If you listen to what the media says, Americans are evenly split on healthcare. Recent polls quoted by Democrats claim half of the public wants to keep ObamaCare. They use these polls to justify their fight to preserve ObamaCare, despite its failure and impending demise. House Minority Leader Nancy Pelosi celebrated the recent defeat of the bill to repeal and replace ObamaCare as a “victory for the American people.”

In a recent letter to their fellow Senators, Senate Minority Leader Chuck Schumer (D-NY) and Senator Bernie Sanders (D-VT) argued public support for ObamaCare is “at an all time high” and “the overwhelming majority of Americans want to improve the ACA, not destroy it.” With this cry to battle, they organized events at town hall meetings to protest Republican efforts to repeal and replace ObamaCare. They lobbied Republican governors, especially those who expanded Medicaid.

How accurate are these statements from the Democratic leadership?

Statements like these are presumably based upon polls or surveys of the public. There are many such polls and surveys conducted by both liberal and conservative organizations. Let’s sample some of these to test the accuracy of the Democrats.

Kaiser Family Foundation

The Kaiser Family Foundation, a subsidiary of Kaiser Permanente, the largest managed care organization in the country, purports to be a neutral source of healthcare statistics and information. In truth it leans toward the liberal side of issues, being based in the heavily liberal state of California. But it can be a useful source of data on a wide range of healthcare issues.

Kaiser is currently reporting the results of surveys known as the Kaiser Health Tracking Poll conducted in January, 2017. They report that healthcare is the third most important issue on the minds of Americans following closely behind economy/jobs and immigration. Nineteen percent of Americans consider it the top issue.

According to their polling, 49% of Americans want to repeal ObamaCare and 47% want to preserve it. But the strength of their responses depends entirely on the wording of the questions used by pollsters.

A careful review of this graphic shows that 60% of Americans favor repeal when informed that many are experiencing large increases in the costs of their healthcare (which is true). Support also rises to 60% when told the country can’t afford the cost of providing subsidies to purchase health insurance.

However support for repeal drops to 27% when the pollster tells them that many people will not be able to get coverage for pre-existing medical conditions (which is not true). No plan being considered will allow that. Support also drops to 32% when the pollster tells them some of the 20 million newly insured by ObamaCare will lose their coverage (which is possible).

The Kaiser poll reports that all political persuasions including Democrats, Republicans, and Independents agree that lowering out-of-pocket expenses is the most important goal. Seventy percent of Democrats, sixty-five percent of Independents, and sixty-four percent of Republicans consider this the top priority. But they don’t agree on the means to achieving that goal. Democrats want to preserve ObamaCare and let the government pick up more of the cost for consumers. Republicans favor less government spending and more flexibility in designing coverage that meets the specific needs of individuals – at less cost.

This graphic shows about 67% of all survey respondents consider lowering out-of-pocket expenses the top healthcare priority. But it also shows that 58%, a clear majority, consider repealing ObamaCare the top or nearly top priority. A strong 68% majority wants to decrease how much the federal government spends on healthcare and 65% to decrease the role of the federal government in healthcare.

In other words, a careful analysis of even liberal-leaning polls show clear majorities favor repeal of ObamaCare and lowering of out-of-pocket costs by decreasing federal spending and involvement in healthcare.

American Action Network

These findings are confirmed in the American Action Network survey of January, 2017. In this poll, they report the following key findings:

• 54% support repeal while 43% favor keeping ObamaCare
• Nearly 70% support repeal with a transition period that assures continued coverage until the new law takes effect.
• Few believe the Republican plan will “make America sick again”. Only a mere majority of Democrats (57%) believe this is true. Strong majorities of Republicans (85%) and Independents (65%) disagree.
• 63% support the plans being considered by the House Republicans called a “Better Way”.
• There is strong support for coverage of pre-existing conditions and keeping young adults on their parents’ plan until age 26.
• There is overwhelming support for more transparency in provider fees, selling insurance across state lines, strengthening Medicare, offering tax credits, and malpractice reforms.

 

Democratic leaders like Schumer, Sanders and Pelosi are misleading the public and their supporters by spinning a narrative that suggests Americans don’t want to repeal ObamaCare. This is no surprise. Progressives have been pushing for socialized medicine for over one hundred years and ObamaCare represented their deepest penetration of the federal government’s involvement in healthcare.

