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What Is Rand Thinking?   Leave a comment

When Politico reported that the House Freedom Caucus, an influential group of House conservatives, was considering whether to give its official endorsement to Sen. Rand Paul’s Obamacare Replacement Act (S. 222) I was excited. I’ve always been a fan of Rand Paul. But then we looked at it and discovered that it’s got a lot of problems.

 

First and foremost, it doesn’t repeal most of Obamacare. Yes, it repeals almost all of the law’s major mandates … the individual and employer mandates to obtain insurance, the guaranteed issue to those with pre-existing conditions, the community rating regulations, the essential health benefits, and various other insurance mandates that work to raise premiums.

Image result for image of rand paulStill, the bill doesn’t repeal Obamacare’s new entitlements – the subsides for exchange health insurance and the massive Medicaid expansion to the able-bodied and gainfully-employed, leaving in place nearly $2 trillion in spending over the coming decade. It doesn’t repeal any of the Obamacare taxes used to fund the spending, except those associated with the individual and employer mandates.

It has some similarities to the reconciliation bill that Congress passed, but President Obama vetoed, in 2016. That bill would have repealed the law’s entitlements (after two years), and its tax increases (effective immediately), but not its regulations. Paul’s office might argue that his bill repeals the critical portions of Obamacare not included in last year’s reconciliation bill—the major insurance regulations—while providing a replacement vision to go beyond repeal.

But that position assumes last year’s reconciliation bill will be the starting point for this year’s discussion—and it doesn’t appear to be right now. Politico reported that Republicans were having difficulty figuring out how to square Medicaid reform with Obamacare’s massive Medicaid expansion. Likewise, some Republicans have discussed not repealing the law’s tax hikes. The Paul bill repeals the individual and employer mandates, even though last year’s reconciliation measure also effectively repealed them, but it doesn’t repeal all the other tax hikes and spending increases. Why not? Perhaps it’s because his home state expanded Medicaid to the able-bodied under Obamacare and the leadership there wants to avoid taking a position on whether to keep that expansion.

The Paul bill does provide tax credits for health coverage, but largely of the non-refundable kind, which is an important difference. Paul’s bill provides a $5,000 tax credit to individuals who contribute to Health Savings Accounts (HSAs), but only to the extent such individuals have income tax liability. The Paul bill also includes a refundable tax credit for health insurance premiums, but the refundable portion of the credit only applies up to the limit of an individual’s paid payroll taxes.

Many Republican health reform plans would offer refundable tax credits to individuals in excess of tax liabilities, which represents pure welfare spending—the government issuing “refunds” to people with no net income or payroll tax obligations. By contrast, the Paul bill would ensure that credits only apply to individuals with actual payroll and income tax obligations.

This critically important distinction will likely be lost on many members of the press — not to mention the public. I can see the headlines now. “House Freedom Caucus Endorses Tax Credits.” Having endorsed tax credits once, the pressure on Freedom Caucus members to then go further and endorse the House leadership plan for refundable tax credits will be immense. Put simply, the slippery slope to endorsing a major spending package in the form of refundable tax credits starts with the Paul bill.

While the Paul bill includes no outlay spending—its incentives all come via tax cuts—those incentives are numerous, and costly. The legislation would supplement the current, uncapped exclusion on employer-provided health insurance with a new, uncapped deduction for individual-provided health insurance. It would eliminate contribution limits to HSAs, and introduce a new federal subsidy (via the tax credits) of up to $5,000 for HSA contributions.

Apart from the direct fiscal implications of the tax incentives, economists on all sides of the political spectrum believe that the current uncapped exclusion for employer-provided health insurance encourages over-consumption of health insurance, and thus health care. Instead of reining in this tax incentive as one element of pro-growth tax reform, Paul’s bill goes in the other direction, creating two new uncapped tax incentives for health insurance.

As a medical doctor, Paul has shown little inclination to rein in health care spending. He voted for budget-busting Medicare physician payment legislation in 2015 that raised the deficit by more than $140 billion in its first decade alone, while failing to solve the long-term problems it purported to address. He has also previously proposed budgets that included minimal savings to Medicare, despite long-running deficits within Medicare.

