What happens to Obamacare with GOP in charge?

Having failed to get a vote in the Senate after the House voted more than 50 times to repeal the Affordable Care Act (aka Obamacare), Republicans rode the horse to take control of the Senate yesterday.

With a Republican majority in the Senate now, at least a symbolic vote to repeal the Act could be held before sending a bill to President Obama for a veto.

“A swift ACA repeal vote in both houses is what the most right-leaning want most,” Republican strategist Juleanna Glover told the Washington Post earlier this week.

Forget it.

In an “exclusive” interview with Time today, new Senate boss Mitch McConnell made it plain:

I think we need to do everything we can to get America back to work. And exactly which bill comes up first will be determined after discussing that with my colleagues and with the Speaker. Some examples of things that we’re very likely to be voting on: approving the Keystone XL pipeline, repealing the medical device tax, trying to restore the 40-hour work week, trying to get rid of the individual mandate. These are the kinds of things that I believe there is a bipartisan majority in the Senate to approve.

Note the absence of the full repeal of the Affordable Care Act. It wasn’t by accident. He suggested there would be no full repeal of Obamacare, opting instead for some repeals via appropriation bills.

That refers primarily to the medical device tax and Forbes notes why that will constitute the assault on Obamacare under McConnell — it’s low-hanging fruit.

The largest medical device companies in the United States are all in states with Democratic senators: Johnson & Johnson (New Jersey), Medtronic (Minnesota), Baxter (Illinois), Stryker (Michigan), Boston Scientific (Massachusetts), and St. Jude (Minnesota). In March 2013, 79 senators, including Elizabeth Warren (D., Mass.), Amy Klobuchar (D., Minn.), and Al Franken (D., Minn.), voted symbolically in favor of a device tax repeal.

What else might go? The New Republic says the employer mandate for coverage. The Obama administration has already delayed the mandate until 2016 anyway.

Economists don’t like the employer mandate, because they think it doesn’t actually do much to boost coverage. That is why the Obama Administration, which has no philosophical attachment to the idea, might go along with changes. But the president would probably insist upon two conditions, neither easy to meet.

First, he’d be wary of changing the threshold to 40 hours, as some Republicans propose, because that’s a standard work week and significantly more people would probably lose hours because of it. Also, the employer mandate generates revenue: Anywhere from $46 to $149 billion over ten years, depending on whose estimates you trust. The Obama Administration almost certainly wouldn’t sign off on a proposal that didn’t pay for itself.

One other, related possibility would be changing the definition of which businesses are subject to the requirement. Right now, it’s any business with at least 50 full-time employees. Republicans could propose raising that to 100 full-time employees. The White House might even go along—again, if the proponents found some way to replace the lost revenue.

To do much more — full-scale repeal, for example — carries risks, Bloomberg says.

“More than 10 million people have so far gained insurance coverage under the health law, and some Senate Republicans up for re-election in 2016 may want to avoid voting against a law benefiting many of their constituents,” it says today.

  • >>More than 10 million people have so far gained insurance coverage under the health law<<

    But I thought 46 billion people all lost their coverage and the rest had their insurance premiums go up by 1024% due to "0bamacare" ?

    /Sarcasm

    You know, nothing is really going to change. The President still holds the veto power and congress doesn't have the votes to override said veto.

  • Dave

    I sincerely hope McConnell enjoys the next two years, because that’s all he’s going to get. He and his party now have a much bigger stage on which they can accomplish nothing.

  • kevinfromminneapolis

    I expect it will be on the back burner and the law will continue to be untouchable but for all the times the administration has acted on its own to change or delay it. That’s probably where it should be. McConnell hit the right notes.

    • Dave

      Politicians say all sorts of conciliatory things immediately after an election.

  • Ryan P

    Just get rid of the individual mandate and I will be happy. I want no part of the insurance system.

    • And how will you pay for medical coverage when you are sick or injured or are you independently wealthy?

      • Ryan P

        Well let me elaborate. I have medical insurance – temporary medical insurance. It is 1/5th the cost. So in an emergency I use that. All other situations I either pay out of pocket or go to Mexico. My savings are immense. If I became long term unhealthy though I would just get a normal health insurance package or continue to get treatment in Mexico which is a 4 hour drive from me and provides superior costs and service. I’m not wealthy, I’m not poor, but I’m not paying $400 a month for a PPO. I just don’t use that much medical care. $400 is a lot of money to me for something I won’t even use. Even catastrophic HMO insurance costs me $230 a month. Obamacare hurt me. If it helped you thats great but I need a way to opt out of it.

        • David

          If everyone is jumping in and out of the insurance market, in when they need coverage and out when they don’t, how does that not become a death sprial? http://en.wikipedia.org/wiki/Death_spiral_(insurance)

          • Ryan P

            That’s why the old system was better. But since I am forced to live in this system, I will choose the $85 bill over the $400 bill.