Despite ObamaCare’s obvious failure they refuse to accept defeat and work toward a better solution to America’s healthcare needs. The American people deserve more honesty from their representatives – and the perseverance of Republicans and Independents to provide a “Better Way” forward.

 

 

Too many cooks spoil the soup. That old truism applies to the healthcare debate currently being waged in Congress.

Republicans were on the brink of a huge victory in cutting taxes and regulations that have weighed down the economy and burdened the American people with rising healthcare premiums. Yet conservative Republicans joined all the Democrats who held out for their ideological principles and thwarted passage of the reforms.

House Speaker Paul Ryan pulled the legislation at President Trump’s request when it was clear there were not enough votes for passage.

Democrats are celebrating the preservation of ObamaCare – for now. House Minority Leader Nancy Pelosi called the defeat of the AHCA “a victory for the American people.” Hillary Clinton tweeted “It’s a great day for all Americans.”

What Americans could they be talking about?

The demise of ObamaCare is recognized by all but the hard left. One out of every three counties in America has only one choice of insurance company on the ObamaCare exchanges. Some have none. Premium prices went up an average of 25% across the country this year and in some states like Arizona (116%) the increases have reached three figures. And that’s just to purchase the premium. After that you have to pay an average of $6000 deductibles for individual policies and $12,000 for families.

The only reason there isn’t widespread outrage is because most Americans (160 million) receive their insurance through their employer and pay little or nothing for the premiums. However, wages are being held down because employers have to spend more on providing health insurance benefits. Hours are being cut to avoid mandatory health insurance coverage for companies with more than fifty full time employees. Jobs are being eliminated as businesses collapse under the weight of the ObamaCare mandates.

It gets worse – soon! In 2018 there will be even fewer healthcare insurers participating on the exchanges as more and more bail out from the marketplace due to staggering losses. Molina Healthcare announced in February they will not offer healthcare insurance on the ObamaCare exchanges in 2018. Aetna CEO Mark Bertolini admitted ObamaCare was in a “death spiral” and predicted more insurers would withdraw because of the law’s poor risk pools. Aetna already dropped 70% of its ObamaCare offerings in 2017 because of losses exceeding hundreds of millions of dollars.

What went wrong?

Start with the Democrats refusing to acknowledge the need to repeal and replace ObamaCare. This left Republicans needing wide spread support within the Party to pass the needed legislation. They needed to stick together to succeed.

For seven years Republicans have had the “luxury” of being able to espouse their conservative ideology without any real impact on legislation. With Democrats in control of Congress and the White House under President Obama, nothing conservative ever made its way into the law. Even though conservatives voted more than 90 times for symbolic repeal of ObamaCare, there was never any real chance these votes would become law because Obama would veto them.

The heart of the opposition in the Republican Party is called the Freedom Caucus. This group of 29 House Republicans is sufficient to defeat any legislation that doesn’t satisfy their demands. The Wall Street Journal editorial board calls them the “Freedom-From-Reality Caucus.” Rather than compromise their ideals they crushed the chance for reform by holding out for their principles. But refusing to compromise is the difference between the opposition party and the governing party.

Conservative Demands

The opposition of the conservatives focused on two issues:

• Essential health benefits – this refers to the list of benefits that must be included in every ObamaCare-compliant insurance policy. The list was originally determined at the discretion of then-HHS Secretary Kathleen Sebelius as codified in the Affordable Care Act. This can be changed at the discretion of current HHS Secretary Tom Price – as planned by the Republican leadership. However, the Freedom Caucus wants that eliminated in the new legislation, not trusting Democrats who might reverse the changes by Secretary Price at some future date.
• Lowering insurance premiums – The Freedom Caucus also wants to lower insurance premiums more than the current legislation offers. Although measures are promised by House Speaker Ryan in phases 2 and 3 which will further lower premiums (deregulation, eliminating mandates, selling insurance across state lines, actuarial rating), they don’t want to rely on these future steps.

 

The House leadership made a calculated decision when they introduced the AHCA. Knowing they could not expect any support from Democrats, they decided to propose legislation that needed the fewest number of votes for passage.

The problem concerns the rules of the Senate. To get the legislation to pass the Senate with only 51 votes, it must be approved by the Senate parliamentarian under the rules of “reconciliation.” This means the changes made must be budget-related. Since changing the essential health benefits will probably not pass parliamentarian scrutiny, this was left out of the original bill. Other desired changes such as increasing flexibility of HSA accounts, tort reform and selling insurance across state lines were also left out for the same reason.