Health care already consumes nearly one-fifth of our economy. With our national debt approaching $20 trillion it doesn’t seem that solution really lies in creating new, uncapped incentives for tax-free spending on health care and health insurance.

While ostensibly promoting market-oriented solutions, the legislation contains several strategic trip-wires that could contaminate any attempt to repeal Obamacare, or enact a conservative alternative.

Four Very Similar Weak Ideas   3 comments

Let’s be clear. The Republican majority with the ability to pass a repeal and replacement of Obamacare just taken office a few weeks ago. So it seems odd that the Democrats are accusing them of failing to put forth a replacement plan for Obamacare. After all, these things are supposed to take time and it might be a good idea to think it out a little longer than the Democrats did.

Republicans in both the House and the Senate have unveiled a number of proposals to replace Obamacare in the years since Barack Obama signed the ACA into law. They never got out of committee, but most share some key provisions … offering tax credits to consumers, expanding the use of health savings accounts or reforming Medicaid.

They say the devil is in the details and the strengths and weaknesses of each proposal can be found there. There are at least four plans being crafted to replace the law. I plan to focus on the Cassidy-Collins bill later, but basically, it repeals only Obamacare’s mandates, maintains its subsidies and taxes and allows states that like Obamacare to keep Obamacare.

 

In addition to the Cassidy-Collins plan, there are proposals offered by Paul Ryan and the Republican conference; Rep. Tom Price, R-Ga., who is now President Trump’s Secretary of Health and Human Services; the Republican Study Committee; and Sen. Richard Burr of North Carolina, Sen. Orrin Hatch of Utah, and Rep. Fred Upton of Michigan.

Image result for image of obamacare replacements

Price’s Empowering Patients First Act offering age-adjusted, refundable tax credits and individuals can opt out of the government health care programs and receive the tax credit instead. It creates a one-time, refundable tax credit for HSA contributions and increases the amount of money individuals and families can contribute. It caps the tax exclusion at $20,000 for families, $8,000 for individuals. It requires insurers to provide coverage to those with pre-existing conditions if the patient has had coverage for at least 18 months. It also creates high-risk pools and allows consumers to purchase insurance plans across state lines.

House Speaker Paul Ryan and the House Republican Conference have proposed A Better Way for Health Care. It also offers age-adjusted, refundable tax credits and health savings accounts. It also expands access to HSAs for BIA benefit and Tricare recipients. It caps tax exclusions for employer-sponsored coverage. It requires insurers to provide coverage for pre-existing conditions for those maintain continuous coverage and it creates high-risk pools. It allows consumers to purchase plans across state lines and covers dependents on their parents’ plans until age 26. It also reforms Medicaid.

The Republican Study Committee also came out with the American Health Care Reform Act of 2017 which allows tax deductions for individuals and families, health savings accounts that include Indian Service or Tricare and allows HSAs to be used for long-term care, premiums for HSA-qualified plans and Cobra. Of course, it requires insurers to provide coverage to those with pre-existing conditions who maintain continuous coverage and it creates high-risk pools. It also allows consumers to purchase plans across state lines.

Senators Richard Burr and Orrin Hatch and Representative Fred Upton have comes out with the Patient CARE Act. It also provides age-adjusted and income-based tax credits and expands health savings accounts to BIA benefit holders, as well as allowing consumers to use HSAs to pay for COBRA and premiums for HSA-qualified plans. It caps the tax exclusion on employer-sponsored coverage at $30,000 per family. It coverages pre-existing conditions and creates high-risk pools. It allows consumers to purchase coverage across state lines and keep their kids on the family plan until age 26. And of course, it reforms Medicaid.

All four of these proposals are basically the same bill with somewhat different details, so I am not going to focus on them beyond this brief coverage (unless Rick comes up with something he wants to share). All of them share an element that could work. It’s similar to a suggestion Ben Carson made at the Prayer Breakfast that made him a conservative darling. In his suggestion, he recommended annual deposits by the government from birth to whenever that you can pass onto your kids. That is similar to something parents here in Alaska can do with a portion of the Permanent Fund  Dividend to fund an Education Fund for their children. I know young people who are attending college without debt now using these accounts.

But I have issues with them because they really don’t go far enough. More on that later.