            And I don’t really care about a death spiral of a system which is attempting to loot me.

          • David

            Ahhhh, but if the system that is attempting to loot you finally dies, what happens when you want to jump back into the market?

          • Ryan P

            Just go into what ever replaces it. You think the medical system will disappear? It’s just going to be replaced with some other bad model when this bad model dies.

            The road goes on forever and the party never ends.

          • Michele

            How was the old system better? If you got seriously ill, no insurance company would have touched you and if you already had insurance before the illness the ins. cos would drop you. If you can’t afford $400 for insurance you would certainly wouldn’t be able to afford hundred of thousands of dollars to pay for medical bills. I guess you would just hope some hospital/provider would write off the cost of your treatment and then those costs would be rolled into the costs assumed by everyone who actually does have insurance.

          • Ryan P

            It’s interesting Michele, most people had insurance anyways. I’m not defending the old system as a great thing or a model to emulate, I’m just saying that now my situation is worse and I didn’t have insurance woes in the past. Some people are better off now, some people aren’t. Currently my mainstream insurance options are inferior than they were 3 years ago… except for the temporary health insurance route. Granted, this isn’t an option for a person with a pre-existing condition. I’m not suggesting I found the solution for the majority of the population, simply that I found the best choice for me. If your situation has improved or even stayed the same over the past couple of years I truly am happy for you. With this type of law there were bound to be winners and losers. Judging by approval of the law, there are more losers than winners but that’s hard to say.

        • brian

          You realize that is a freeloading strategy, right? Insurance companies shouldn’t let you switch to a comprehensive health plan when you get sick because you don’t pay for it while you are healthy. But they will because they have to. All the individual mandate does is add some fairness to the system.

          • Ryan P

            Yes, it is a free loading strategy. In a welfare state there are only two options: Be a leech or be leeched upon. The entire premise of Obamacare is freeloading: They want young people to subsidize the unhealthy. They want the middle class to subsidize the poor. It’s all freeloading. Tell me a scenario in a welfare state where there isn’t leeching. I’m not pro or anti welfare, but if I am going to be forced to live in this system I would rather be the guy with an $85 bill instead of the guy with the $400 bill. Those are my two options. I was happy paying $185 for a PPO in 2011, but apparently that system was “broken” and now I have to pay $400 if I want a PPO. So no thanks.

          • Michele

            Your argument presumes you will always be young and healthy. One day you will be unhealthy. Fact. It could happen much sooner than you think and if so, you will be SOL or society will pick up your tab. For this reason I really like Bob’s suggestion to get rid of EMTALA if the individual mandate goes. It is the only way that makes sense.

            You do have options which includes upside and downside. (Which makes me wonder, why don’t you just pay the fee and not carry any insurance or whatever ins you want?) Maybe your just a troll…

          • Michele

            By fee I mean the fine. Just pay that and be done with the matter. It’s not that big a deal.

          • Ryan P

            That’s true Michele, the tax + ACA invisible catastrophic insurance is a better deal than the $2xx high deductible ACA HMO plan. That’s what I’m doing now, the tax + temporary insurance. That’s the argument I’ve been making this entire time. Unless you are unhealthy and need a comprehensive insurance plan Obamacare doesn’t make sense. One alternate scenario is if your plan is subsidized enough.

          • Ryan P

            Michele, I’m not a troll, I’m having an honest conversation. My argument doesn’t presume I will always be young. I pay $85 a month for temporary medical insurance because it has a $1000 deductible. It is cheap catastrophic insurance. It isn’t comprehensive insurance. You might not have read the post where I explained the insurance so I’ll give you the benefit of the doubt. If I went with out insurance I would have no catastrophic coverage. If I go with the $400 PPO comprehensive I will never actually use it and will be throwing money down the drain. If I go with a $2xx HMO catastrophic I will have something like $8000 deductibles and 20% which is mostly pointless. If I get old, as Brian pointed out is a freeloading strategy, then I will go on an Obamacare plan because then it makes financial sense. My rebuttal is Obamacare is designed around the idea of one portion of society covering the bill of another portion of society and so my freeloading is no different. I’m not anti-Obamacare, I understand it’s good for some people, but it’s bad for me and so I am simply choosing the best cost / benefits option.

          • brian

            Your catastrophic insurance also works by having a portion of society covering the bill of another portion of society (healthy policy holders pay for sick policy holders). This is how all insurance works.
            Luckily for society as a whole (and getting back to the point of the post), the individual mandate isn’t likely to go anywhere. All policy makers know it needs to be there, they just can’t say so. And Republicans get to benefit since they didn’t vote for it.

