We Report, You Decide

 

Obamacare will implode. So say the GOP president, congressional representatives and local enthusiasts. The popular media focuses on the incongruity of 8 years active oppositions, and over 60 legislative bills to end the Affordable Care Act. And yet it remains “the law of the land.” Stephen Koff of cleveland.com thinks otherwise. In a 3-29-17 article entitled “Did Republicans sabotage Obamacare? Ohio insurers owed $100M they’ll likely never see” he looks at how any success was undermined in advance. Analysis finds this to be worthwhile, especially considering that the current chief executive interprets government to be by decree, without regard of legislative involvement or intent. Most of his priorities are being promulgated and enforced by executive order. As the chief executive, he would differ little from his predecessors in eliding enforcement of existing laws. Could the implosion of the ACA be one of them? Mr. Koff points out that the ACA, like the expansion of Medicare prescription drug benefits during the Bush presidency, relied on government underwriting of risk for its initial years of operation. “One way of protecting them involved a concept known as a risk corridor, a way to guard insurers against inaccurate projections. At the ACA’s full start in 2014 no one truly knew what the enrollment mix would be — young, old, healthy, sick — and how much insurers would have to spend on medical care.” Koff explains “With risk corridors, insurers made their best estimates when they priced their policies and offered them for sale. The projections were based on actuarial principles and double-checked by state insurance officials and HHS. If insurer projections turned out to be wrong even after all that checking and a company made a big gain, the company would have to share part of it with the losers through the risk corridor program, maintained by the federal Centers for Medicare and Medicaid Services, or CMS, a division of HHS.” But a funny thing happened on the way to affordable healthcare, “Under risk-corridor rules, no company would give up all its gains, and no company would be able to recoup all its losses. But it could recoup enough to stay in business.” “Obamacare passed narrowly when Democrats had majorities in Congress. Republicans never liked it. So in 2014, as both parties hurried to pass a year-end spending measure that was already overdue, Republicans managed to work in a small but meaningful change to the Obamacare rules — specifically, the risk corridor rules. They required that the risk corridors be self-funding, or what is known as budget neutral. That meant any money paid out to insurers would have to come from money coming in from other insurers. Key to this: CMS would not be permitted to draw from other accounts if the risk corridors lacked enough money. Democrats arguably left themselves open to this change by not being more specific when drafting the ACA. Yet it’s clear Republicans knew this would create problems. Some even bragged about it.” The article quotes one of Ohio’s Senators: “”There’s no question,” said U.S. Sen. Sherrod Brown, an Ohio Democrat, “that efforts to undermine the ACA’s risk corridors program drove insurers out of Ohio’s marketplace and starved our state’s CO-OP of the resources it needed to get off the ground, leading to less competition and higher prices for consumers.”” Newark’s 12th congressional district’s representative chose to address his constituents through a spokesperson: “”Obamacare is fundamentally flawed,” Olivia Hnat, spokeswoman for Rep. Pat Tiberi, said when asked about Republicans using the risk corridors to undermine Obamacare. Tiberi is on the House Ways and Means Committee and chairs its subcommittee on health. “The individual mandate is failing to patients in the marketplace,” Hnat said. “No matter how much the government subsidizes care or props up the insurance market, the individual mandate hasn’t worked and it is just one reason why Obamacare is on an unsustainable path.”” Analysis concludes with the article’s beginning. “The provision slipped into a spending bill in late 2014, after the Affordable Care Act was under way, restricted the government in making payments. As a result, some insurers have been forced to pare down their medical networks, cut their markets or leave Obamacare altogether — contributing to the higher premiums for customers and insurer withdrawals that Republicans point to as proof of the program’s failure. Republicans say they were just preventing an ill-advised insurer bailout because, they say, Obamacare was bound to fail. But Democrats and some health policy analysts say Republicans purposely sabotaged the Affordable Care Act by denying promised payments to insurers at a crucial time.” Analysis ends with those inimitable words of Fox News: “We report, you decide”

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