Oopsy!Care
Obamacare promises and Obamacare reality are a bit far apart -- as expected by those of us who aren't Obama fanboys and girls. That's okay -- they got it passed. As for now, at the WashEx, Philip Klein writes:
There are very real and serious problems facing the law. Now that insurance companies have had a chance to assess medical claims being filed from those who signed up for Obamacare, it's become clear that the pool of enrollees is costlier than expected. Simply put, insurers aren't signing up enough young and healthy individuals to offset the cost of covering older and sicker enrollees. And the administration has slashed its enrollment projections for 2016....On the surface, there seems to be a growing consensus among Republicans when it comes to crafting an Obamacare alternative. Several plans introduced by Republicans in Congress have significant overlap with the presidential proposals unveiled by Gov. Scott Walker when he was running, and more recently, Jeb Bush. Those plans would generally repeal Obamacare and provide a tax credit to individuals to help them purchase insurance instead.
But many conservatives object to the idea on the grounds that a tax credit in effect is really another term for more government spending.
Other proposals, including ones introduced by Jindal and the House Republican Study Committee, instead rely on giving a standard tax deduction to individuals for purchasing health insurance. But fans of the tax credit argue that this approach wouldn't do much to help those with little or no tax burden against which to deduct, meaning that it wouldn't be competitive enough on coverage to be a politically viable alternative to Obamacare.
...In March, Cruz released a bill called the Health Care Choices Act, but aside from repealing Obamacare regulations, all it would do is allow for the interstate purchase of insurance. That's a positive step, but that alone would do little to change the multitude of barriers to a free market that would remain even if Obamacare were repealed. His presidential campaign has not released a detailed alternative.
Basically, the Republicans all have their thumb up their ass and there's no sign of any meaningful impending extractions.
"But many conservatives object to the idea on the grounds that a tax credit in effect is really another term for more government spending."
This is what happens when people allow themselves to be fooled repeatedly with tricky language.
What the hell does anyone think a subsidy is?
How abysmally stupid do you have to be to pay for something you do not get?
Again: the solution.
Unfortunately for us all, it doesn't give government power.
Radwaste at November 13, 2015 2:33 AM
Don't expect any detailed plans from the republicans. Every plan has upsides and downsides. The media will harp and heckle any republican plan to death. It doesn't matter if it is better than what we currently have. Any downsides will be repeated ad nauseam. So there is no upside in revealing your plan.
Also, it is congress that makes and passes laws. Not the president.
Ben at November 13, 2015 4:59 AM
"Simply put, insurers aren't signing up enough suckers to offset the cost of covering older and sicker enrollees. "
FIFY. You're welcome.
Also, it is congress that makes and passes laws. Not the president.
Yeah, well, tell that to Mr. "I have a pen and a phone" Obama.
I R A Darth Aggie at November 13, 2015 6:32 AM
"Yeah, well, tell that to Mr. "I have a pen and a phone" Obama."
A trend I'm hoping we discontinue. If the imperial presidency becomes standard it's time for a revolution.
Ben at November 13, 2015 7:51 AM
"Simply put, insurers aren't signing up enough suckers to offset the cost of covering older and sicker enrollees. "
Obamacare itself says that those young, healthy people can stay on Mommy and Daddy's insurance until they're 26! Shazam!
As far as the tax credits: I object to the idea that the government allowing you to keep more of the money you earned constitutes a "subsidy". (As long as it isn't something narrowly targeted to one entity or industry... then the point becomes arguable, because it's a tax break not available to the vast majority.) And in a way, the tax-credit idea is fiendishly clever: the politican proposing it can claim that he's giving you free stuff, even though it's your own stuff, and the low-information voters who just want to hear "free stuff" won't comprehend the difference.
Seriously, any proposal that moves in the direction of opening up the market, and decoupling health insurance from employment, is a huge step forward.
Cousin Dave at November 13, 2015 8:08 AM
One is coming. But it won't be the 1776 revolution to secure individual liberty. It will be the 1917 revolution to impose collectivism. It will be fought in the name of making society "safe" for all.
The Great Experiment is almost over, and it's not looking good.
Conan the Grammarian at November 13, 2015 8:55 AM
I just keep hearing libs say it would be perfect if we just pushed further left and made it single payer.
Joe J at November 13, 2015 9:03 AM
Cousin Dave,
A refundable tax credit is a subsidy. Even if you didn't pay taxes you get this 'credit'. You are thinking of a tax deduction or tax break. There you only get as much of the reduction as you paid taxes in.
As Rad said, tricky language.
Ben at November 13, 2015 9:12 AM
I somewhat disagree, Ben. I only consider it a subsidy if it drives your total tax obligation below zero. The big problem with something like the Earned Income Tax Credit is that nearly everyone who is eligible to claim it winds up with a negative tax obligation, meaning that not only do they not pay any taxes, but the government pays them. The compromise I'd offer is that it still be a tax credit, but the amount available is capped by your total tax owed.
Cousin Dave at November 13, 2015 9:50 AM
A subsidy doesn't have to take care of their entire tax burden to be a subsidy. We, the other taxpayers, are subsidizing their payment of their taxes by letting them pay less while we pay more.
Conan the Grammarian at November 13, 2015 11:06 AM
I somewhat disagree, Ben. I only consider it a subsidy if it drives your total tax obligation below zero. ~ Posted by: Cousin Dave at November 13, 2015 9:50 AM
A subsidy doesn't have to take care of their entire tax burden to be a subsidy. We, the other taxpayers, are subsidizing their payment of their taxes by letting them pay less while we pay more.
