If Obama wins in 2012, will the GOP still be trying to repeal healthcare in 2017

[Wesley Clark]

If Obama wins in 2012 and the dems maintain control of at least one chamber of congress, repealing the ACA will be fairly hard (unless the GOP attempts to crash the economy again by messing with the debt limit. However doing that could cause the business class that funds the GOP to turn on them). Is healthcare going to be one of those issues like the Iraq war, where people oppose the policy until it has been fully reversed even if it takes a decade, or will the ACA be something where after it has been implemented in 2014 and people have had a few years to try it out, people stop caring (sort of like gay marriage, people opposed it then they got used to it and now opposing gay marriage is not the political winner it was 8 years ago).

Is repealing health care going to be an issue in the 2016 elections?

[Fear Itself]

It really depends on how successful Obamacare is. If it significantly reduces the number of uninsured, and (more importantly) is profitable for the insurance companies, Republicans would be fools to go after it. But I hope they try.

[L. G. Butts, Ph.D.]

Originally Posted by Fear Itself

It really depends on how successful Obamacare is. If it significantly reduces the number of uninsured, and (more importantly) is profitable for the insurance companies, Republicans would be fools to go after it. But I hope they try.

Why do you hope they try? From what I know about your healthcare strategy (attempt to defraud insurance companies and declare bankruptcy when they finally catch on), I would think you would welcome some of the parts of the ACA.

[New Deal Democrat]

Originally Posted by Wesley Clark

If Obama wins in 2012 and the dems maintain control of at least one chamber of congress, repealing the ACA will be fairly hard (unless the GOP attempts to crash the economy again by messing with the debt limit. However doing that could cause the business class that funds the GOP to turn on them). Is healthcare going to be one of those issues like the Iraq war, where people oppose the policy until it has been fully reversed even if it takes a decade, or will the ACA be something where after it has been implemented in 2014 and people have had a few years to try it out, people stop caring (sort of like gay marriage, people opposed it then they got used to it and now opposing gay marriage is not the political winner it was 8 years ago).

Is repealing health care going to be an issue in the 2016 elections?

That depends on how well it works. Republicans opposed Social Security and Medicare. Now they call both "the third rail." They have learned that when they touch either they get a terrible shock. My hope is that the Obama health care plan will become part of the third rail: a program the voters like, appreciate the Democrats for, and know the Republicans want to take away.

[ElvisL1ves]

They'll be looking for ways to take credit for it, such as by telling all of us that it's the reason they nominated the visionary founder of Romneycare in 2012.

[Fear Itself]

Originally Posted by L. G. Butts, Ph.D.

Why do you hope they try? From what I know about your healthcare strategy (attempt to defraud insurance companies and declare bankruptcy when they finally catch on), I would think you would welcome some of the parts of the ACA.

I support Obamacare 100%. If it is successful, Republicans will suffer at the polls if they persist in trying to repeal it. Perhaps it is the mistake that will finally rid us of their influence for a generation or more. Besides, I think the likelihood of them capturing the trifecta of the House, 60 seats in the Senate and the White House is extremely slim.

[L. G. Butts, Ph.D.]

Oh, OK. I sure hope you are right, I live in fear of the trifecta. I do think that President Obama will most likely be reelected, but only just.

[Wesley Clark]

Originally Posted by Fear Itself

I support Obamacare 100%. If it is successful, Republicans will suffer at the polls if they persist in trying to repeal it. Perhaps it is the mistake that will finally rid us of their influence for a generation or more. Besides, I think the likelihood of them capturing the trifecta of the House, 60 seats in the Senate and the White House is extremely slim.

The GOP doesn't need 60 seats. Unlike the dems, the GOP will fight harder for what they want. Because the ACA mandate was ruled a tax, that means overturning it can be done via budget reconciliation.

