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<\/a>Here are three changes Con\u00adgress should make to Oba\u00admacare: 1) no can\u00adcel\u00adla\u00adtions; 2) no bailouts; 3) no tax on the unin\u00adsured. [Cred\u00adit: thinkquest.org]<\/p><\/div>Here\u2019s a crazy idea: Repub\u00adli\u00adcans and at least some Democ\u00adrats say they sup\u00adport mak\u00ading changes to Oba\u00admacare; why doesn\u2019t Con\u00adgress give vot\u00aders a pleas\u00adant sur\u00adprise and change it?\n
These changes would be polit\u00adi\u00adcal\u00adly pop\u00adu\u00adlar, rel\u00ada\u00adtive\u00adly mod\u00adest and enjoy at least some bipar\u00adti\u00adsan sup\u00adport. Although the pre\u00advail\u00ading polit\u00adi\u00adcal cli\u00admate makes it hard for law\u00admak\u00aders to do any\u00adthing of sub\u00adstance, mak\u00ading the health care law more friend\u00adly to con\u00adsumers and less accom\u00admo\u00addat\u00ading to cor\u00adpo\u00adrate inter\u00adests would appeal to vot\u00aders across the spectrum.<\/p>\n
To under\u00adstand why, start with the cur\u00adrent state of the law\u2019s imple\u00admen\u00adta\u00adtion. Obamacare\u2019s first open enroll\u00adment peri\u00adod has passed the mid\u00adway point and the results remain some\u00adwhat dif\u00adfi\u00adcult to eval\u00adu\u00adate. On the one hand, more peo\u00adple are select\u00ading plans. On the oth\u00ader hand, they don\u2019t appear to be the peo\u00adple that the law\u2019s archi\u00adtects had hoped or expect\u00aded to select them.<\/p>\n
They are, to begin with, dis\u00adpro\u00adpor\u00adtion\u00adate\u00adly old\u00ader. Fig\u00adures released last week by HHS<\/span><\/a> indi\u00adcate that 1\/3 of the 2.2 mil\u00adlion peo\u00adple who select\u00aded plans offered through the exchanges are between the ages of 55 and 64. Only 15 per\u00adcent are between the ages of 26 and 34, the group that is most like\u00adly to be unin\u00adsured and the one whose busi\u00adness insur\u00aders most covet.<\/p>\n More detailed infor\u00adma\u00adtion from oth\u00ader sources pro\u00advides anoth\u00ader trou\u00adbling sign: it appears that most of the peo\u00adple who have so far select\u00aded plans already had insur\u00adance<\/a>. The Wall Street Jour\u00adnal<\/em> recent\u00adly report\u00aded on a sur\u00advey of over 4,500 peo\u00adple con\u00adduct\u00aded by McK\u00adin\u00adsey &<\/span> Co., which found that only 11 per\u00adcent of exchange enrollees pre\u00advi\u00adous\u00adly lacked cov\u00ader\u00adage. The Jour\u00adnal<\/em> also reports on data pro\u00advid\u00aded by Health Mar\u00adkets Inc., an insur\u00adance agency that has enrolled around 7,500 peo\u00adple in exchange plans. Of those, near\u00adly 2\/3 pre\u00advi\u00adous\u00adly had cov\u00ader\u00adage. They signed up for exchange plans either because the gov\u00adern\u00adment required their insur\u00ader to can\u00adcel their pol\u00adi\u00adcy, because their employ\u00ader dropped their cov\u00ader\u00adage, or because they pre\u00adferred sub\u00adsi\u00addized insur\u00adance sold through the exchanges to their exist\u00ading policies.