Perhaps I’m being overly optimistic, but I don’t see Trumpcare in its current form passing in both chambers of Congress even with the benefit of using reconciliation to get it through the Senate. I am very doubtful that it can pass the House. I don’t see any Democratic support and the Republicans are far from united in support of it. With earmarks gone, Speaker Paul Ryan no longer can control his caucus like in days gone by. That was one of the things that led to John Boehner effectively saying take this job and shove it. On the premise that I’m counting the votes incorrectly, let’s explore what Trumpcare might yield.
There definitely would be winners in the deal. Almost exclusively they would be the very high earners who are subject to a small tax increase under Obamacare. Remember that was the first part of Obamacare that Trumpcare repeals. Looking to more of the masses the only possible winners would be young, high income, healthy people who very possibly would pay a bit less for their health insurance. Since they are healthy things like co-pays are irrelevant to them. The reality is that very few Americans fit that description.
One of the provisions that would end up in Trumpcare is the ability for individuals to purchase health insurance across state lines. The Republicans have long touted this as a panacea that would unleash the magic of the free market and its competition to dramatically reduce consumer costs. Under this scheme cost would go down but so would coverage. To parody a current (and somewhat misleading) TV commercial, you would have great coverage for a zombie apocalypse but not for a heart attack.
In the first place there are only a handful of insurers capable of operating on a national scale. That barrier to entry into the field would stifle competition from the start. What is most likely to happen is that insurers would flock to the state that offered the loosest laws and was the most lax in enforcing them. You may live in a state that requires certain coverage but your out-of-state insurer would only be required to satisfy the regulators in their home state of operation.
Call me cynical, but I see a tremendous opportunity for corruption in such a system! In most states the Insurance Commissioner has tremendous power over making sure insurance regulations are vigorously enforced. How difficult is it to “buy” one individual. While I’m not indicting any current or past State Insurance Commissioner, they don’t all have the strength and integrity of former Kansas Insurance Commissioner Kathleen Sebelius. Now as to those state regulations being weak in the first place, my skeptics will point to the oversight of the state legislatures. If you don’t think a single entity can effectively purchase a state legislature I present Art Pope and the North Carolina General Assembly as my evidence and rest my case. Keep in mind Pope is a pauper when compared to America’s largest insurance companies.
If you listen to Trump and his spinners this new health care plan is much better and much cheaper. Does that even sound believable? It is like someone telling you that you can eat all the holiday candies and sweets you want while never gaining an ounce or risking a cavity. If you buy that scenario, (Joe would accurately call it malarkey), I have a mood music suggestion: The Impossible Dream from the play Man From LaMancha.
This topic is complex and today’s posting was another incomplete critique of it. While the repeal of Obamacare is a Republican dream the vast majority of us would be well served to remember that nightmares are dreams too.
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