[BigAppleBucky]

Originally Posted by Wesley Clark

The GOP doesn't need 60 seats. Unlike the dems, the GOP will fight harder for what they want. Because the ACA mandate was ruled a tax, that means overturning it can be done via budget reconciliation.

Exactly. And that's also why the Democrats need to be particularily concerned about down ticket elections.

The Democrats could easily lose the Senate.

[Iggy]

There is a real risk of things going bust financially that could play out very badly for the Dems.

I take it as almost a given that those who currently want insurance but are unable to get a policy due to pre-existing conditions will now buy insurance. This adds the expensive customers to the risk pools. Insurers are required to price by community rating so they cannot up the price for these high risk persons. These customers depend on healthy customers to pay premiums to make the whole insurance pool financially viable.

If sufficient numbers of the young and healthy instead opt to pay the tax penalty rather than purchase insurance then there will be a repeat of the fiasco that Kentucky, Washington and Maine have already been through. The insurance pools will collapse. Private insurers will flee the market. And people will not be able to keep the insurance they want. The blamestorm will be unlike anything seen in recent times.

An early sign of things going bad would be for large number of mid-size and small businesses to drop insurance and pay the tax penalty, thereby forcing their workers into the open market.

Once such uninsured workers realize the tax penalty is low or negligible and that they can just sign up for insurance if they do get a terrible diagnosis then I think they will stay out of the market in droves. Those who buy insurance would be much sicker, on average, than the population as a whole.

If an uninsured worker does get hit by a bus then we will all still be on the hook for emergency care. Maybe ambulances will start to stock insurance applications forms and train EMTs to get a bloody X as a signature while transporting the wounded to the hospital?

In such circumstances I think the public will be screaming to get rid of the ACA... not necessarily to replace it with single-payer Universal Health Care.

[foolsguinea]

And the incentives in this scenario are different from the status quo ante how?

[Martin Hyde]

The only way I see the GOP going after the PPACA is if Romney wins the White House, and the GOP wins 60+ seats in the Senate. I think otherwise it will be too painful to overturn. With just the White House Romney could force a budget show down to essentially eviscerate the law but it could be a political atomic bombing of his Presidency right at the beginning. My prediction generally is the GOP keeps the House, the Dems keep the Senate/White House, and by 2016 no one will be seriously trying to repeal Obamacare. A hypothetical Republican President in 2016 might repeal some parts of it, maybe some parts of it will end up being unpopular. But too many people will have coverage based on Obamacare provisions for it to be politically feasible to repeal it after 2014.

There is a big difference between Social Security and Medicare and Obamacare though. By and large while there are ongoing funding issues SS and Meidcare work as they should and actually are pretty well administered and provide good benefits for millions of Americans. Obamacare only really answered one problem: the uninsured. Sure, that was a problem no doubt, but it doesn't really help us get our healthcare costs under control.

I've not read the entire law (almost anyone who says they have are liars), but I am fully aware of some of the cost control measures in the legislation. I think we'll have some reigning in of some costs, no doubt. However if you even look at countries that have UHC, their health care costs have been rising greater than inflation for some time now, and America's healthcare costs are rising the fastest and are already larger than for any other country per capita (as far as I'm aware.) There are real systemic cost problems with healthcare that no country that provides healthcare has found answers for yet, and unfortunately if we don't then the crisis of the next 25-35 years isn't going to be lack of coverage but healthcare coming to be the only thing we as a society can afford to pay for (at the cost of everything else) and the disastrous effects that will have on our economies.

[Wesley Clark]

Originally Posted by Iggy

There is a real risk of things going bust financially that could play out very badly for the Dems.

I take it as almost a given that those who currently want insurance but are unable to get a policy due to pre-existing conditions will now buy insurance. This adds the expensive customers to the risk pools. Insurers are required to price by community rating so they cannot up the price for these high risk persons. These customers depend on healthy customers to pay premiums to make the whole insurance pool financially viable.

