A Brief Observation Regarding ‘Trumpcare’

This has been buzzing around in my head all day long, like the time my brain made a mashup of “Where Did You Go?” by Mighty Mighty Bosstones and “Lay Lady Lay” by Bob Dylan and kept playing it in a constant loop, or when it did the same thing with “All About that Bass” by Meghan Trainor and Bobby McFerrin’s “Don’t Worry, Be Happy, except this is an observation about Impeached Preznit Carnage Superspreader Not Really A Billionaire’s weird pronouncements that he’s going to announce a new healthcare plan someday, and why, in fact, Republicans generally have been all about the repeal but have not actually been able to do much replacing. It is simply because the Affordable Care Act did everything that can possibly be done to reform healthcare just short of an actual government takeover.

Think about it. What else are you going to do beyond Obamacare unless it’s just back to the draconian old days or moving forward with Medicare For All (which this particular amateur wonk doesn’t think is plausible). Look at everything Obamacare does, which I don’t think our Impeached Dear Leader could explain.

So each state creates an exchange. This creates a reasonable marketplace and a larger participants’ pool. The law mandates health care coverage, which will drive younger, healthier customers into the pool. In return, the law prohibits the exclusion of care based on pre-existing conditions, and there are funds available, called high-risk corridor payments, to keep insurance companies from going under while they have to cover more older sicker people while the younger healthier people are bulldozed into the pool.

Insurance plans were improved as well. This led to an unfortunate oversight by Preznit “Si Se Puede” Barack Obama, who mistakenly shouted to reporters once that everyone would get to keep their current doctors. I think he iterated this without factoring in that Obamacare threw shit insurance plans out of the airlock. Under Obamacare, coverage would mean coverage, not holy shit I’ve been paying into this for years and now it won’t cover X? Also, let’s let parents keep the kids on their policy until they’re oh, what, 26?

And it provided help to pay into the pool, in the form of expanded Medicare and subsidies for those who qualified. And it worked. It still works. The Congressional Budget Office estimates that ACA/Obamacare was responsible for 22 million persons covered via exchanges and Medicaid expansion in 2019.

The reason the Republicans can’t provide an alternative to Obamacare is that there is no alternative. Their dire looking choices are to beg the Supremes to do what Congress failed to do 70 times with no alternative available; to allow the ACA to stand and to thrive; or to jump to the end of all of this and do Medicare For All. If you are a Republican and you hate the Affordable Care Act just because of the fella whose signature is on it (which, let’s face it, is what this is really all about), you’re fucked.

The Affordable Care Act is irreplaceable. The reason the Republicans can’t present an alternative is that there are no alternatives. I think that, like so many other fiascos Trump gets his party into, the Supreme Court effort is going to backfire. It’s gonna be splendid. Difficult, but splendid.

2 thoughts on “A Brief Observation Regarding ‘Trumpcare’”

  1. The ACA did as much as it could at the time. It was “OK, we’ll take the pie with one piece missing, which is better than no pie at all.” The missing piece was the Public Option. Pres Obama originally said he would not sign the bill without the PO, but being a pragmatist and knowing that we had to start somewhere, he took what we could get. The assumption was that nearly all states would opt into Medicaid expansion, and that a coverage mandate would broaden the pool, both of these helping with cost. Neither of those two assumptions stood, yet somehow the ACA survived and in the early years thrived. It has even survived with the current Congress trying their best to beat it to death what, 70 or so times? So when we take back the White House and the Senate there are ways to keep and improve the ACA. Add a Public Option. Provide a fairly calculated risk adjustment to private insurers. On the Medicare side, work on lowering the age to “buy in” at 62 or 60. Not “Medicare for All” whatever that means. It’s “Coverage for All” building on the current system but just adding ways for people to get covered at prices they can afford. OK everyone, get out there and vote like lives depend on it.

    1. Indeed. Bravo. I would add or amend:

      ~ The missing piece was the Public Option. (The House bill included a public option. They had to kill it in the Senate to get Joe Lieberman’s vote. )

      ~ The assumption was that nearly all states would opt into Medicaid expansion (the option to even opt out was provided by the Supreme Court in National Federation of Independent Business v. Sebelius)

      ~ Provide a fairly calculated risk adjustment to private insurers. (originally included in the ACA but whacked down by one Marco Rubio, reference, How Marco Rubio is quietly killing Obamacare, Washington Post, December 14, 2015 )

      ~ On the Medicare side, work on lowering the age to “buy in” at 62 or 60. (Lowering it to 60 is in Biden’s proposal. In an ideal world, this would be a no-brainer even for the health insurance industrial complex.)

      ~ OK everyone, get out there and vote like lives depend on it. (Fuckin’ A)

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