Tuesday, August 1, 2017

On health care, is it time for "skinny improvement?"

 - by New Deal democrat

While I don't think the GOP assault on Obamacare is over for the long term -- for example, if they pick up at least a couple more Senate seats in 2018 -- the crisis appears to have passed for the moment.

That being said, there are some significant problems with the Act as it stands.  In particular, the individual market in a few states needs shoring up. And just about everybody hates the individual mandate for one reason or another..

Since the 3 Senate GOP dissenters, the few others who expressed severe doubts, and perhaps members of the GOP House's "Tuesday group," might be open to working with democrats, maybe there is at least some narrow ground for agreement to fix a few problems and make health care insuance better.

Call it "skinny improvement."

What would "skinny improvement" of the ACA look like? Here are 4 things I think are within the realm of reasonable possibility:
  1. codifying the Cost Sharing Reduction payments to insurers to stabilize the markets and preclude Executive caprice.
  2. replacing the individual mandate with an automatic payroll deduction, or self-employment tax, for those not covered by employer healthcare or a chosen individual plan. The payments in the automatic deduction could qualify the individual for Medicaid, or perhaps go to a bronze plan insurer, e.g., the lowest priced plan in the employee's state. 
  3. establishing a catastrophic insurance fund for exceptional cases, such as the Iowa boy whose $12 Million annual bill has singlehandedly caused all of the insurers to flee the market in that state.
  4. allowing a Medicare buy-in for those age 62-64.
Of course, to enact "skinny improvement" both Ryan and McConnell would have to permit it to come to a vote, even though a majority of their respective caucuses would presumably be in opposition. And to assure the President doesn't use his veto, we would probably have to name it something like the "Donald J. Trump Healthcare Enhancement and Obamacare Repeal Act."

But if doing nothing is not an acceptable option, then "skinny improvement" looks like the narrow way forward.