Monday, April 17, 2017

Trump threatens to blow up Obamacare exchanges. Why?

(This was carried in all editions of the Sky Hi Daily News, 4/19/17)

Have some in Washington DC lost their minds over repealing/replacing Obamacare?  Intervention is seriously needed.  The GOP House leadership and President Trump are so determined  to get their widely and wildly unpopular  health care agenda through Congress,  that  last week Pres. Trump threatened to blow up the Obamacare exchanges  immediately.  The question is why is Trump so desperate to get this particular bill passed now?

Last month GOP attempts  to pass their  repeal/replace bill went down in flames. Their plan endorsed by Trump and written by House leadership, the AHCA, did not have enough support in the House to be voted upon. Public polls put approval as low as 17% once the Congressional Budget Office disclosed 24 million would go without insurance over the next ten years.

This month Pres. Trump threatened to withhold subsidies which make premiums affordable, thereby  wrecking Obamacare insurance policies bought on the exchanges. Why? To force Democrats  and moderate Republicans to cave in.  6.4 million  nationally and 178,000 in Colorado are exchange customers.  Over 850 residents of Grand County (population 15,000)  received their insurance through Obamacare  exchanges thanks to subsidies that average over  $668 per policy. If GOP House members thought they were facing angry townhalls now, just wait until Trump tries to pull  off that stunt.  

In addition to  reducing participants in the exchanges, the AHCA phases out medicaid expansion. Nearly 600,000 in Colorado have benefited from Medicaid eligibility expansion under Obamacare.  As reported in the Colorado Statesman,  the AHCA would result in “  $15 billion in Medicaid costs for Colorado to pay, end the Obamacare Medicaid expansion and likely leave more than 420,000 residents without health care coverage.” Denver Health, which depends upon the ability to be paid for services, would lose $85 million a year. Denver Health also provides services to Grand County through their ski area clinic.

Driving the renewed effort to pass the GOP/Trump’s  AHCA is more than just philosophical,  ideological dedication to arguments that the free market system is always better, or  keeping campaign promises,  or a desire to give consumers more choice of plans with benefits they can cherry pick.   The claim that Obamacare is failing anyway is bogus  because the problems that are real can be fixed.  Consumer choice? The 24 million unfortunates losing insurance would choose between nothing and nada.

The puzzle is why are the GOP and Pres. Trump  trying again  to get their plan passed.The prime suspect  has to do with tax reform  The AHCA  contains nearly a  $300 billion reduction in  Obamacare taxes for the top 2%. Of course, to remove $300 billion in funding would require reducing benefits and the numbers of beneficiaries, and the AHCA would do just that.
 It is a sneaky way to bury a very unpopular tax relief in  health care legislation  before an even more contentious tax reform bill is taken up .The Congressional leaders know that to get tax reform passed, they will need Democratic votes in the Senate, but including  the $300 billion tax relief for the rich would be a poison pill, making that piece of  legislation difficult to pass, risking another loss for Pres. Trump.

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