<\/p>\n Then there is Med\u00adic\u00adaid. The Admin\u00adis\u00adtra\u00adtion and some state offi\u00adcials have sug\u00adgest\u00aded that those signups are going great guns, with HHS<\/span> report\u00ading near\u00adly 4 mil\u00adlion<\/a> enroll\u00adments in Octo\u00adber and Novem\u00adber alone. But a clos\u00ader look at those num\u00adbers by Sean Trende <\/a>of Real Clear Pol\u00adi\u00adtics<\/em> shows that the fig\u00adure is high\u00adly mis\u00adlead\u00ading. Med\u00adic\u00adaid, unlike the exchanges, has been around for 50 years. Peo\u00adple apply for Med\u00adic\u00adaid all the time. In fact, accord\u00ading to the HHS<\/span> report (p. 5<\/a>), aver\u00adage enroll\u00adment in Octo\u00adber and Novem\u00adber actu\u00adal\u00adly declined<\/strong> in states that expand\u00aded Med\u00adic\u00adaid. The aver\u00adage num\u00adber of month\u00adly Med\u00adic\u00adaid appli\u00adca\u00adtions was high\u00ader in July-Sep\u00adtem\u00adber than in Octo\u00adber-Novem\u00adber in those expan\u00adsion states. And of the 1.7 mil\u00adlion enroll\u00adments that occurred in Novem\u00adber, 780,000 (45 per\u00adcent)<\/a> were in states that did not<\/strong> expand Med\u00adic\u00adaid. In all, of that 4 mil\u00adlion in Med\u00adic\u00adaid enroll\u00adments, Trende attrib\u00adut\u00ades about 190,000 \u2013 380,000 to the Oba\u00admacare Med\u00adic\u00adaid expan\u00adsion. While his analy\u00adsis is by his own admis\u00adsion rough, it is clear that the 4 mil\u00adlion fig\u00adure great\u00adly over\u00adstates new Med\u00adic\u00adaid enroll\u00adments attrib\u00adut\u00adable to Oba\u00admacare, prompt\u00ading Poli\u00adti\u00adfact to give itself 3 Pinoc\u00adchios<\/a> for hav\u00ading ini\u00adtial\u00adly accept\u00aded the fig\u00adure at face value<\/p>\n Few\u00ader unin\u00adsured peo\u00adple than expect\u00aded have so far signed up for cov\u00ader\u00adage through Med\u00adic\u00adaid and the exchanges. That sug\u00adgests that Oba\u00admacare may fall con\u00adsid\u00ader\u00adably short of expec\u00adta\u00adtions. The num\u00adbers, of course, only con\u00adsti\u00adtute a snap\u00adshot. The next three months may pro\u00adduce very dif\u00adfer\u00adent results. It is far too ear\u00adly to con\u00adclude, as many of the law\u2019s crit\u00adics pre\u00addict and some of its sup\u00adport\u00aders wor\u00adry, that the law will fail.<\/p>\n But what if those trends do hold up? What if Oba\u00admacare ends up large\u00adly enrolling peo\u00adple who already had cov\u00ader\u00adage and those who pre\u00advi\u00adous\u00adly couldn\u2019t get it because of their med\u00adical con\u00addi\u00adtions? What if mil\u00adlions of peo\u00adple just don\u2019t want health insur\u00adance, even if the gov\u00adern\u00adment sub\u00adsi\u00addizes it?<\/p>\n The pre\u00adsump\u00adtion behind Oba\u00admacare is that pret\u00adty much every\u00adone wants health cov\u00ader\u00adage. There has long been con\u00adsid\u00ader\u00adable evi\u00addence that they don\u2019t. About 20 per\u00adcent of work\u00aders<\/a> decline employ\u00ader-spon\u00adsored health ben\u00ade\u00adfits. It is esti\u00admat\u00aded that in 2009, 4.5 mil\u00adlion of 39 mil\u00adlion unin\u00adsured adults<\/a> (11.5 per\u00adcent) were eli\u00adgi\u00adble for full Med\u00adic\u00adaid ben\u00ade\u00adfits but did not enroll. And Med\u00adic\u00adaid is free. Then there\u2019s that healthy cohort of peo\u00adple aged 19\u201334 that insur\u00aders are try\u00ading so des\u00adper\u00adate\u00adly to attract. Their youth and well-being make them a very hard sell. They are near\u00adly twice as like\u00adly to be unin\u00adsured as the rest of the under 65 pop\u00adu\u00adla\u00adtion \u2014 27.2 per\u00adcent vs. 14.4 per\u00adcent<\/a> \u2014 which is part\u00adly because they don\u2019t want or need cov\u00ader\u00adage. Pass\u00ading a law didn\u2019t sud\u00adden\u00adly make these peo\u00adple crave health insurance.