Republicans Are in Control…..the ACA is Toast…..But What Will Replace it?

From the Desk of Bob McNett……

Republicans Are in Control…..the ACA is Toast…..But What Will Replace it?

Republican won big-time in November. The party retained control of the House and the Senate, as pretty much expected. And, against all odds, and against the predictors of the various public opinion polls, Donald Trump will be moving into the White House to give the Grand Old Party control of the Executive and Legislative branches of our government.

After voting to repeal the Affordable Care Act (ACA) more times than we can count, with always the assurance of a veto from President Obama, it is now almost certain the the ACA will actually be repealed, with resounding support from President Trump.

Should Republicans be careful what they wish for?

The ACA was passed in 2010, with zero Republican votes, and implemented, in stages, over the next four years. We have all had time to adjust (as well as possible) to the law, it’s terminology (individual mandate, non-compliance penalties, mandates for large employers) and all the rest. Basically, the ACA train has left the station, and it will be nigh on impossible to call it back as if it never left!

The strategy that currently seems to be coming out of Republican-controlled Washington is to immediately repeal the ACA, but delay the timing of the repeal until something to replace it can be concocted.

When Democrats were trying to come up with a plan in 2008, they turned, for a blueprint, to a plan that was, ironically, originated in a Republican think tank, and was actually instituted, fairly successfully, in the state of Massachusetts under a Republican governor, Mitt Romney.

In my opinion. a lot of the characteristics of the ACA make some sense. However, as it says in the book From Good to Great, to make a private company successful, you’ve “got to get the right people on the bus.” And then, give them the autonomy to carry out the details to make a success. The same goes for a government program like the ACA. I think Obama made the mistake of successfully devising a program, getting it passed into law, but then he didn’t “get the right people on the bus.” The individual insurance website, as we all remember, when it went live in 2014, was a huge embarrassment as it simply did not work, and most people trying to enroll in insurance were not able to do it. It took months to correct this shortcoming. The government website for employers to buy a plan that would qualify for a tax subsidy still does not work right even to this day. Reinsurance programs, part of the original law as written, were supposed to protect insurers participating on the healthcare.gov website from taking big losses in the first few years of implementation, limiting premium increases. These programs were not funded properly, insurers were not protected as planned, and took a bath on claims losses. As a result, humongous premium increases resulted on individual policies in 2016 (averaging 85% in Oklahoma.) Most insurers that participated at the plan’s inception have now dropped out, leaving Blue Cross as the only participant for this year in Oklahoma. It seems to me a classic case of pretty good idea, but very bad implementation.

Republicans say they want to keep the popular parts of the ACA, and do away with the unpopular parts. People like guaranteed insurability with no pre-existing wait periods, which is a part of the ACA. But, the part that imposes a penalty on those that do not buy insurance is not so popular. But how do you require insurance companies to take all comers with no wait times for current health conditions, without requiring universal participation? Will we just let people wait until they get sick or hurt before they buy insurance? This has already happening, to some degree, under the ACA, because provisions prohibiting it have not been enforced. Common sense says this cannot continue under a new system if we are to have an affordable insurance market.

“Medicare for All,” or a single-payor government-run system, which many believe was the end goal of supporters of the ACA, is not likely to see the light of day under a Republican-controlled government, so this will not be an option any time soon.

So, what are we left with? From what I hear…..not much. The ACA might be repealed very soon, but the actual discontinuance of the law will have to be delayed until someone comes up with something else that makes some kind of sense. And, for now, the Republicans have yet to offer any kind of replacement plan. Stay tuned for more excitement!

Robert K. McNett, LUTCF
The McNett Agency
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