 

 

 

For a Reasonable ACA Debate   Leave a comment

Back in January, Chuck Schumer kicked off the fight to save Obamacare with the slick slogan “Make America Sick Again.” Basically, the idea is to frame the dialogue by pushing hte narrative that Republicans want to repeal Obamacare and deprive millions of people of health insurance without a replacement plan. If Republicans can’t disprove that dark fantasy, they will deserve a midterm drubbing.

Image result for image of obamacare failureLet’s be clear – Obamacare is horrible. The unAffordable Care Act has increased health-care costs for many people. You don’t get to keep your doctor or your insurance plan. That’s important to say because it is the overwhelming reality for many Americans.

But recognize that Obamacare’s misguided supporters can trot out individuals who have benefited from the provisions of the Affordable Care Act and these two points against Obamacare does nothing to counter the now-growing narrative that 20 million Americans will lose their insurance if Congress repeals Obamacare.

I totally hate Obamacare, especially since Brad has spent the last three months just trying to get in to see a doctor for a shoulder injury and still hasn’t received any actual treatment, though he now has a diagnosis – quadralateral space syndrom. A muscle was damaged (trying to keep up with the teenager at bouldering) and the resulting scar tissue is pressing on a nerve. By the way, without an MRI machine or any real training in medical care beyond a few basic first aid classes, I guessed this problem. I sent him to the doctor to FIX the problem, but so far, crickets. Except we are now paying medical bills. Was the point of Obamacare to make health care less affordable? It’s working.

Back to the topic. Opponents of Obamacare must acknowledge, frankly and sincerely, that the Affordable Care Act has helped some Americans and assure the pubic that the replacement plan will also protect the sick and vulnerable. Take the anxiety away. Then stress that while the law created some winners, it also created many more losers, and that Obamacare supporters are blindly ignoring this reality.

Next, the repeal and replace faction must counter the false impression that the Affordable Care Act created 20 million winners. It’s important to understand that 20 million figure was an estimate from the Obama administration that comes from a government figure rather than actual enrollment data.

Here, proponents of repeal and replace should first remind Americans that the 20 million figure is merely an estimate from the Obama administration. Actual enrollment data, compiled by the Heritage Foundation, tells a different story. About 14 million people gained coverage from the end of 2013 to the end of 2015. Of that 14 million, 11.8 million gained their insurance through Medicaid expansion (otherwise known as welfare) and 2.2 million through private coverage. Other problems with the 20 million figure were outlined by the Heritage Foundation, laid out at length for Forbes. These too should be highlighted.

But adjusting the 20 million figure downward to reflect a more accurate count will still result in a fairly large number of Americans obtaining insurance under the Affordable Care Act. So how to answer that? Explain that health insurance does not equal health care.

Brad and I have good health insurance. My employer is the largest group pool in Alaska. The union I am reluctantly a member of has been fighting being labeled a “cadillac policy.” That doesn’t do Brad any good because despite having medical insurance, he can’t get medical care.

We have to remind the public that while Obamacare helps some individuals, it harms many more. That’s my major argument with Obamacare boosters. They seem incapable of acknowledging this truth. They portray the Affordable Care Act as merely having some minor glitches which, if Republicans only helped, could be addressed. “Just tweak it,” they say.

Nonsense. It’s not a glitch that the unAffordable Care Act created losers. The law was intended to do that. Obamacare sought to cover older and sicker Americans by providing them government subsidies, which makes the taxpayers the losers and ripping off younger and healthier Americans. Because young and healthy Americans stayed away from the exchanges, insurance companies were forced to increase deductibles and co-pays and limit doctor and hospital networks, making the healthy individuals who did buy insurance even bigger losers.

The more indirect losers—such as workers unable to find full-time employment because of the Obamacare mandates, as well as doctors in private practice forced to sell out to hospitals—are more difficult to quantify, but they are just as real.

The Left hammers the need to protect those with preexisting conditions, but then acts as if Obamacare is the only way to do this. The public needs to learn that individuals with preexisting conditions who were unable to obtain insurance before Obamacare were only about 14 percent of the population. Obamacare did not adequately address the issue. About 10 percent of individuals with pre-existing conditions are still uninsured, and Obamacare doesn’t assure medical care for the seriously or chronically ill. There are a lot of people now paying so much for health insurance that they can’t afford actual medical care.