          • Ryan P

            Actually Brian, and this might be my fault for not explaining it well enough, Temporary Medical Insurance is immune to all ACA and many other regulations. They can block you for preexisting conditions. That is one of the reasons why it is so cheap for a healthy person such as myself. Nobody is subsidizing my current insurance. Again, it’s my fault for not pointing that out. There are several insurance models and systems that are not effected by ACA and other laws, that’s what my $85 plan is part of.

          • brian

            No, I mean all insurance (car, homeowners, health, life) works by having someone pay for another. The isurance company doesn’t save your premiums and only pay out what you have paid in. If you get sick it is other premium payers that subsidize you and you are currently subsidizing other policy holders.

          • Ryan P

            I understand that Brian. My point is that by my insurance rate being tied to my health and also by them being able to not renew me when the policy expires (temporary insurance), my market insurance rate is $85. For a similar level of coverage under the Obamacare model, my insurance rate is $3xx. And for an inferior deductible, $2xx. These are all catastrophic plans. The $85 is just with me ‘subsidizing’ people of similar health backgrounds to me and nobody receiving discounts.

          • brian

            Which would not work if everyone did it. Hence, the mandate.

          • Ryan P

            I really feel like I’m not explaining Temporary Medical Insurance well enough. Temporary Medical Insurance is not under the umbrella of the ACA. Temporary Medical Insurance has had strict pre-existing condition requirements since Obamacare has passed. Temporary Medical Insurance companies do not also have ACA compatible plans. Temporary Medical Insurance in the past few years has transformed into a way for healthy people (and only healthy people) to avoid the pitfalls of the ACA. I am not suggesting Temporary Medical Insurance is a solution to the medical woes of the nation. I am only suggesting it is a way for, in my case, the saving of thousands of dollars a year. I am not suggesting Temporary Medical Insurance is best for you, I am only suggesting it is best for me at the present. As far as the mandate goes, I, and the 65% of the public that has been hurt by the ACA, have no concern that doing away with the mandate will make the ACA fail. The mandate is unpopular because it has harmed such a large portion of the populace. Yes it has protected a portion of the populace, but at the expense of another portion. And with this high disapproval, you can bet it will be gone.

          • You’re pretty much describing all insurance, however. I’m paying for the person texting and driving, for example. The concept of shared risk isn’t anything new.

            What IS new is the idea that you don’t have an option of joining a risk pool as you do with other kinds of insurance.

          • brian

            I wouldn’t bet on the mandate going away. The mandate is unpopular, but the preexisting condition part of the ACA IS popular and the two go hand in hand.

          • tboom

            >>I am not suggesting Temporary Medical Insurance is best for you, I am only suggesting it is best for me at the present. <<

            For the present – until such time that you experience a chronic medical condition requiring expensive treatment over time – when you will learn just how temporary "Temporary Medical Insurance" is (and how fast a pre-existing condition can deplete your savings).

          • Temporary medical insurance isn’t intended for permanent coverage, as the name obviously implies. It’s meant as bridge coverage until regular insurance is available, either through open enrollment or job loss etc.

          • Michele

            Your argument does presume you will always be young. Everyone gets old/sick and eventually dies. In one way or another, we all access healthcare in various ways throughout our lives, although statistically the most care is delivered in the final 6 months to year of life. But make no mistake you will use the h/c system. In some ways you can look at insurance as a “pay it forward” type of plan. You are paying now for benefits you will receive in the future. In our current system there is an artificial divide between “Obama-care” and Medicare, but in reality there is so much cost shifting in h/c that people who pay into the system under “Obama-care” are in fact subsidizing healthcare for senior citizens. (Regular insurance typically picks a part of the tab for Medicare because M/care payments are often lower than the costs to deliver.) The bottom line is that by contributing now you are supporting a system from which you will recieve benefits.

            On another note, your health and your h/c needs are largely determined by your genetics. Look at your relatives–grandparents, parents, uncles/aunts, siblings–to get an idea of how your health will play out. How long did they live? What health issues did they face? Etc. If you live a healthy lifestyle that is great but the genes don’t lie.

        • MSF

          Yes!!! Lets all go to Mexico for healthcare! GOP plan for Obamacare replacement!

      • I wonder if it would be a good idea to tie the rollback to a bill that eliminates the requirement for ERs to treat everyone regardless of insurance?

        • Ryan P

          That’ll certainly decrease costs. How much is unclear. I doubt it will significantly affect the medical inflation we have been seeing.

          Politically it would be very bad PR.

        • kevinfromminneapolis

          Zero people have proposed that.

          • Well, of course not, but wouldn’t that make for a much more transparent conversation on the question of who should be responsible for providing someone’s health care?

        • kevins

          In the past, some hospitals would simply send the poor to the next hospital, which eventually caused the charitable hospital to close because they were providing so much unreimbursed care. (True story…that’s the way it was in Moorhead-Fargo).

        • brian

          This is the only fair alternative to requiring health insurance.

          • Ryan P

            No complaints from me. Seems like a good trade off.

