Thursday, October 19, 2017

The Outlook for Stabilizing Obamacare in 2018 and the President Who Can't Shoot Straight

The Alexander-Murray bipartisan effort to stabilize the Obamacare individual insurance markets will not pass the Congress on its own. 

The only chance it now has is to be added to a must-pass legislative deal, such as the one needed to fund the government by the December 8th deadline in order to avoid a government shutdown.

Also sitting in the queue, and certain to pass at some time, is the Children's Health Insurance Program (CHIP) reauthorization bill. The Congress is currently struggling over the pay-fors for this reauthorization but there is wide bipartisan agreement that it must be funded before the states start running out of money, which will begin in a few weeks. CHIP now covers nine million kids.

Conservative Republicans are adamant that they do not want to pass an “insurance company bailout” bill like Alexander-Murray. Particularly in the House, where Republicans were able to pass a "repeal and replace" bill, these members have already taken a controversial vote to cut Medicaid and insurance subsidy support and after that tough vote don't now want to have to explain why they have backtracked to "bail out" Obamacare with the Alexander-Murray short-term patch bill.
Tuesday, Trump pulled his initial support for the bill. That he would first support it and then abandon it just speaks to how little he understands the health issue and how essentially worthless his presidential leadership is toward getting a solution for Obamacare. This Trump flip-flopping just proves that there is only one place health care gets decided—in the Congress and a very divided Congress at that.

On health care, if leading conservative organizations told Trump to sign a ham sandwich he would do it and declare it, “A Marvelous victory, really a very marvelous victory.” 

If you want a description of a President who can't shoot straight, look at Trump’s citing the stock price gains among the big managed care companies as justification for his killing the cost sharing subsidies (CSRs) for low-income people in the insurance exchanges. 

Hasn’t anyone told Trump that almost all of those big publicly traded health insurers he's been railing against for their big stock price appreciation since Obamacare launched––Aetna, United, Humana, and Anthem–– have bailed, or are in the process of bailing, on all or most of their insurance exchange business and won’t be hurt by his action? It’s the not-for-profits that have largely stayed in the exchanges, not his intended targets!

There is no hope of the Republican caucus in either the House or the Senate advancing anything in the coming months—repeal and replace or a short-term patch––on their own. We saw them exhaust all of their policy ideas over the past four months. They claim they will again try to advance a Graham-Cassidy-like bill focusing on state block grants but until they can reconcile the cuts to Medicaid and the insurance subsidies the conservatives want with the cuts the moderates don’t want, they aren't going to pass anything.

That leaves us with the Democrats. The Dems don’t have a majority in either house. But there are must-pass bills on the table—such as funding the government by December 8th to avoid a shutdown and the reauthorization of CHIP before the states run out of money to continue health insurance for nine million kids. The most likely vehicle for them to exert their leverage will be on the shutdown bill. It will take 60 Senate votes to avert a government shutdown just before the Congressional holiday break (never underestimate an ideologues desire to get his holiday vacation). Look for the Dems to try to take the December 8th funding bill hostage toward getting something like Alexander-Murray. 

Of course, it they are successful, any short-term help for the insurance exchanges will be too late for 2018 since next year's open enrollment is scheduled to end on December 15th.
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