Posted by: Conan the Grammarian at November 13, 2015 11:06 AM
And down that slippery slope goes the argument, that this is the government's money we are talking about, and that somehow under our progressive tax system, those who get a break, in the form of a credit, are not paying their *fair share*.
The income tax was not designed to be fair, it has been used almost since the start to encourage behavior the government approves of (like buying insurance) and discouraging behavior it doesn't ) like cashing in your 401k.
Isab at November 13, 2015 12:56 PM
Single payer? I thought I heard someone say single payer. If you encounter someone espousing the efficiencies and joys of the single payer system, remind them that we have a single payer system in the USofA.
It's called the VA.
I R A Darth Aggie at November 13, 2015 1:23 PM
Cousin Dave,
From what I understand about Bush's tax credit it would be another fill out the tax form and we send you a check for taxes you didn't pay situation. If you make enough money to cover the credit with taxes you are no longer eligible.
But please double check me on that. Also, it's not like the plans are set in stone.
Personally I say they should just repeal O-care. Make insurance purchasable across state lines. Offer the same deduction to individuals as businesses get for premiums. Done. Call it a day. Not everyone has to have insurance. That is what state and local poverty programs are for as well as medical charity. Personally my heath insurance is just a little cheaper than my house mortgage. It is very expensive and only getting more so.
Ben at November 13, 2015 1:26 PM
Of course there's no credible solution coming from the Republican camp! The problem is this:
- Make healthcare cheap and widely available
- without increasing costs to consumers... including taxes
- while maintaining the current insurance setup
- and expanding/mandating broad coverage (not just catastrophic)
- AND increasing costs to health providers via new regulations (e.g. digital records, mandating new medical/insurance codes
Since there's no such thing as "free" AND we are insisting upon having the insurance be cheap and not the care, we've really made something impossible. Sure, Europe might have "cheap" healthcare, but they pay for it in spades - just indirectly.
Shannon at November 16, 2015 10:22 AM
Here's my proposal:
1. Make all medical expenses and insurance tax meductible. Kill some other deductions to compensate. I suggest putting caps on the mortgage tax deduction, so it is no longer an incentive for the very rich to buy ridiculously bloated mansions, nor for the upper middle class to buy more house than they can afford and call it an investment. That is, I would limit this deduction both in absolute amount and as a percentage of income.
2. As the main means of deducting medical expenses, make _everyone_ eligible for HSAs, whether or not they have insurance or an employer. Just like now, what you put into the HSA is non-taxable, as is any interest it earns. You can pay for your insurance through an HSA, as well as for all medical and dental treatments, devices, and drugs. Change the annual limit on contributions per individual to $5,000 plus all expenses paid through it - that is, encourage people to build up tax free savings in their HSA while they can afford more than they are spending.
3. Insurance should be separate from employment.
4. Insurance should actually be _insurance_. That is, it should pay off only on large expenses due to unexpected events. You use the HSA for routine stuff. You should never lose coverage because of illness, even when the expenses go on for years. (Unlike the current so-called insurance plans, which are sometimes comparable to a fire insurance policy that only paysfor rebuilding your house if you can get it done before they can cancel it at contract renewal time.) Get a serious condition that is only treatable, not curable, and your insurance company can neither get you off the books nor raise your rates.
5. Insurance must be portable between states. You change jobs and move to another state, and you have the option of taking your insurance with you. If they don't have "in network" providers in your new area, including any specialists you need, they'll have to treat all the providers as "in network". Insurance companies will have one out - they can negotiate with other insurers to transfer your policy to one with a better local presence, but coverage must be as good or better, and the premiums can go up only to the extent that the federal plan ("CrappyCare", see below) rates the new location as a higher cost area.
6. Finally, what happens when the uninsured get sick (and don't have enough in their HSA and bank accounts), and what happens to people that never make enough to cover their medical expenses? We'll provide for them, but not generously:
7. Emergency rooms are still required to provide care for anyone brought in with a medical emergency. Hey, if someone conks you over the head and steals your wallet, you want to be cared for until you wake up and can tell them how you're going to pay. But they are no longer providing free care for the indigent and irresponsible, and no longer allowed to inflate the paying customers' bills to make up for the deadbeats. Instead, unpaid charges can be sold to the IRS for collection. (Preferably this is tied to a tax code simplification, so the IRS can transfer staff rather than expand.) There are limits on the amount, and an appropriation to cover those debts
that cannot be collected, but lets make it quite clear that misusing an emergency room for a "free" visit to the doctor's office is going to cost you.
8. The ultimate fallback: CrappyCare (the federal healthplan, like an expanded Medicaid). Politicians will make a nicer name for it, but let's be honest in these pages: government insurance either busts the budget or it is crappy. Everyone is eligible, but there is a means-tested premium; it's only free for the very poor. You can pay from an HSA or with a checkoff on your income tax return. Pre-existing conditions are covered, and you can even sign up in the emergency room and have that and other recent expenses covered, but if you were uninsured before, you might owe premiums for the last three years. Once again, if you need treatment now, you get it (whatever CrappyCare will pay for), and can pay later, but you do have to pay it and the IRS is the debt collector.
markm at November 19, 2015 3:42 PM
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