Congress, Policy, Politics

Define the Promise BEFORE You Decide the Policy

The Political Great Whine has some thoughts about the current health care crisis.  This post is about The Power of Three, The Problem, The Promise, and the Policy. 

Now that the “Skinny Repeal” has failed, the President and Congress are still trying to figure out how to get rid of the Affordable Care Act (ObamaCare).  The reason given is that they promised American voters that ObamaCare would be repealed and that is what voters still want. Well, actually…hold on a minute senators.  You need to first define the promise you made to voters before you decide on the policy. Hopefully, the Political Great Whine can remind some voters what was actually promised so that they can hold their representatives in Washington accountable. Remember, they would not be there without our votes.

The Power of Three
Three Republican senators voted against the “skinny repeal” bill and despite being chided by Mitch McConnell for not keeping their commitment, each of them have received thanks and support from their constituents and other voters. They are Susan Collins (R-Maine) who received a round of applause at an airport; Lisa Murkowski (R-Alaska) received a lot of love when she returned to Alaska; and John McCain (R-Arizona) who went home to “Thank You” signs waiting for him on a road that he and has family frequents. Of course, the Political Great Whine is thankful too that they placed the people before political party.

The Problem


The Affordable Care Act (ACA) has problems…big problems. If you are reasonably healthy, have steady income, but do not have health insurance through an employer…then you have to be covered under ACA, politically known as “Obamacare”. As such, you are probably paying for health insurance that you are unable to use due to a very high deductible or worse…you have no health insurance because all the insurers have left your state. Regarding the former, for an unemployed person who is young and healthy, they are able to afford health insurance under ACA but just like auto insurance, the lower the premium—the higher the deductible. Unlike auto insurance though, there are so many other things to drive up the costs such as prescription drugs, emergency room visits, and hospital stays.

Essentially, Obamacare has not made health coverage affordable for EVERYONE and the provision that allows health insurance companies to opt out of the market place if they are not profitable makes things worse because that is exactly what many big health insurance companies are doing.  WHY on earth would you give money-sucking health insurance companies an out?? As companies leave the market place, this decreases competition and increase prices even more making health insurance less and less affordable. Unless you are very poor and/or very sick…you are in a bind. So, when Republicans started saying that American people deserved better…they were right!

The Promise: A Better Health Care Plan for All Americans

Promise3We were told that Obamacare was a failure because many people were and are losing their health coverage with no way to pay for their doctor visits/medication. Fast-forward to the general Presidential election and Trump sealed his victory path to the White House by promising to give us something better!

Trump made many promises about healthcare such as: “No one will lose coverage”; “We’re going to have insurance for everybody”; “no cuts to Medicaid”; and that those covered “can expect to have great health care”.  That’s is in a nutshell…the promise was that we would get BETTER health care not ZERO health care! Most senators and congresspeople are wealthy in their own right and can afford to pay their medical expenses out-of-pocket.  However, they do not have to because the health insurance plan that our elected U.S. senators and congresspersons have is the BEST. They do not have an HMO or PPO, so there is no worrying about whether a physician is inside or outside a network or if something will be approved for coverage by the insurance company.  They have indemnity health insurance (fee-for-service) that allows them to go to any doctor they want and get whatever treatment or medication prescribed and it will be paid for without questions or special approvals. Now that’s good health insurance!  Can the American people have the same health insurance as Congress?

Bottomline: American voters do want the President and Congress to fulfill their promise, but simply repealing the Affordable Care Act or allowing it to “implode” is not what was promised.

The Policy: Give us Something better NOT Nothing!


All of the policy discussions seem to just be focused on repealing the Affordable Care Act instead of addressing the issue that many people still do not have any health care coverage despite having to pay a premium (individual mandate). Although the argument is that many young, healthy people should not be forced to pay for health insurance that they will not use, the truth is anything can happen at anytime. Young people do all sorts of things that may cause serious injury to themselves and sudden illness does not ask to see your ID before befalling you. In a previous post, it was discussed that similar to auto insurance, it does not matter whether you are a safe driver or a crazy driver— you are still required to have insurance if you drive a vehicle. You cannot even drive off a parking lot in your new car without having auto insurance.

Our representatives in Congress (House and Senate) should focus on drafting a health care policy that truly allows working people employed by small businesses and/or who are entreprenuers themselves to afford health insurance that they can use.  Below are a few policy suggestions to consider:

  1. Permanently lower the limit for out-of-pocket maximums for deductibles – The Affordable Care Act lowers maximum deductible limits each year for individuals and families. However, the maximum limit this year is $6,550 for individuals and $13,100 for families! Permanently lower this to $3000 for individuals (still high but reasonable) and $6000 for families.
  2. Provide incentives to States to expand Medicaid –  Encourage states to increase the income amount that is required to be covered under Medicaid. To do that, the federal government would have to give states more money  for their budget. This would reserve the marketplace for those with higher incomes who may also be younger and healthier. Such people may have their own business (freelancer, consultant, etc) and could be voluntarily under-employed at another business (work less than 30 hours a week).
  3. Provide financial incentive for health insurers to participate – Competition is needed in the marketplace to help drive costs down, but the only way to increase the number of participating insurers is to provide a financial incentive. The financial incentive could be in the form of generous tax breaks and continuing to provide subsidies.
  4. Increase penalties for opting-out – Currently there are penalties for both individuals and insurers who choose to opt-out, but it should be increased so there is a big dis-incentive. This will only work if deductible limits are lowered, Medicaid is expanded, and the number of insurers is increased. Those things would help to increase competition which also lowers cost. 

Those are all just suggestions that the health care policy think tanks in Washington have already explored. As long as the focus of the policy discussions shift from repeal to coming up with a way to actually fulfill the promise of giving Americans better. How about REPLACE and REPEAL rather than vice versa?



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