If sufficient numbers of the young and healthy instead opt to pay the tax penalty rather than purchase insurance then there will be a repeat of the fiasco that Kentucky, Washington and Maine have already been through. The insurance pools will collapse. Private insurers will flee the market. And people will not be able to keep the insurance they want. The blamestorm will be unlike anything seen in recent times.

An early sign of things going bad would be for large number of mid-size and small businesses to drop insurance and pay the tax penalty, thereby forcing their workers into the open market.

Once such uninsured workers realize the tax penalty is low or negligible and that they can just sign up for insurance if they do get a terrible diagnosis then I think they will stay out of the market in droves. Those who buy insurance would be much sicker, on average, than the population as a whole.

If an uninsured worker does get hit by a bus then we will all still be on the hook for emergency care. Maybe ambulances will start to stock insurance applications forms and train EMTs to get a bloody X as a signature while transporting the wounded to the hospital?

In such circumstances I think the public will be screaming to get rid of the ACA... not necessarily to replace it with single-payer Universal Health Care.

That death spiral is what is occurring now. That is why health insurance premiums jump 30-40% a year despite health costs only growing 5-8% a year. If anything, a reason the insurance industry didn't fight the bill like they did in the 90s is because they know their industry is in a death spiral. Large companies self insure, small companies and individuals drop coverage.

At least with the ACA there is a penalty for opting out of the system, which will compel people to stay in. Right now there is no penalty.

I believe in MA only 1% of people choose the penalty over the insurance.

[ElvisL1ves]

And that's only if you think the 2012 Romney is the sincere one, not the 2006 Romney, if there is a sincere one at all. There'd be a very good chance he'd backpedal from the wingnuts he's had to court lately, make some noises about "It's the law now, so let's make it work" etc., and implement it the same way he implemented Romneycare in MA.

But we don't need to take that chance.

[foolsguinea]

Originally Posted by ElvisL1ves

They'll be looking for ways to take credit for it, such as by telling all of us that it's the reason they nominated the visionary founder of Romneycare in 2012.

This will happen eventually, though not to a noticeable extent in 2017. The GOP can't govern worth a damn—or perhaps they refuse to govern well out of malice, corruption, and/or sheer perversity—but they are pretty good at mendacious election politics.

[Iggy]

Kentucky already tried mandatory issue with community rating. It failed spectacularly. They did not have a mandate.

I am not convinced that a threat of up to a $695 penalty is going to get enough people to buy a $7000 product in order to make this all financially sustainable.

Thik of it this way. I have the choice of paying $695 once per year or $584 every month. I am reasonably healthy. If I am diagnosed wth cancer tomorrow then I can just start paying the $584 monthly.

Easy choice, financially.

[Fear Itself]

Originally Posted by Iggy

Think of it this way. I have the choice of paying $695 once per year or $584 every month. I am reasonably healthy. If I am diagnosed with cancer tomorrow then I can just start paying the $584 monthly.

No, you can't; you have to wait for the open enrollment period to get insurance through the exchanges, which is once a year, if you didn't enroll when you were first eligible.

The Affordable Care Act appropriately establishes an initial open enrollment period (before exchanges first make coverage available, starting in January 2014), as well as annual open enrollment periods in subsequent years. In an open enrollment period, people would be free to sign up for a plan or switch plans. Only in limited circumstances would people be able to enroll in or switch plans outside of an open enrollment period.

This restriction is a critical feature: it ensures that individuals and families don’t wait until they get sick to enroll in coverage, or switch to more comprehensive coverage when they are about to have an expensive medical procedure. That is a problem Massachusetts initially faced under its health reform initiative, but the state recently tightened its exchange enrollment rules in response to reports that people were enrolling in coverage for short periods and then dropping coverage after receiving medical services. At the same time, however, it is essential to ensure that people have the freedom to move into coverage or into different coverage when they experience certain changes in their lives in the course of the year.

That is going to delay your treatment up to nine months, which might be significant in the case of cancer.

