Doc110 Loc: York PA

02/21/2017 Is the Trump Administration on Its Way to Its Own "If You Like Your Health Plan You Can Keep It" Fiasco?

Bob Laszewski
http://healthpolicyandmarket.blogspot.com/2017/01/is-trump-administration-on-its-way-to.html

On Friday night the administration issued an executive order giving Trump administration appointees enormous flexibility in modifying how the Obamacare individual health insurance market works.

Trump's executive order on Obamacare
http://www.cnn.com/2017/01/20/politics/trump-obamacare-executive-order/index.html

Specifically, President Trump has given his administration the power "to waive, defer, grant exemptions from or delay the implementation of any provision or requirement of [Obamacare]."

The administration has not been clear about just exactly what it is they now want to do.

Their action raises a basic question: Why grant this flexibility if it is not their intent to materially change the way Obamacare works in the individual health insurance market?

Every Republican I know of thinks that Obamacare is failing and unstable––particularly because the plans it offers consumers are especially unattractive to working class and middle class people who can only buy individual health insurance that complies with Obamacare rules.

Maybe some of these Republicans know this because that is what I have been saying for three years.

If the Republicans are able to repeal and replace Obamacare, in a best case scenario, they won't be able to have the new program up and running any sooner than 2019 –– and that could easily slip to 2020.

First, they have to repeal Obamacare.
Then they have to replace it by getting at least eight Democrats onside in the Senate.
Then the Trump administration and/or the 50 states will have to write the new rules for the new marketplace.
Then the health plans will have to develop and price the new plans. Then the states will have to approve them for sale.

So, there is no way, under the best of circumstances, the new scheme will be ready until 2019.

Meaning Obamacare will have to operate for the rest of 2017 and at least for 2018.

There are a number of potential steps the Trump administration could take, as the order describes it, to modify "any provision...that would impose a financial burden on individuals, families..."

These could include:

• Refusing to enforce the very unpopular individual mandate's penalty for not purchasing health insurance.

• Leaving the mandate and its penalty in place but dramatically increasing the Obama administration's "hardship" exemptions in the face of the expensive high deductible plans people now face.

• Enabling health insurers to offer limited duration health insurance plans that they are still allowed to medically underwrite. The Obama administration had intended to eliminate these policies that provided more than three months of coverage.

By bringing these policies back to the market, a parallel market of cheaper plans attractive to the healthy could be created thereby pulling healthy consumers out of the Obamacare pool.

The short of it is that the Trump administration, by trying to bring relief to some consumers, could just as easily further undermine the already shaky Obamacare risk pool.

If the pool were to be made worse than it is now, health plans would be challenged to figure out how they could remain in a market already intended for demolition once the new replacement plan was ready in 2019.

In 2017, 31% of counties have only one insurer and 62% of counties have two or fewer insurers in the Obamacare insurance exchanges.

Preliminary Data on Insurer Exits and Entrants in 2017 Affordable Care Act Marketplaces
http://kff.org/health-reform/issue-brief/preliminary-data-on-insurer-exits-and-entrants-in-2017-affordable-care-act-marketplaces/

Republicans need to be careful.

Making an already fragile insurance exchange market even worse could easily lead to some markets having only one or no health plans selling individual health insurance in 2018.

Even if a health plan chooses to stay, a less stable market could lead to even higher prices and deductibles and even narrower provider networks for consumers.

The Republicans have promised to repeal Obamacare, replace it with something better, and make sure no one is hurt in the transition.

Trump advisor Conway says no one will lose health coverage after Obamacare repeal
http://www.cnbc.com/2017/01/03/trump-adviser-conway-says-no-one-will-lose-health-coverage-after-obamacare-repeal.html

But if you take this new executive order to its logical conclusion, doing things like killing or easing the individual mandate or allowing for cheaper medically underwritten plans can't have any effect other than making an already fragile Obamacare risk pool worse.

Making the pool worse can only lead to fewer consumer choices, or no choices, or higher rates and bigger out-of-pocket expenses for those who remain in the Obamacare risk pool.

