Here’s what happens after ObamaCare is gone

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Michael Tanner:

Republicans are wrestling with how to repeal and replace ObamaCare. It turns out that legislating is much more complex than campaigning. Still, ObamaCare as we know it is unlikely to be with us much longer.

So what happens after it’s gone? On Friday, we looked at some of the most likely provisions of any ObamaCare replacement. They would expand consumer choices, by expanding the use of health-savings accounts and allowing the purchase of health insurance across state lines.

Still, there are some people who would face challenges if the law were repealed. This includes those with low incomes and those with pre-existing health conditions.

ObamaCare did expand the number of Americans with health coverage by some 20 million people. Most of those, however, received coverage not through the program’s subsidies for private insurance but through the expansion of Medicaid.

There is ample evidence to suggest that Medicaid provides little if any benefit. One notable experiment in Oregon found no improvements in health outcomes from Medicaid enrollment. But regardless, repeal of ObamaCare is unlikely to have any short-term impact on Medicaid.

The same can’t be said for those Americans receiving subsidies to purchase insurance through ObamaCare’s exchanges. Those subsidies will almost certainly be cut back or eliminated, so some people could end up paying for the full cost of their premiums.

Of course, that also means less of a burden for taxpayers overall, since they were picking up the cost of those subsidies. Besides, even with subsidies, the rising cost of premiums under ObamaCare was leaving many Americans struggling to afford insurance.

There will undoubtedly be winners and losers, but by bringing down the cost of insurance, the Republican plans will leave most Americans better off.

The question of pre-existing conditions is a much tougher nut to crack. Pretty much all the problems with ObamaCare flow from the decision to require insurance to cover people with pre-existing conditions — that is, people who are already sick — without charging them more than healthy people.

Because insurers will lose money on those sick individuals, the cost has to be offset by enrolling young and healthy individuals, who pay premiums but require few benefits. Since the young and healthy are reluctant to buy insurance on their own, ObamaCare included the unpopular individual mandate in order to force them to do so.

A mandate meant the government had to define what qualified as insurance, hence the minimum benefits package and the elimination of low-cost catastrophic policies. People who liked their policies found out they couldn’t keep their policies. The dominoes fall.

The number of truly uninsurable people is actually quite small, and will decline further under Republican plans to reduce insurance costs and make it easier for people to keep their coverage if they lose their job.

Still, any replacement plan will have to include some provision to make sure health insurance — or at least health care — is available to people whose medical condition makes them otherwise uninsurable.

Some GOP plans preserve the pre-existing-conditions requirements as long as a person maintains continuous coverage, or signs up during a limited open-enrollment period.

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No blood letting no use of leeches no having big brother in your medechine cabinet

There will undoubtedly be winners and losers, but by bringing down the cost of insurance, the Republican plans will leave most Americans better off.

Let me write that down: “Repealing the Affordable Care Act…will bring down… the cost of insurance.” I think at some point in the near future I might want to remind people they were told that.

The number of truly uninsurable people is actually quite small, and will decline further under Republican plans to reduce insurance costs and make it easier for people to keep their coverage if they lose their job.

OK, let’s see the plan. Give us the details and explain how it works.

Still, any replacement plan will have to include some provision to make sure health insurance — or at least health care — is available to people whose medical condition makes them otherwise uninsurable.

Uh… Some provision? If you haven’t got that worked out, you don’t have a plan.

Here’s the only possible way that can happen, in the absence of the Affordable Care Act’s health insurance mandates: You provide them with health insurance—or at least health care—at the taxpayers’ expense. Since you have also cut taxes, however, you lack the funds to cover this increased expenditure, so deficits—which had been declining since 2009—would once more take off for the stratosphere. What we would be doing, as before, is subsidizing private sector insurance company profits using borrowed money. As before, many people will simply forego insurance. Then they’ll show up at ERs following accidents or seriously ill, and their costs will fall to the taxpayers, or be passed on to those who responsibly carry insurance in the form of rapidly rising health service costs.

Do people think the Affordable Care Act was created just to annoy republican voters? It was created in response to a bunch of rapidly worsening systemic problems that hadn’t been addressed in decades. It provides a means to get a handle on things, IF you’re willing to face reality and make the necessary changes and improvements. Totally scrapping it is idiotic. Doing so would be incredibly expensive, incredibly disruptive, and possibly threaten to destabilize the economy. There may well be better approaches, but there is no frickin’ quick and easy total replacement that’s better and cheaper—as voters will soon find out when republicans fail to provide one that actually works.

@Greg:

The very best plan out there right now is a very simple one, repeal the deplorable care act completely, period…

It may be necessary to create a “no frills” civilian government program (of basic – to – critical needs) healthcare providers on a similar operational method as the VA and military hospitals operate. Perhaps as teaching hospitals and clinics, with a requirement that students serve a minimum residency period in return for lowered or even subsidized education. This would also help address the current problem of there being insufficient doctors and nurses to fill the increased numbers of patients. This could perhaps be created as an enlisted Civilian Medical Corps, An organization such as this would create jobs and provide training for lower and middle class workers who can not afford tuition to more prestigious medical schools. an elite mobilization group of this medical corps workforce could also be available for disaster relief. mobilization.

Paul Ryan promises to replace key Obamacare policy with that same policy

So…a different approach to subsidies, but still subsidies? And allowing the sale of insurance across state lines? (The main effect of which, by the way, would be to allow insurance companies to shop for the most lenient regulatornot to lower consumer costs.)

If that’s what the big changes actually come down to, why not just change the Affordable Care Act to make those changes, and avoid spending hundreds of billions of dollars to tear the whole thing down and rebuild it from the ground up?

@Greg:

so deficits—which had been declining since 2009

deficits declining? National debt went from 10 Trillion to 19.5 Trillion all while deficits was declining. Wonder how that works. I’ll bet you drive your bankers nuts demanding that your checking account should have more in it without you depositing anything.

But with 56% unemployment,not too many were drawing paychecks to deposit.

@Greg:

Let me write that down: “Repealing the Affordable Care Act…will bring down… the cost of insurance.” I think at some point in the near future I might want to remind people they were told that.

You mean like “if you like your doctor, you can keep your doctor” and “if you like your plan you can keep your plan” Affordable care act. So affordable no one can pay for it.

@RedTeam, #6:

Wonder how that works.

How that works is fairly simple to understand. You begin with a disastrous recession, immediately on the heels of a near-collapse of the financial system that threatened to take the entire world economy down like a line of falling dominoes. The stimulus spending necessary to forestall total catastrophe then takes place in an environment where federal revenues have crashed through the floorboards.

As if that were not enough, add to it two enormously expensive ongoing overseas wars, financed entirely with borrowed money.

Deficits skyrocketed as a result, but have fallen steadily as our military occupations have been scaled back and as the economy has recovered. If we do something similarly stupid again, we will once again find deficits spiraling out of control.

@Greg:

obama once said Bush 43 was unpatriotic for the debt he accumulated as president.

obama proceeded to double that, some president, not.