Killing Obamacare

Tuesday, January 7, 2014

There are two ways Obamacare could die.

The first is by political means. It probably could not occur until 2017 with a Republican president signing a repeal bill passed by overwhelming Republican majorities in both the House and Senate.

Otherwise, filibusters and unoverridden vetoes and general stalemates would apply. A government that can’t get anything done can’t get anything undone, either.

Some Republican would have to beat Hillary Clinton in 2016. Chris Christie, maybe.

The other possibility, more likely and plausible, is that long before 2017, Obamacare collapses on its own by unsustainable costs and impracticality, primarily because people aren’t signing up.

In this scenario, President Barack Obama and Democrats have no choice but to yield to political and economic reality and grudgingly suspend or abandon key elements-the individual and business mandates, primarily.

That would need to occur late this year or early next year. After that the law might start to work itself out.

With additional time, people would begin to grow accustomed. Obamacare would achieve inevitability, much like the Medicare prescription-drug benefit.

So I was holding forth on this subject the other day.

I speculated that, by this fall or next winter, new rates for 2015 on the health-insurance exchanges would be prohibitively high because healthy people and young people are not signing up. Instead they’re opting to take their chances with their healthiness and tax penalties. So older and sick people dominate the pool.

In the industry they call that “adverse selection” and a “death spiral.”

The outcry of middle-class working people facing tripled premiums or greater for no fault of their own would kill Obamacare quicker than anything.

Only if Obamacare could get to the second and third years, when tax penalties for not having insurance get steep enough to cause uninsured young people some real Form 1040 pain, might the new system reach the magic point.

That’s the point at which something stays in motion by being in motion.

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But then I read an informative article on these matters beginning on the front page of this newspaper Sunday.

The article quoted key Arkansas health-insurance officials as saying, essentially, that the “adverse selection” and “death spiral” were taking place.

So far, enrollees are far below estimated levels and inordinately older and sick.

Younger and healthier people, whose premium remittances and medical inactivity are vital, haven’t been signing up so much.

Logically, that means rates put out for the second year of enrollment beginning in October will be through the roof. People will face a government mandate to buy something utterly unaffordable, which is the worst politics imaginable.

That may yet occur. But the article covered several factors that suggest it might not necessarily happen.

For one thing, state insurance companies won’t have a lot of relevant experience with the new insurance pool by spring when they began working on these new rates.

So they probably won’t yet have any real basis for steep increases. Second, it might be that-failing a lot of actual data-the carriers would choose to continue first-year rates or something close to them. The idea would be not to drive away younger and healthier people.

By the second year, these younger and healthier people might be deciding to bite the

bullet and sign up, if the price was right enough.

Third, state Insurance Commissioner Jay Bradford pointed out that the Medicaid expansion population-those delivered to private insurance carriers with federal dollars-will be young and generally healthy.

The sicker Medicaid recipients are being steered back into regular Medicaid on a “medically frail” designation. Finally, Obamacare contemplated “adverse selection” and a potential “death spiral” for the startup period.

It provided a $63 charge on everybody’s health-insurance policy to set up a high-risk pool for the unhealthy newly insured.

And it provided two mechanisms-in the beginning, until 2016-by which carrier revenue and government subsidies can be switched from one company to another to even out the costs of covering expensive care for the newly insured.

That’s less a premium restriction aiding consumers than a transitional spreader of carrier responsibility.

Conservatives call it a government bailout. But they’re probably less opposed to bailouts of the inconvenienced private sector than to softening Obamacare’s direr and more unpopular effects.

It would be easier to kill Obamacare if it had killed a couple of insurance companies.

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John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. Email him at [email protected]. Read his blog at brummett.arkansasonline.com, or his @johnbrummett Twitter feed.

Editorial, Pages 15 on 01/07/2014