<\/p>\n Some have argued that insur\u00aders won\u2019t be able to turn a prof\u00adit unless peo\u00adple who don\u2019t want cov\u00ader\u00adage buy it any\u00adway. It\u2019s hard to say for sure. Com\u00adments made by health insur\u00adance CEOs dur\u00ading the recent JP<\/span> Mor\u00adgan Health\u00adcare Con\u00adfer\u00adence<\/a> sug\u00adgest that insur\u00aders real\u00adly aren\u2019t all that wor\u00adried about dis\u00adap\u00adpoint\u00ading enroll\u00adment num\u00adbers. \u201cWe believe that over time, a lot of these bumps will work them\u00adselves out,\u201d Joe Swedish, pres\u00adi\u00addent of Well\u00adpoint, the country\u2019s sec\u00adond-largest health plan, recent\u00adly told the Wash\u00ading\u00adton Pos<\/em>t. \u201cWe have always expect\u00aded it to have a sort of lumpi\u00adness to it, the roll\u00adout. It\u2019s cer\u00adtain\u00adly become more lumpy than one would have pre\u00addict\u00aded [but] over time, this will work out.\u201d<\/p>\n The Post<\/em> also quotes from a note pre\u00adpared by a JP<\/span> Mor\u00adgan health care ana\u00adlyst which sug\u00adgests that insur\u00adance com\u00adpa\u00adnies nev\u00ader expect\u00aded much rev\u00adenue from the prod\u00aducts they sell through the exchanges. \u201cAlthough they may gar\u00adner the most head\u00adlines, we do not expect the new health ben\u00ade\u00adfit mar\u00adket\u00adplaces to be a sig\u00adnif\u00adi\u00adcant fac\u00adtor to 2014 earn\u00adings,\u201d the analy\u00adsis stat\u00aded. \u201cWe think the down\u00adside risk of low ini\u00adtial enroll\u00adment for large, diver\u00adsi\u00adfied man\u00adaged care com\u00adpa\u00adnies is lim\u00adit\u00aded giv\u00aden that this is a rel\u00ada\u00adtive\u00adly small por\u00adtion of their business.\u201d<\/p>\n Do the exchanges real\u00adly mat\u00adter that lit\u00adtle to insur\u00aders? The Post<\/em> notes that the pro\u00adpor\u00adtion of the pop\u00adu\u00adla\u00adtion expect\u00aded to enroll through the exchanges is rel\u00ada\u00adtive\u00adly small. CBO<\/span> projects that around 7 mil\u00adlion<\/span><\/a> pre\u00advi\u00adous\u00adly unin\u00adsured peo\u00adple will enroll in plans sold through the exchanges this year. Com\u00adpare that to the 171 mil\u00adlion<\/a> peo\u00adple that were cov\u00adered under employ\u00ader-spon\u00adsored plans in 2012. And even if young peo\u00adple sign up for exchanges at just half the pro\u00adject\u00aded rate, insur\u00aders still will turn a prof\u00adit<\/a>,<\/span> accord\u00ading to a Kaiser Fam\u00adi\u00adly Foun\u00adda\u00adtion study. So if the exchanges end up being a bit \u201clumpy\u201d and don\u2019t attract a lot of young peo\u00adple, insur\u00aders arguably can make do.<\/p>\n It is, of course, pos\u00adsi\u00adble that these ana\u00adlysts and insur\u00adance exec\u00adu\u00adtives are under\u00adstat\u00ading the risk of exchanges col\u00adlaps\u00ading in a \u201cdeath spi\u00adral.\u201d Per\u00adhaps they\u2019re sim\u00adply try\u00ading to be sup\u00adport\u00adive of the law and of their own stock prices. Time will tell. If insur\u00aders make a prof\u00adit, Oba\u00admacare will suc\u00adceed. If loss\u00ades cause them to aban\u00addon the exchanges, it will fail.<\/p>\n Either way, the prof\u00aditabil\u00adi\u00adty of a par\u00adtic\u00adu\u00adlar indus\u00adtry isn\u2019t the tax\u00adpay\u00aders\u2019 cross to bear. All of the hand-wring\u00ading and spec\u00adu\u00adla\u00adtion about young and healthy peo\u00adple sign\u00ading up, as I have not\u00aded pre\u00advi\u00adous\u00adly<\/a>,<\/span> is real\u00adly noth\u00ading more than fret\u00adting over the prof\u00aditabil\u00adi\u00adty of insur\u00adance com\u00adpa\u00adnies. That is not the government\u2019s con\u00adcern. Its objec\u00adtive is to make health insur\u00adance more wide\u00adly avail\u00adable and afford\u00adable. Oba\u00admacare offers one way to achieve that goal. Gov\u00adern\u00adment should not, in pur\u00adsuit of this objec\u00adtive, pad the bot\u00adtom line of insur\u00adance companies.