The stubborn illogic of the Congressional Freedom Caucus on replacement of Obamacare

Revised March 1, 2107
The stubborn illogical members of the Freedom Caucus types in Congress regarding repeal and replace Obamacare ignore changing public opinion. They stonewall attempts to replace it when it contains any thing smacked of "entitlements" which they define as providing any subsidies to make insurance affordable. For them, tax credits are subsidies; they oppose some GOP plans that would replace federal subsidies with tax credits to buy insurance . (This is not an endorsement of those tax credit plans, but that is another topic) ..They would rather, it appears, yank insurance from their own constituents. After all, they say they promised repeal and their constituents want it repealed. Replacements are not relevant because they claim.consumers of health care will not be worse off than they are now, they claim. The Freedom Caucus logic: the ACA (Obamacare) is going to collapse of its own weight so even if it does not cover the same number of people that Obamacare covers, so what difference does it make.

Wait a minute, There is something worse: having no insurance. There is also something worse; not trying to make the ACA succeed. What is worse is that those with pre-existing conditions cannot get coverage; that once again their insurance will a limit of the amount in a period of time they will cover; that those who are living pay check to pay check and whose budget struggles  leave no room to pay for health insurance so they  will go without; that even annual check-ups  and cancer screenings will be put off until the disease is so far along, the choice is bankruptcy or die or go into debt and lose their homes; or insurance policies are not required to allow young adults to stay on parent's policies?

It appears that Democrats are going to make Obamacare the major issue in their resistance to the GOP. Gov. Beshear's rebuttal to Trump's addresss laid out the case to those who would be impacted the most by any changes, replacements, and/or repeal...blue collar workers in the south (and with similar demographics in the midwest. 64% of the sign ups for Obamacare this year are from states Trump carried. In the speech to Congress, Trump endorsed the GOP plan to give tax credits to help subsidize insurance, instead of tax deductions as promoted by the Freedom Caucus. (in itself deceptive because it would only benefit those who pay income taxes..and most needing health care insurance subsidies are those who do not have enough income to pay any income taxes..so deductions would be useless). . However, watch the devilish details: What Paul Ryan, house majority leader and advocate of the tax credit approach, also wants is the credit based on age; and the other part of the equation is how much? Currently subsidies of health insurance are based on income. The poorer an applicant is, the larger the subsidy. The GOP wants it to be based on say 2K for young people and 4K for older, or a ratio like that. Unfortunately for older people the cost of healthcare ratio is more like 5x the younger people. This would screw the older people and leave the younger with barely enough to buy catastrophic insurance, with little incentive to subscribe for insurance, plus destroy the "pool"...which keeps costs down for all by mixing a correct ratio of those who use insurance v those who do not..an actuarial method upon which nearly all insurance is based.

If Obamacare is headed downhill, why not fix it, repair it?  For eight years any fixes to Obamacare were stonewalled by the GOP in hopes it would collapse.  However, now that the GOP controls Washington, the old china shop rule applies: If they break it, they own it.  The day after the State of the Union address, the Republic National Committee chairman, Ronna Romney McDaniel and Sen. Ted Cruz appearing on Morning Joe on MSNBC both refused to promise they would guarantee those who had their newly acquired Obamacare/ACA health insurance would keep it.  In fact, Cruz took it a step farther and said he was concerned about everyone who had been hurt by Obamacare instead. He should absolutely no concern for the rest.


The comment made by Ronna McDaniel was that Obamacare broke the health care system so the GOP will fix it.   I rarely name call statements stupid, but this one was a doozy. Adding 22 million insured was hardly breaking the system; it is an indication of its success.  Even the 80% got better benefits. Kicking off 22 million from their insurance or even a large percentage of that would truly be breaking the system. If Cruz and McDaniel get their way, they  and their party will own that one.