And, remember, about half of those in the Obamacare compliant individual health insurance market are not subsidized.

Detailed Obamacare Blue Cross Enrollment--About Half the Enrollment Doesn't Get a Subsidy!
http://healthpolicyandmarket.blogspot.com/2016/09/detailed-obamacare-blue-cross.html

This is not just about poor people getting subsidies.

It is also about the health insurance market millions of middle class consumers participate in –– many of them Trump voters.

How can Republicans agree with me that Obamacare is unstable and getting worse and think they can make it even more unstable in the transition and people won't get hurt?

On Tuesday, the Senate Finance Committee will hold a hearing on Congressman Tom Price's nomination to be Secretary of Health and Human Services.

Senators should be asking Mr. Price if he intends to stabilize or destabilize the already fragile Obamacare risk pool during the transition to the new health insurance program President Trump has promised us.

lpnmajor Loc: Arkansas

It's easy to understand, really, when one recognizes that Republicans are no better at figuring this shit out. For the last 8 years, they've bashed the ACA, correctly pointing out it's many failures, and promising a much better solution - to be unveiled soon. They've had 8 years to work on this, but apparently didn't, instead working on new bashing slogans for the next election cycle. Each election cycle, they promised a "soon to be unveiled" alternative to Obamacare, and after each election cycle promptly forgot all about it.

What special kind of moron waits until the last minute to work on the promised alternative to Obamacare? Obviously, Republican morons who did exactly that. If they could not ( or would not ) come up with a viable solution in 8 years, what makes anyone think they'll be able to do it in 1 year, or ever? It's easy to promise shit during campaigns, but damn hard to deliver on those promises - when reality bites you in the ass. Lawmakers don't like to work, I mean, real work, the kind that makes you sweat and causes your brain to swell. They could have lazily worked on the new healthcare plan over the last several years, taking their time and thinking things through, but chose to take multiple recesses and play golf instead. Now - they got nothin'.

So, the easy way out is to act like you're large and in charge, continue to promise the moon, but actually do very little. Let Obamacare play out, blame Obama and democrats when shit hits the fan, but take credit for the few things Obamacare got right. That's probably not going to snow the public, but that's all they got. While all this is going on, and between recesses, they can begin the work they should have begun in 2010 and actually come up with their own plan, not just an "Obamacare lite", a plan promised in 2012, 2014, 2015, 2016, 2017, etc.

Ricko Loc: Florida

DOC110-The ACA is on a path to self destruction. The republicans need to be careful what they replace it with. It has to be done both thoughtfully and methodically so that nobody falls through the cracks. There will be complaints primarily from people who are now subsidized who should not be receiving any subsidy. The republicans would have been foolish to attempt any change to the ACA while Obama was president. Why waste time and effort designing replacements which would go nowhere. The republicans have a few months left before the ACA is in its death spiral so they should take their time and get it right. The only people who are in a hurry to get this done are the democrats around whose necks the ACA hangs. I say let it weigh on them for a few more months. Once the cabinet is approved more things will get done quicker. Meanwhile , let the left wingers play their stalling game. America First !!!!

Doc110 Loc: York PA

lpnmajor,

Obama and his minions have totally screwed up the existing "HEALTH CARE IN THE UNITED STATES OF AMERICA"

Let me explain, With the passage of the ACA, e.g. Obama-Care, which is not Insurance, is not, I repeat, not healthcare. It allows you to gain access to healthcare through $ premium's .


But was sold to the Gullible American people and by a devious President Obama and the Democratic party, with eyes wide open, and the American people, took this lie hook, line and sinker.

Like walking in a cow patty with no shoe's on . . . total compost . . .

The ACA is nothing other than a pyramid scheme scam, of countless proportions, out doing the "Tower of Babel" . . .


As the Supreme Court pronounced their ruling and decision, the "central argument in King v. Burwell."

"This is a Tax," that was voted on and sold to the American people, Congressman, Senators and by the President of the United States Barak Obama.


But the American people were lied to.

President Obama "Continued To Lie" to the American People, in as much that he, Obama went on National Television and affirmed.