While those with uninsurable preexisting conditions represent just a small portion of our society, a replacement plan must address their needs, but what many Americans don’t know is that the Health Insurance Portability and Accountability Act of 1996 already provides some protection for those with pre-existing conditions who lose their insurance.

While the public thinks of HIPAA as a law protecting the confidentiality of medical records, prior to Obamacare, HIPAA prohibited both group insurance plans and plans obtained in the individual market from excluding coverage of pre-existing conditions, under specific circumstances.

HIPAA’s protections had some gaps, but an Obamacare replacement plan can address those limitations separately, and without upending the entire insurance market, perhaps by providing grants to states to fund high-risk pools. Alaska already had such a pool that offered coverage prior to Obamacare. Like many states that offered these plans, it was discontinued as a result of Obamacare, but the Alaska Legislature is already seeking to reinstate the state-sponsored pool as high-risk insurers flee the market.

Other than adult children with chronic health conditions, the real beneficiaries of Obamacare’s 26-year-old coverage mandate are the parents. I cover both of our adult children because it gives us peace of mind that if something happens to my risk-takers, they will have coverage. But that benefit comes at the cost of higher premiums for all families with children. Require insurance companies to provide one quote covering children up to 26 and one that doesn’t. The true cost will no longer be masked, and parents can decide then if the cost is worth it. And I’ll negotiate with my children as to whether they should reimburse me for this expense as we do with care insurance.

Finally, Congress should add provisions for tax-free contributions to health savings accounts for the payment of medical expenses and for the purchases of medical insurance.

Then stop. Americans don’t want another comprehensive health care overhaul. Let’s give it time to see if the reform works to bring down costs and improve medical care again.

Republicans Have No Plan?   1 comment

Image result for image of obamacare failureWe all remember when America’s streets were strewn with the bodies of the neglected and dead. Before Obamacare began to cover people with medical insurance, people were dying right and left and it was HORRIBLE! And the Republicans have no viable plan to replace Obamacare, so riot in the streets to protect the only health care coverage that has ever worked in the United States.

No, I haven’t become a pod person. I’m just stating what the Democrats are doing as they focus on this myth that Obamacare is working for most Americans. They must create the impression that no viable alternatives exist. According to pundits on CNN and PBS, the Republicans haven’t produced a viable comprehensive plan that replace the unAffordable Care Act.

Most progressive pundits don’t consider a replacement plan “serious” if it doesn’t meet the following criteria:

  • expensive
  • highly regulatory
  • forces Americans to participate through a series of mandates

 

If that’s the definition of a plan, we can hope the GOP never comes up with one. If we’re talking a proposal that will actually accomplish something, the GOP has several plans.

The speaker of the House has come up with one and there are numerous other conservative plans being floated. Figuring out a way to turn them into legislation that can pass both houses and meet the approval of a new populist president will probably take more than a couple of weeks.

Remember, it took the Democrats several months to work out their plan … and it didn’t turn out well. They had been talking and scheming to reform the health-care system for decades and they still trotted out a reform plan that failed … a reform plan that anyone with a modicum of economic intelligence knew would fail from the moment it was proposed … hence all those town halls asking for Congress to stand against it. Then Democrats had to drop the public option and redo their abortion coverage to make the bill politically palatable to the moderate Democrats. Then they passed the basic structure of Obamacare without worrying about any Republican opposition in the Senate, only later being forced to use reconciliation to make it acceptable for the Democrats in the House.

It’s possible Republicans are embracing a newfound competence by avoiding those political pitfalls and looking for consensus on timelines and specifics that will make it more feasible. Most likely, we’ll get to watch sausage be made again.

Democrats know their policy promises have failed, but they still perpetuating the myth that there are no replacement plans, acting as if coverage can only exist through fake state-run exchanges or welfare.

Don’t worry! Today’s “they have no plan!” is tomorrow’s “that plan is extremist!”

Yeah, the Democrats will insist that the replacement plan must be conceptually or functionally similar to Obamacare, but that’s not really true. The main failures of Obamacare are its comprehensiveness, massiveness, complexity, and rigidity. It might be better to pass replacement legislature piecemeal.