        • Rich in Duluth

          While it’s certainly an interesting thought experiment, some people would surly die if they were actually denied emergency care because they couldn’t pay for it.

        • DavidG

          Also, make medical debt like student loans: non-dischagable.

    • Jerry

      “Neddy doesn’t believe in insurance. He considers it a form of gambling”

      • Ryan P

        I have medical insurance, but my insurance doesn’t qualify under the individual mandate.

      • Guesty Guesterson

        Always a time and a place for a Simpsons quote. Well played, sir.

  • Ryan P

    My insurance costs $85 a month. I have temporary medical insurance which is immune to the obamacare regulations. The only problem is it isn’t recognized as insurance by the obamacare individual mandate, that’s why I hope the individual mandate is repealed. As long as I am young and healthy I can keep renewing this insurance instead of paying 5 times that amount for normal health insurance, but the individual mandate will take a bite out of my savings.

    • Ryan P

      I don’t want to make it sound like temporary medical insurance is the only alternative though. Another alternative if you find the cost / benefits of Obamacare to be poor is to join a Healthcare Sharing Ministry. These are immune to the individual mandate tax and a PPO costs on average 30% less than an Obamacare PPO. My only problem with these is I use medical care so rarely that a PPO still doesn’t justify itself in my life.

    • >> I can keep renewing this insurance<<

      Not necessarily.

      I just hope you realize how risky just having this insurance is and that you never have to use it. I have a feeling that if you ever find yourself having to actually use this insurance, you will find yourself dropped from the plan like a hot potato with an eventual HUGE hit to your savings.

      Good luck, you'll need it.

      • Ryan P

        Hello Onan, that is correct. However it doesn’t happen like you say. When the temporary period ends (6 months or 11 months depending on your state) what happens is you can’t repurchase the insurance if you now have a condition. In that past this strategy would have been dangerous, but now with Obamacare you can get insurance even if you have a preexisting condition. So get cheap insurance as long as you can, then when you get sick switch to the ACA backed plan. That’s why Brian called what I am doing ‘freeloading’. My retort is that the ACA is designed specifically to aid ‘freeloaders’.

      • Ryan P

        One addendum to what I wrote before: In the period between no insurance if you get sick in the first half of the year, while waiting for the ACA enrollment period, you have several options. 1) You can lie about a status change, although I wouldn’t count on that. 2) You can simply use some of the massive amount of money you saved and pay out of pocket for half a year.

  • zoe

    I use to work for a major insurance company in the marketing department. My job was to prepare health insurance plans for companies from 50 to 400 employees. The company I worked for aimed at us selling 40% of the plans at what they termed ‘ cost efficient ‘. Insiders called the policies ‘ death policies ‘. The reason they were so cheap was because they basically didn’t cover most of the things that people were likely to need. Plus, they sounded ok in print but try to get your doctor, lab, hospital to accept them. The providers wanted you to give them your credit card and they wanted to give you a receipt in return. Now, good luck getting reimbursement from that receipt. Temporary insurance plans were part of the ‘death policies’, excuse me, ‘cost efficient’. Unfortunately, I can’t prove any of this to you. But, if you ever need to use this policy you have just learned a very expensive lesson. Plus, once you have a medical history under the old health insurance rules you were out of luck getting future
    insurance at any cost you could afford. This is part of what the ACA is designed to protect all of us from.

  • davehoug

    AHHHHHH but now paying the penalty for non-ACA compliant insurance plus a
    cheapie temporary insurance plan makes logical sense for some. Several
    years go by with large savings until bad diagnosis or accident then
    just hang on until the next open enrollment. It IS a gamble because one
    accident can cause huge bills. Some will prefer this gamble rather
    than paying the penalty and having absolutely no insurance.

    Some
    will gamble with the absolute cheapest ACA compliant plan until that
    bad news, then switch to best plan (knowing the need is big) at the next
    open enrollment. Some will rest easy paying high premiums, knowing IF
    the bad news comes, they have great coverage all year.

    The ACA means the gamble is only until the next open enrollment, not the rest of your life.

    Folks
    will not want to go back to before when they can never get insurance at
    group rates even if they could get a plan to accept them. With ACA some win,
    some lose, uncompensated care at ER and medical bankruptcy is reduced. Either the ACA – – OR – – a
    high-risk statewide pool for folks plans do not accept and higher
    uncompensated care at ER rooms and medical bankruptcy due to choosing no insurance. It is not the downfall of the US either
    way.

  • kellie

    I’ve been self-insured for over a decade. The Affordable Care Act’s exchanges made shopping for insurance much easier (=easier to compare plan offerings from different companies). I think it’s also lowered rates because the additional transparency means the companies have a reason to be more competitive.
    However, my plan’s cost is going up 30% this year! I’ll shop the exchange for a cheaper option, but I’m disappointed in that.