That in fact he lied to the American People, became the scapegoat and was not held accountable.


1. We have, a. Nixon, b. Clinton and c. Obama, to hold in contempt, for lying to the American people.
a. Nixon gave up the presidential office,
b. Clinton was one vote from being impeached and lost his law license,
c. Obama given a pass from congress for lying on the greatest concentration of government finance or 1/6 of the US economy and government oversight e.g. healthcare and Student College loans.

The architects of this monstrous government money boondoggle is none other than Hillary Clinton, 1.0 defeated in Congress.

Hillary 2.0 was resurrected 2.0 aka. The ACA (The Affordable Health Care Act) an oxymoron statement that was ever pronounced e.g. Obamacare was pushed through congress.

Through backdoor deals, to States, religious organizations e.g. Muslims, Quakers, Amish, and countless business, social groups, etc. . . .


And what about Congress they have a separate Healthcare plan separate from the ACA, e.g. Obamacare insurance.

Undocumented Aliens were not to receive healthcare benefits under this legalization.

Abortions were not to be funded by the American taxpayer.

All is lost in the dungheap by the news sycophant media presstitutes and the presentation sold by Obama and the Democratic party, the new Nazi Joseph Goebbels, the architect of the "Big Lie."


With out any input, oversight or review from the GOP and Independence counterparts in Congress. Not one Republican voted for this "piece of compost legislation.

Just remember what House Chair Nancy Pelosi said, Well we will just have to vote in it, and find out what's in the bill.

What a devious "Succubis" To what end ... If the devil can deceive eyes and ears so that they fancy they see and hear things which ... Hence, the devil may so deceive frivolous people and such as live without the fear of God.

The American Senate and House of representatives, did not do their 'Job.' Their God given fiduciary responsibility, to read the 1,000 plus page boondoggle legislation. And act and vote accordingly . . .

What a failure in government . . .


Then we have Jonathan Gruber, OBAMACARE Architect, and his lack of transparency was huge political advantage.
http://www.nakedcapitalism.com/2014/11/jonathan-gruber-obamacare-stupid-voters-couldnt-happen-nicer-shill.html

Gruber basically call it the stupidity of the American voter, or whatever, but basically that was really, which was really critical in getting Obamacare to pass.

This bill was written in a tortured way to make sure that the CBO (Congressional Budget Office) did not score the mandate as taxes.

If CBO scored the mandate as taxes, the ACA bill dies in congress. Hillary 2.0 goes down in defeat once again.

Here are the exact problem of the ACA e.g. Obamacare.

1. It is a tax.

2. 15 million Americans had no health insurance, and we're not talking about healthcare.

3. Now 30 million Americans have no insurance and no healthcare because the ACA is now unaffordable, and Americans can not pay the insurance premiums. Dam "Do-Gooders."

4. The ACA enrollment rate is unsustainable, The ACA needs 90% enrollment rates to sustain it's self, at best results it's at 30 %, and will implode on It's self. It's a pyramid scheme.

5. The ACA took 700 million dollars in funding to start up the financial monstrosity, from medicare that taxpayers and employers contribute in a general fund. Talk about Highway robbery . . .

6. 20 of the 26 State Insurance exchanges (Not Healthcare) have failed and are bankrupt, the computer infrastructure has been a waste of billions of U.S. taxpayer dollars . . .

7. The young people of America are not willing to join the ACA and the insurance tax, so they go without . . .

8. The healthcare market place for healthcare insurance is all but dried up and is consolidating through Aetna, Humana, Kisser through mergers, buyout's and corporate stock takeovers . . .

9. Over thirty five States have only one insurance option, the rest of the 15 states only have two or three insurance options . .

The ACA and or Obamacare was the the biggest political and financial scam ever perpetrated on the American taxpayer public . . . There are more problems to the ACA e.g. Obamacare to listd can go on and on to list.

GO TRUMP . . .

lpnmajor Loc: Arkansas

And the GOP's answer is...um.....let me see...... geez, we should have been working on this a long time ago, like since 2009. Wow, this is really hard!