<\/p>\n Oba\u00admacare should advance the inter\u00adests of con\u00adsumers, not cor\u00adpo\u00adra\u00adtions. Unfor\u00adtu\u00adnate\u00adly, that is not always the case. The law includes pro\u00advi\u00adsions that harm con\u00adsumers in the inter\u00adest of boost\u00ading cor\u00adpo\u00adrate prof\u00adits. It is laden with bil\u00adlions in cor\u00adpo\u00adrate wel\u00adfare pay\u00adments to insur\u00adance com\u00adpa\u00adnies. Sub\u00adsi\u00addies are sup\u00adposed to be for peo\u00adple who buy insur\u00adance, but Oba\u00admacare includes plen\u00adty of hand\u00adouts to cor\u00adpo\u00adra\u00adtions that sell it.<\/p>\n James Capret\u00adta and Yuval Levin recent\u00adly advo\u00adcat\u00aded in the pages of the Week\u00adly Stan\u00addard<\/a> for changes to the law that I have pre\u00advi\u00adous\u00adly endorsed<\/a>. These changes can eas\u00adi\u00adly be sum\u00adma\u00adrized: no can\u00adcel\u00adla\u00adtions, no bailouts, no tax on the unin\u00adsured<\/strong><\/em>.<\/p>\n These changes would make Oba\u00admacare more of what Amer\u00adi\u00adcans say they want and what many thought they were get\u00adting. If Con\u00adgress were to enact them, Oba\u00admacare would become a pro\u00adgram under which peo\u00adple could keep the cov\u00ader\u00adage they like and buy the cov\u00ader\u00adage they need regard\u00adless of their med\u00adical con\u00addi\u00adtion. Gov\u00adern\u00adment would no longer penal\u00adize peo\u00adple who don\u2019t want insur\u00adance. And insur\u00adance com\u00adpa\u00adnies could no longer count on bil\u00adlions in hand\u00adouts from taxpayers.<\/p>\n For Democ\u00adrats who are run\u00adning on the propo\u00adsi\u00adtion that they want to fix Oba\u00admacare<\/a>,<\/span> these pro\u00advi\u00adsions rep\u00adre\u00adsent an oppor\u00adtu\u00adni\u00adty to show they mean it. For Repub\u00adli\u00adcans who hope to repeal Oba\u00admacare in 2017, this is a chance to give con\u00adsumers and tax\u00adpay\u00aders some relief in the meantime.<\/p>\n The Pres\u00adi\u00addent prob\u00ada\u00adbly wouldn\u2019t like this bill. Con\u00adgres\u00adsion\u00adal lead\u00aders of both par\u00adties also might object \u2013 Demo\u00adc\u00adra\u00adt\u00adic lead\u00aders because they regard the law as untouch\u00adable, Repub\u00adli\u00adcan lead\u00aders because they don\u2019t want to give Democ\u00adrats the oppor\u00adtu\u00adni\u00adty to cast polit\u00adi\u00adcal\u00adly pop\u00adu\u00adlar votes to amend it. But with suf\u00adfi\u00adcient sup\u00adport from Mem\u00adbers in both par\u00adties, that could change. Har\u00adry Reid<\/a> has turned the Sen\u00adate into a leg\u00adisla\u00adtive bone\u00adyard, but even he might have trou\u00adble with\u00adstand\u00ading pres\u00adsure from with\u00adin his own cau\u00adcus to act, par\u00adtic\u00adu\u00adlar\u00adly in an elec\u00adtion year.<\/p>\n A bipar\u00adti\u00adsan effort to change Oba\u00admacare is indeed a crazy idea. It is also one that vot\u00aders would embrace.<\/p>\n","protected":false},"excerpt":{"rendered":" Here\u2019s a crazy idea: Repub\u00adli\u00adcans and at least some Democ\u00adrats say they sup\u00adport mak\u00ading changes to Oba\u00admacare; why doesn\u2019t Con\u00adgress give vot\u00aders a pleas\u00adant sur\u00adprise and change it? These changes would be polit\u00adi\u00adcal\u00adly pop\u00adu\u00adlar, rel\u00ada\u00adtive\u00adly mod\u00adest and enjoy at least \u2026 Con\u00adtin\u00adue read\u00ading \n