The GOP is still stuck in 2009 when people complained they had to change insurance plans and did not keep their doctor.  To them, that was a catastrophe.  There is even a commercial running about a mother of for who had to change her ob-gyn because of Obamacare.   What would really have been a catastrophe if she had no health care insurance  at all . That is what the GOP is proposing  for many when they repeal  the ACA without an adequate replacement.

 Having been married to an ob-gyn for over 50 years, being a very clost observer of his private practice. I know changing ob-gyns can be traumatic. However, even before Obamacare, that was a common occurrence when jobs were changed and the new employer offered different benefits, jobs were lost, or choices were made to  sign up with another insurer.  Now, many consumers are faced with having to go without insurance at all if the hard right of the GOP has its way.

What the challenge is for Congress is to come up with a way to make Obamacare financially sustainable, if they think Obamacare is not, and so far, what is coming out of the rumor mill is that the GOP does not have a plan to do that without reducing benefits and  increasing the cost to individual consumers while kicking many off their insurance coverage. What I see are plans to make health care insurance even less  sustainable by reducing the size or ratio of the "pools", leaving the sicker left insured and the healthy opting out of insurance.  If they do propose a plan, the issues become who and how many will be hurt, instead of helped , and the cost which will be "scored " or estimated by the Congressional Budget Office.

 The arrogance of the Freedom Caucus is that they do not realize the public opinion ground is shifting under their feet. They are still functioning under the  old polls where tagging the Obama name to any health plan was considered by their base as bad, yet a significant part of their base liked their ACA and did not know that was also Obamacare.  That is an ongoing education project, but the marches and  angry attendees at townhalls are getting the message across.   CNN had an interesting approach of having those listening to the President's address to Congress on February 28. They have a pulse poll of thousands responding in real time to what the President was saying.  The part of his speech that got the most negative response was repealing Obamacare/ACA.  The self identified  independents pulse taking line  plunged below approval the most dramatically, but interestingly enough, even the Republicans/ approval line took a significant dip.

The public is waking up and getting educated to what the ACA (Obamacare) provides. That is  the same  insurance they could not afford before, and they do want not to lose it now. The polls show that its popularity is different than it was in November. Even their own party members are realizing the repercussions on their own self interests, if not the interest of their constituents.  The GOP governors fear their budgets will be blown apart if medicaid expansion is not funded; that small, rural hospitals will go under without the paying customers who had subsidized insurance.

Where Congress should focus is repair. Where they have a problem is that any of their proposals being discussed is that it would only make the costs soar because they want to shrink the "pool", removing any mandates for even the healthy and those with faith they will never get sick or have an accident to carry insurance.  They want to remove required  benefits, leaving consumers with poor, inadequate policies, that means paying more out of their pockets and not having the kind of coverage when they need it.

 Where they can begin is to aim their guns at the cost of prescription drugs, requiring competitive bidding for Medicare, Medicaid, and insurance  company participants in  any government supported insurance..They can  include in exchanges a public option that forces competition and makes sure that at least one insurer remains in the market. They can stop advocating fake panaceas that do little  to provide competition and lower costs such as cross state insurer options. They can do more to break up the insurance company monopolies that allow them to collude  to set the same benefits and cost of coverage  nationwide.. That monopoly by a few big insurers makes a mockery of a free, competitive market.

They are assuming that the collapse of Obamacare would cause consumers to embrace their minimalist, poor replacement plans, or just  go insurance naked. The Freedom Caucus should be careful what they wish.  Those  are not the only alternatives. If Obamacare does collapse,, the GOP will find that public demand for a single payer system will become the only way out and it  will gain popularity just because of the pressure from demand by desperate consumers.

http://thehill.com/policy/healthcare/321425-gop-lawmaker-would-vote-against-leaked-obamacare-replacement-draft-report

https://www.yahoo.com/news/democrats-turn-immigrant-counter-trump-221148394--politics.html

Also see the 2/11/17 post for a long list of resources:

Where were those Save Obamacare activists last year? Asleep ? Fooled?