Your choice, though.

[BrainGlutton]

Originally Posted by Wesley Clark

If Obama wins in 2012 and the dems maintain control of at least one chamber of congress, repealing the ACA will be fairly hard (unless the GOP attempts to crash the economy again by messing with the debt limit. However doing that could cause the business class that funds the GOP to turn on them). Is healthcare going to be one of those issues like the Iraq war, where people oppose the policy until it has been fully reversed even if it takes a decade, or will the ACA be something where after it has been implemented in 2014 and people have had a few years to try it out, people stop caring (sort of like gay marriage, people opposed it then they got used to it and now opposing gay marriage is not the political winner it was 8 years ago).

Is repealing health care going to be an issue in the 2016 elections?

No, but moving from this half-assed patch job to single-payer might be.

[Victor Charlie]

Originally Posted by Iggy

Thik of it this way. I have the choice of paying $695 once per year or $584 every month. I am reasonably healthy. If I am diagnosed wth cancer tomorrow then I can just start paying the $584 monthly.

Easy choice, financially.

While you can't be denied coverage, the exchanges will still have policies based on risk. If you wait until you have cancer to get insurance, you won't be paying the same rate as people with no pre-existing conditions.

[2ManyTacos]

If the health care overhaul is allowed to be completely phased in, then no, I do no expect that the GOP will still be trying to repeal it by 2017; Hell, I don't expect that they'll still be pushing for repeal past its first full year of implementation, really.

The biggest boneheaded decision that the Dems made when they were actually drafting the bill was that they opted for this extended roll-out and implementation period, not having the full benefits package kick in until four fucking years after they enacted the law. The Republicans KNOW that once the public starts receiving the ACA benefits that it will be virtually impossible to derail or kill the bill from then on, and so they've been masterfully waging this (hitherto successful) smear campaign and (now rebuked) judicial war against the law in order to stop it before it takes root. This stupidly long implementation period, consequently, has enabled the Pubs to repurpose the ACA as some kind of hypothetical future reality in which the US will be doomed to turning into communist Russia or something; if the law had kicked in immediately - or at least within the first year after it was signed - repeal would be impossible because everybody would've come to love it by now.

The USSC decision validating the law was only the first obstacle that needed to be met in order to completely implement the ACA. The second obstacle - and probably the most difficult one - will be the elections this November: if Obama wins reelection and the Dems keep control of the Senate, full speed ahead for the rest of the ACA; if Romney wins the presidency and the Dems keep the Senate, the law will be weakened but not destroyed; if the GOP takes the Senate and the presidency, yeah, the law is toast.

[Jas09]

Originally Posted by Victor Charlie

While you can't be denied coverage, the exchanges will still have policies based on risk. If you wait until you have cancer to get insurance, you won't be paying the same rate as people with no pre-existing conditions.

I was under the impression that this isn't accurate. The exchanges will operate on partial community rating - they can only take into account demographic information (and smoking status) when determining your rates.

[Wesley Clark]

Originally Posted by BrainGlutton

No, but moving from this half-assed patch job to single-payer might be.

How realistic is single payer on the national level anytime soon?

I see it being realistic 10 years out, but only in a handful of things all occur at the same time.

1. Various states implement it and find it is 20-30% cheaper than regular insurance health care, like the studies say it will. That will give proof of concept that it works in the US. Vermont predicts their health care will be about 25% cheaper (compared to keeping the current system) in the 2020s due to their new health model.

2. A public option tied to medicare or modeled after the VA's recent reforms, or some other option is eventually added that does the same thing, offers national health insurance option that is 20-30% cheaper and as high quality or higher quality than private insurance. Medicare is rated more highly than private insurance by respondents, I believe the VA system is now rated highest of all in the US due to recent reforms. Both are cheaper than private insurance.