The Way Forward

Republicans can choose one of two pathways forward:

• Wait for complete ObamaCare collapse – President Trump has repeatedly said it’s only a matter of time until the whole ObamaCare system collapses – and then the real crisis will come. Republicans could wait for that to happen to force Democrats to come to the table to fix the problems they created in the first place.
• Introduce new legislation with all the changes needed – Rather than craft a bill designed to adhere to the rules of “reconciliation” they could instead introduce a new bill with all the changes Republicans agree are needed, including the demands of the Freedom Caucus, and pass it through the House with the necessary Republican votes. Then send the bill to the Senate where it will need 60 votes for passage. That will put the pressure on those Democrats who are running for reelection in states won by Trump (there are ten) and if they fail to support the legislation they will be responsible to the voters for failing to rescue the healthcare system.

 

President Trump has said it may come down to the first choice – but I would prefer the second. Syndicated columnist Charles Krauthammer has advocated the second and his reasoning is sound. This approach should unite the factions in the Republican Party and show they intend to govern. That’s what the American voters asked for and that’s what they should deliver.

 

Today is the seventh anniversary of the passage of the Affordable Care Act (ObamaCare) on March 23, 2010. Symbolically, House Speaker Paul Ryan has chosen this day to call for a vote on a new bill, the American Health Care Act (AHCA) to repeal and replace ObamaCare.

Fixing a broken entitlement program is dirty work. Despite the obvious failures of ObamaCare, replacing it with something better is a stern test of the new Trump administration. No matter how bad ObamaCare gets for most people there are still some who benefitted and their voices are given greater weight by the liberal mainstream media.

Democrats are united in their opposition to the ObamaCare replacement because they sense a political opportunity. Even though this mess was created by the Democrats, most voters will likely blame Republicans if they fail to clean up the mess as promised.

Adding to the difficulties of this situation are Republicans who are demanding the replacement bill reflects their particular interests. Outspoken criticism within the Republican Party is doing more damage to the process than Democratic opposition.

Republican Progress

Fortunately, there are signs that Republicans are coming together with compromises that are uniting the Party. President Trump recently met with a group of 13 House Republicans who opposed the plan and announced concessions that have united this group. More compromises like these are needed, especially in the Senate. Senators Rand Paul, Ted Cruz, and Tom Cotton have all voiced opposition to the American Health Care Act (AHCA) as proposed.

Among their concerns are the tax credits of ObamaCare that have been modified, but not eliminated, and the transition from Medicaid to tax credits that leaves many low income older Americans with bigger financial burdens. Changes in these tax credits are being considered in the negotiations at this time.

Avik Roy, writing in Forbes, explains how these tax credits affect low income Americans now and how they can be improved. The graph below shows how low-income older Americans pay more (the area in gray) under the AHCA than they did under ObamaCare. Higher income patients pay less (green line below blue).

To fix this, Roy says two changes are needed:

• Means tested, age-adjusted tax credits – The current tax credits are age-adjusted but not means tested. Means-tested tax credits, while harder to administer, are fairer to low-income patients. They smooth the transition from Medicaid to private insurance. The formula for this is actually contained in Section 202 of the AHCA.
• Standard deduction for healthcare insurance – To level the playing field for tax treatment of health insurance for those purchasing individually, a standard deduction of $10,200 is proposed. This smooths out the transition for those making a little more than 400% of the FPL. It eliminates the steep cliff that those in this category will experience under the current AHCA .

 

The result of these two changes is reflected in the graph below:

Now the transition for low-income patients is gradual and adjusted by income and age. The dotted green line is a gradual change. The gray area (worse off under the AHCA than under ObamaCare) is very small and very slight. The dotted gray line shows how the standard deduction allows more help for those just beyond the income ceiling for the tax credits to smooth out the transition – and decrease the disincentive in earning more income.

These changes should make the AHCA more appealing to Republicans and Democrats alike. These numbers will be even better if the AHCA lowers premiums as expected. Working together we can have better healthcare.

 

(Note: Last minute changes in the bill have included increased value of the tax credits for older Americans as suggested in this post. Further changes are likely, especially if it passes the House and goes to the Senate. If the Senate bill differs from the House there will be a conference committee to reconcile those differences before a final vote.)