For instance, the GOP can start by overturning the “nondiscrimination rule” that assaults religious freedom. They can get rid of the individual mandate. They can cut funding to abortion mills.like unPlanned Parenthood  They can deregulate to bring down costs and grant waivers that allow states to innovate in ways previously closed to them. Democrats demanded change overnight. The GOP doesn’t have to do the same.

Yes, Republicans will need to convince the American people on the wisdom of market-based solutions. They will have to contrast that vision with the top-down economics adopted by the Left. They are likely adopt some of the more popular aspects of Obamacare like coverage for preexisting conditions. I’m not sure how they plan to pay for it without a mandate if the tradeoff is deregulation of Obamacare’s most intrusive components, it would be worthwhile in the long run.

They will also have to deal with Medicaid expansion. The the vast majority of Obamacare’s “newly insured” are actually new welfare recipients. They will have to answer Democratic claims that “millions of Americans will lose insurance, and thousands more will die unnecessarily each year because of lack of care.” Republicans will have to convince voters that opening up affordable and competitive markets without coercion is preferable to preserving unsustainable state-run programs that grow in perpetuity.

So, can they do it? They’re making a good start, despite what Democrats would have us believe otherwise.

No Equivalency Between “the Resistance” and “the Tea Party”   8 comments

So one of my socialist (oops, social worker) friends is trying to convince me that the “Resistance” movement against Trump is the same (or at least very similar) to the Tea Party movement eight years ago.

Carlene, aside from the fact that they are both protest movements against the policies of the current president, there is no political, moral or even structural equivalency.

Image result for image of republican and democrat tug-of-warFirst, the Tea Party was an overwhelmingly peaceful and legal movement. They gathered in parks with permits, waved signs, shouted slogans and then went home to work their jobs. They weren’t firebombing cars, smashing store windows or blocking traffic. Even the famous “racial slur” on the Capitol steps was never proven with any evidence, despite the fact that the TV cameras caught 100s of cellphones recording the event. They also started as a grassroots movement, partially flowing from the 2008 Ron Paul candidacy, but then spontaneously galvanized by the Obamacare fight. It started out without much of a budget and had to play catchup to fund its goals, while the current “Resistance” is heavily funded by existing liberal progressive outfits.

Moreover, the teaparty were regular patriotic Americans who started out arguing against a policy that would increase the size of government astronomically and reduce everybody’s freedom. When their immediate anger had been vented and they realized they couldn’t win by peacefully waving signs, they turned to looking inside the Republican Party to challenge those Republican leaders who had never practiced what they preached … free markets, lower regulation, lower spending, limited and smaller government As they did this, they were physically attacked by Democratic operatives, verbally smeared by the biased media and castigated by the Republican Party leadership as miscreants and idiots who should just go home and be led by their betters.

But they didn’t give up.

The tea party went to political town halls in 2009 and said:

  • we want government out of our lives
  • we want you politicians to adhere to the Constitution
  • we want less government, limited government
  • we prefer freedom and liberty
  • we’ll take care of ourselves if you get out of our way.

 

The “resistance” movement, instead, is demanding more government that intrudes more deeply into our lives, which require less adherence to the Constitution and they are absolutely opposed to freedom and liberty. They scream “do your job” and demand Congress:

  • to control people
  • give us more government
  • give us more handouts
  • give us more taxes
  • give us more regulation
  • take from others to give to us, so we don’t have to take care of ourselves

 

Related imageThe “Resistance” are resisting the Constitution. They do not seek liberty, but tyranny. They claim they are “the People”, but they are not the people the Constitution was meant to govern. Ben Franklin warned us in 1789 that we had “a republic, if you can keep it.” Ben was prescient. We’re at the moment he predicted. The Constitution was more durable than he probably thought, but it’s about to go down into the dustbin of history if we don’t wake up and resist “the Resistance.”

I don’t think Trump was what most tea partiers wanted when they began their protests in 2009. He’s a strong man who is promising to fix stuff with more government. There are a few things I like about his policies … reducing regulation and installing reformers in his cabinet, but he’s at best an interim relief from the strangling power of the statists. I know when I talk to my tea party friends, many of them thought if they just got an outsider into the White House things would be better. Some of us knew that it would take more … years of education, thousands of conversations, and no rest for our minds. We cannot become complacent now. This is just the first step on a very long and arduous journey.