3. Demographic shifts actually continue with the Fox news audience and tea party members dropping off and being replaced by more open minded young voters. This assumes millennials maintain their center left policy views in the 2020s, when they are 35-40% of the electorate and the majority of fox news and talk radio viewers (who are 70 years old on average) are gone.

To me it seems possible, but it'll be a decade or more before the convergence happens and a meaningful, pragmatic health policy is enacted on a national level. For the time being I think just keeping the ACA alive is most important, because it moves the overton window to the left and allows reforms to the ACA (like a public option modeled after medicare or the VA) to be added.

[MilTan]

Originally Posted by Iggy

Kentucky already tried mandatory issue with community rating. It failed spectacularly. They did not have a mandate.

I am not convinced that a threat of up to a $695 penalty is going to get enough people to buy a $7000 product in order to make this all financially sustainable.

Thik of it this way. I have the choice of paying $695 once per year or $584 every month. I am reasonably healthy. If I am diagnosed wth cancer tomorrow then I can just start paying the $584 monthly.

Easy choice, financially.

New York has guaranteed issue and community rating. It has high health insurance rates, but there are plenty of insurance companies. Massachusetts has guaranteed issue, community rating and a mandate. Premium growth has slowed since the trifecta was instituted.

[Iggy]

Originally Posted by MilTan

New York has guaranteed issue and community rating. It has high health insurance rates, but there are plenty of insurance companies. Massachusetts has guaranteed issue, community rating and a mandate. Premium growth has slowed since the trifecta was instituted.

Takes a while to the spiral to have its full effect.

1. Rates go up.
2. Some healthier persons decide they cannot afford it. They cancel.
3. Remaining persons in pool are sicker, on average, than before.
4. Rates increase to cover higher cost of insuring sicker persons. Go to 1.

Taken to extreme, eventually the insurance pool is no longer financially viable. Companies stop offering policies that they cannot make a profit on.

Wash. Rinse. Repeat.

[2ManyTacos]

Originally Posted by Wesley Clark

How realistic is single payer on the national level anytime soon?

I see it being realistic 10 years out, but only in a handful of things all occur at the same time.

1. Various states implement it and find it is 20-30% cheaper than regular insurance health care, like the studies say it will. That will give proof of concept that it works in the US. Vermont predicts their health care will be about 25% cheaper (compared to keeping the current system) in the 2020s due to their new health model.

2. A public option tied to medicare or modeled after the VA's recent reforms, or some other option is eventually added that does the same thing, offers national health insurance option that is 20-30% cheaper and as high quality or higher quality than private insurance. Medicare is rated more highly than private insurance by respondents, I believe the VA system is now rated highest of all in the US due to recent reforms. Both are cheaper than private insurance.

3. Demographic shifts actually continue with the Fox news audience and tea party members dropping off and being replaced by more open minded young voters. This assumes millennials maintain their center left policy views in the 2020s, when they are 35-40% of the electorate and the majority of fox news and talk radio viewers (who are 70 years old on average) are gone.

To me it seems possible, but it'll be a decade or more before the convergence happens and a meaningful, pragmatic health policy is enacted on a national level. For the time being I think just keeping the ACA alive is most important, because it moves the overton window to the left and allows reforms to the ACA (like a public option modeled after medicare or the VA) to be added.

In reference to point number 3:

I've been echoing that sentiment for a while. Basically, we all just need to wait until the folks from my generation - your typical 20-something's of today who were born near the end of or after the Cold War - to become the majority of the electorate and subsequently start taking over the political scene and running the government. You're absolutely right; we generally have center-left leanings and don't have this absolutely irrational fear of socialism that has stymied the health care debate up until now.

In the meantime, I also endorse point number 1:

I've been saying this for a while; the most likely route to true UHC in this country will come in the form of state-by-state adoption of single-payer. A lot - and I mean a lot - of that prediction is reliant upon the degree to which Vermont's system proves to be successful. Assuming it is, I foresee many of the more liberal states emulating the Vermont model; Montana would probably do it next, then California, then maybe Massachusetts, etc. Eventually, that might pave the way for a national model.

