guidelines regarding income, ability to work, etc. Any differences from state to state would surely trigger charges of discrimination in some form or another, and probably result in stiff Federal oversight.

The second problem is the idea that tax credits, even if paid out in advance of coverage would make the funding uncertain.

For instance, what happens if a person is laid off, has received an advance on a tax credit, and then drops the insurance because they can’t afford their share of the cost?

As unpopular as it would be, is it time to consider an increase in the payroll tax well in advance of any new plan’s implementation to build a cushion for coverage costs?

That would do away with the need for a punitive tax penalty on people who already can’t afford insurance, and it would spread the cost out over a much more stable  base.

Rand Paul has received a lot of heat for saying he won’t back repeal unless there is a replacement plan in place at the same time.

While Senator Paul is hardly America’s favorite senator and went essentially no place in his various presidential bids, you can understand why he might be afraid that once the repeal is a reality any replacement plans would never come to fruition.

Given the propensity of both the Trump opposition and the Conservative caucus  to focus solely on and fight over political advantages, he has a valid point.

The flip side of that of course is that if we wait for the perfect replacement plan, the ACA may never be repealed. There would be every incentive for the Democrats to make sure no  replacement is ever available.

Senator Paul also says he has four or five of the best replacement strategies under consideration, and that he could come up with a fully-fledged plan in very short order. He should put his plan where is mouth is, so that there is something concrete to discuss.

Speaking of unpopular truths, the provision keeping children on the parent’s policy until age 26 may be a gift the country can’t afford.

Quite frankly, if your child hasn’t held a single job with benefits between the ages of 18 and 26, all that provision does is keep the kid in your basement longer. It may be necessary to cut back on the parental safety net a few years sooner, ending coverage at age 20 to 22.That would take care of the majority of people during their college years and might incentivize them to actually get a job.

Of course if Obamacare simply dies an agonizing natural death, as it appears poised to do anyway,  a lot of people are going to be without insurance and without a replacement strategy as well.

Maybe making the repeal of Obamacare the headline issue of business for the 115th Congress might have to wait until Inauguration Day, so President Trump can officially supply some of that pragmatic reasoning he says he believes in so strongly.

From → op-ed

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