Let’s not forget that the Republican Party still has a lot of progressives dug into the structure. These are the weak links who want to go along to get along, who have no spine to resist the tactics of the far left who demand they “give the people what they want. Recent history should have shown us that some Republicans have an ideology not far removed from the goals of the Left.

Have you asked yourselves what the resistance movement is protesting? It’s sort of hard to pin it down, right. The marches have included thousands of different issues, resembling uncoordinated mobs with every cause represented from transgender rights to population control and environmental extremists. They are protesting America as founded under the Constitution. How do I know that? They argue the Constitutional election results should be set aside to conform to the media fantasy of a national popular election that has never existed. They protest biological truth and individuality. They protest private property and capitalism. They argue for socialism and communism and the institution of fascism.

Image result for image of partisan control of us states 2017Fascism, among other things, involves government control of private enterprise and abrogation of individualism into the collective and that’s what they’re arguing for. That’s the very thing the tea party argued against. If you go back and study it, you find the tea party mobilized to stop crony capitalism … to stop government from picking private business winners and losers. That’s why they objected to the “stimulus”, the unAffordable unCare Act and green-energy examples like Solydra. All these are crony-capitalist ventures.

I think a lot of tea partiers lost their way during the Trump campaign. They didn’t want to admit that he agrees with the left-wing belief that government should pick the winners and losers. No, we shouldn’t join the protests in the streets, but yes, we cannot be complacent. We need to keep going in the direction that we started.Take a deep breath, fellow

Take a deep breath, fellow tea partiers. Face the fact that pulling things back into the Republican wheelhouse is just one partially successful battle. There’s still a long way before the real war is won. I’m a nonpartisan, so I see that the Republican party is not going to be the salvation of the country. Neither is Donald Trump. We the People are the sovereigns according to the Constitution. Those tea partiers must come back to where we stood in 2009 and face the fact that there must be a stark difference between us and “the Resistance.” Their goal is to drag the country back further to the left as Obama attempted to. Our goal is to return to the Constitutional Republic we were founded to be. Understand that the spineless Republicans will cause more damage to the republic if we allow it. Personally, I’m going to continue to vote for Libertarians in an attempt to hand the revival over to people who actually understand the goal.

So what do we do over the next three years until the next presidential race gets underway?

Don’t sit down to rest. Yeah, I know, it’s been a tough eight years and we’re happy to see some movement in the right direction. It’s not over yet. Trump likes government. He’s not the savior you’re looking for … although I find him very entertaining, in a soft horror movie kind of way. Republicans are in charge of 32 states and in partial control of 37. That’s good. We really could thank Barack Obama’s tyranny and tea party activism for that. While Democrats gleefully gloated about how they were the “new majority” in the country that could not be beaten, Republicans quietly took over the states and ignited a conservative grass fire. We’ve had a highly successful eight years while the Democrats gloated. We should learn from that. Don’t gloat! This is a move in the right direction, but the battle continues. We have to plan our next steps.

Our first step starts with a recognition that there is a vast difference between us and “the Resistance” and that the Republicans in Congress are spineless and easily hijacked because they too believe in big and growing government that will continue to damage the republic if we allow it.

Communism is the logical conclusion of socialism as represented by Bernie Sanders and Elizabeth Warren. The Democratic Party is this weekend deciding if that will be their mainstream for the future.  Socialism hasn’t really worked out well for us. Social Security is bankrupt. Medicare isn’t far behind. The federal government is $21 trillion in debt. But the socialists want more. The tea party protests managed to stop Congressional Republicans from expanding Medicaid, but Republicans in several states did it anyway, which may make it impossible to repeal Obamacare, forcing Congress to replace it with something that will be just as liberty-killing, but will have a less hateful name.

We need to understand that this is a war for the direction of this nation. It won’t be won with one election and probably not with a dozen. We can’t sit and wait while the “Resistance” claim they are the same as the tea party. They’re trying to make a case that they should sweep Congress in the midterms in 2018. The “Resistance” is not the same as the “Tea Party”. They are resisting the Constitutional Republic of America. We can’t allow them to continue to claim equivalency. We need to make it clear in intelligent and respectful tones that “the Resistance” is out to destroy America as we know it.

 

Posted February 25, 2017 by aurorawatcherak in cultural divide

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