But yeah, in the short term, ensuring that the ACA is allowed to be completely implemented is probably the most important thing to do right now.

[Kvorka]

Don't the republican's have to have 2/3 majority in the house & senate to overide an Obama veto at a congressional attempt to repeal ObamaCare? How many seats in each house are up for grabs and will we it be enough to reach the two thirds majority? If, not is it likely that some democrats may support the repeal attempt and jump side.

I'm assuming the Supreme Court will not revisit the law; Is that correct?

If Obama wins, there's no other way to repeal the law except to wait for 2014 or 2016 elections or is there?

[JRDelirious]

California is unlikely IMO to be an early adopter of the single-payer system as long as they're stuck in their fiscal tar pit. Plus with their loose direct-democracy rules, you'd get proposition after proposition every year to reverse or replace whatever was approved the year before.

Kvorka: Still, if the GOP gets majority in one or both houses they can seek to deny funding through reconciliation and/or hold the debt ceiling or defense spending or the continuing budget resolution hostage to a scaleback in the program.

[brickbacon]

Originally Posted by Iggy

Kentucky already tried mandatory issue with community rating. It failed spectacularly. They did not have a mandate.

I am not convinced that a threat of up to a $695 penalty is going to get enough people to buy a $7000 product in order to make this all financially sustainable.

Thik of it this way. I have the choice of paying $695 once per year or $584 every month. I am reasonably healthy. If I am diagnosed wth cancer tomorrow then I can just start paying the $584 monthly.

Easy choice, financially.

The penalty is will be A LOT many than $695 for most people, and the basic plans should cost around 5k/person. The penalty is up to 2.5% of income above around 10k. So a family with a household income of 100k will pay around $2250. After around 200k, you are fined at the cost of the bronze insurance package. So even though you may initially save money forgoing insurance, it often doesn't make sense to. Why pay $2250 for nothing, and pay your regular health care costs (which will likely be billed at a higher rate), rather than paying for a cheap plan?

[Kvorka]

Originally Posted by JRDelirious

California is unlikely IMO to be an early adopter of the single-payer system as long as they're stuck in their fiscal tar pit. Plus with their loose direct-democracy rules, you'd get proposition after proposition every year to reverse or replace whatever was approved the year before.

Kvorka: Still, if the GOP gets majority in one or both houses they can seek to deny funding through reconciliation and/or hold the debt ceiling or defense spending or the continuing budget resolution hostage to a scaleback in the program.

Thanks, I found this article:

http://suite101.com/article/killing-...-purse-a307705

Sounds like really dangerous politics. Teddy Roosevelt's solution was innovative!

[jasg]

Originally Posted by Fear Itself

No, you can't; you have to wait for the open enrollment period to get insurance through the exchanges, which is once a year, if you didn't enroll when you were first eligible. That is going to delay your treatment up to nine months, which might be significant in the case of cancer.

Your choice, though.

I am amazed at how little attention is paid to this fact.

In a few years, I expect to see the talking heads on TV slamming the ACA for those poor idiots who can't game the system and buy insurance immediately after getting sick.

Medicare has always had a similar enrollment period, how many people skip that until they get sick?

[Ludovic]

Originally Posted by jasg

In a few years, I expect to see the talking heads on TV slamming the ACA for those poor idiots who can't game the system and buy insurance immediately after getting sick.

This is one reason I wouldn't support rolling back Social Security.

If we removed the self-funded pension tier of the Social Security system, and kept the other parts, we'd basically have a wealth transfer from working upper middle class people to retired former minimum wage earners. We'd get major complaints of "Grandma Jones is too frail to work and her completely free government pension of $500 a month is too low!" despite the fact that she would have had an opportunity to save for her retirement with the extra money-- a couple thousand a year spread over decades -- from eliminating SS taxes on the poor.