APRIL 29, 2015

Obamacare: the 'silence is deafening' as we await its fate

Will Congress be able to implement a rational and effective means of putting an end to the inequities and inefficiencies?

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WASHINGTON, DC – The "silence is deafening" as the Supreme Court gets ready to hand down a ruling that will almost certainly decide the ultimate fate of Obamacare.

"You don't hear many people talking about the Affordable Care Act these days.  It appears interest in Obamacare has dwindled to perhaps its lowest level in the five years since Obamacare was born in 2010.  Is it because opponents and proponents of the law are holding their collective breath in anticipation?  There's a lot at stake.  If the justices rule that federal subsidies are legit, it'll be business as usual but if they deny subsidies it will be a devastating blow to the law as it stands," said Dan Weber, president of the Association of Mature American Citizens.

But the fact is that, behind the scenes, the new Congress has been working on a "course correction" that has its origins well before the enactment of Obamacare. 

National Journal correspondent Fawn Johnson writes that it started eight years ago, well before the law was passed and even before Mr. Obama won his first term: "Two veteran conservatives-Sens. Richard Burr of North Carolina and Tom Coburn of Oklahoma-believed it should be just as easy for an individual to buy health insurance as it is for a worker to sign up with an employer. The two lawmakers worked steadily on a proposal to use tax credits, cost-cutting tools like high-risk pool sharing, and health savings accounts to bring down premiums."

Coburn, who is doctor, himself, resigned his Senate seat last year for personal reasons, and Burr quickly teamed up with Senator Orrin Hatch of Utah to develop an ACA alternative. 

As it turned out, Hatch became Chairman of the Senate Finance Committee, which is responsible for, among other things, any new health care laws.  Together, they have managed to line up support in the House for what writer Johnson calls their "replace ACA" scheme.  They convinced Rep. Fred Upton, the powerful House Energy and Commerce Committee chairman to join their endeavor. 

The proposal "puts on display the GOP's fundamental philosophy on health care," Johnson explains.  "Not surprisingly, it is diametrically opposed to Democrats' views. Republicans believe that if you make coverage affordable, more people will buy it. They do not believe in mandating that people have insurance or dictating how health plans should look, as the ACA does. And they want states to take the lead in making individual plans easier for people to get. In keeping with their small-government credo, they want the federal government's role in health care to be much smaller than it is now."

Here are some of the things the GOP plan would do:

If you make less than 200 ercent of the federal poverty level, you'd be eligible for a fixed tax credit.  Earn more money and the credit is reduced.

The plan gets rid of the individual mandate; it guarantees coverage if you have a pre-existing condition; it doesn't allow higher premiums if you do have a pre-existing condition; and, if you are 26 years old or younger, you'd be able to remain on your parents' insurance plan.

It has a Medicaid fix that replaces the Obamacare matching rate formula with a health grant determined by an individual's health status, age and "life circumstances."  And it offers a fixed grant for long-term care for low-income Medicaid patients who are elderly or disabled.

The plan encourages states to implement reforms, including the establishment of panels or courts to quickly and fairly deal with malpractice cases.

It would lift the current constraints on health care savings accounts.

Weber cautioned that the high court has a history of handing down upset judgments.  "That means the decision on subsidies can go either way.  No one knows what the nine justices are thinking until they put it in writing with a ruling and that won't come for several months.  But, the Burr/Hatch/Upton venture shows that Congress may be ready to put into motion a path to the creation of a rational and effective means of putting an end to the inequities and inefficiencies of the not-so-Affordable Care Act before it ultimately destroys the fabric of America's health care system."

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