Yes, yes, the ACA was screwed up from day one, something I've mentioned repeatedly. Instead of trying to fix it, the GOP focused on repeated attempts to repeal it - for political purposes. Maybe it can't be fixed, which is what they're finding out now. In any case, there is NO excuse for waiting until after the elections to START working on a replacement, the replacement promised in 2010, 2012, 2014, 2016 and now 2017. You did not answer the question of why they did not have a replacement plan all ready to go - after having at least 6 years to work on one.

Every time they said they had a superior replacement - was a bold faced lie - because they did not, they hadn't even been working on one. How long will it be this time?

Doc110 Loc: York PA

ObamaCare Replacement Plan: "CARE" Act Facts - Obamacare Facts *
www.obamacarefacts.com/obamacare-replacement-plan-facts/Proxy Highlight
It ignores about 900 pages of the 1000 page law, partially because the “CARE” act proposal is a 9 page PDF.
Get the facts on the GOP proposal (it’s not actually legislation that can be voted on yet).
We cover every aspect of the ObamaCare replacement plan.

GOP group promises ObamaCare replacement plan - soon | TheHill *
www.thehill.com/policy/healthcare/276547-gop-group-pr...Proxy Highlight
Jim McDermottGOP group promises ObamaCare replacement plan - soon Sanders fundraising for ...
Michael BurgessThe Hill's 12:30 Report GOP group promises ObamaCare replacement plan - ...
This is the first time an ObamaCare replacement plan is getting airtime on Capitol Hill ...
Paul RyanObama mocks GOP, media and himself in final WHCA dinner address Obama jabs at

House Republicans Unveil Plan to Replace Obamacare - The Atlantic *
https://www.theatlantic.com/politics/archive/2016/06/...Proxy Highlight
Republicans Offer a Plan to Replace Obamacare.
The House GOP’s health-care proposal would expand savings accounts, provide tax credits for buying insurance, and allow Without a President Trump, that long-awaited Obamacare replacement bill gets another few years to sit on the shelf.


GOP group submits ObamaCare replacement plan | TheHill *
www.thehill.com/node/277292Proxy Highlight
The proposal was submitted to a task force of House chairmen crafting a replacement. ...
Paul RyanObama mocks GOP, media and himself in final WHCA dinner address Obama jabs at ...
Obama mocks GOP, media and himself... He threw in jokes about Trump, Clinton and poked ...
Republicans have promised a replacement to ObamaCare for years but have so far failed to


Steve Beshear on GOP replacement plans for Obamacare | MSNBC *
www.msnbc.com/craig-melvin/watch/steve-beshear-on-gop...Proxy Highlight
GOP's history of bad faith on Obamacare.South Carolina Congressman, Mark Sanford, discusses some of his plans to replace the Affordable Care Act addressing public concerns.


GOP group submits ObamaCare replacement plan | TheHill *
www.thehill.com/policy/healthcare/277292-conservative...Proxy Highlight
The proposal was submitted to a task force of House chairmen crafting a replacement. ...
I'd back Trump but not Cruz as nominee House GOP reignites push for budget plan GOP ...
Republicans have promised a replacement to ObamaCare for years but have so far failed to ...
recommendations for a Republican replacement for ObamaCare as it seeks to shape a plan

Rand Paul Introduces Obamacare Replacement Plan | The Daily Caller *
www.dailycaller.com/2017/01/25/sen-rand-paul-introduc...Proxy Highlight
GOP Kentucky Sen. Rand Paul introduced his Obamacare replacement plan Tuesday, calling on Republican lawmakers to “repeal and replace” the legislation simultaneously.

Behind Ryan, GOP unveils plan to replace ObamaCare | TheHill *
www.thehill.com/policy/healthcare/284341-gop-unveils-...Proxy Highlight
House Republicans on Wednesday released their long-awaited replacement plan for ObamaCare, drawing a contrast with Democrats The Republican plan calls for at least $25 billion over 10 years for subsidizing the high-risk pools. Finally, the GOP plan stretches into Medicare and Medicaid as well.