Midterm issues: Healthcare (E-71)

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The top issue in the mid-terms will effectively be a referendum on President Donald Trump. And although they may not deem it expedient to say so at this juncture, Democrats are likely to impeach (charge) the president if they win a House majority in November. “Impeach Trump”: Democratic leaders try to avoid bait to fight, while fanning flames of their voters, Seth McLaughlin, Washington Times, 8/23/18.

As for substantive issues, some polls have indicated that healthcare is at the top of the list – including an NBC/Wall Street Journal poll in early June. Healthcare a top issue for voters ahead of midterms, Jessie Hellmann, thehill.com, 6/7/18.

More than 1 in 5 voters, 22 percent, said in a new NBC News–Wall Street Journal poll that healthcare is their top issue in the November midterm elections. The economy and jobs followed at 19 percent, with guns at 13 percent, taxes and spending at 11 percent and immigration at 10 percent.

According to Gallup, however, only 5% of the voters see healthcare as the leading issue, with dissatisfaction with government, etc. and unidentified issues (we added the last line in the table to show this) predominating. Government back on top as nation’s leading problem, Jim Norman, gallup.com,

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Republican strategists are probably hoping Gallup is right, because other polling suggests that healthcare won’t play well for the GOP.

•Democrats are much more inclined (32%) to see healthcare as the top issue than Republicans (less than 15%?). Healthcare a top issue for voters,
op. cit.

•A majority of Americans (55%) disapprove of the manner in which the president et al. have been handling healthcare. Fox News poll: Obamacare more popular than GOP tax [cut], Nathaniel Weixel, thehill.com,

In order to hold their own in the upcoming elections, it would behoove Republicans to direct the political conversation towards substantive issues versus the Mueller probe, etc. that Democrats seem to be hanging their hats on. The forbidden “I word,” Wall Street Journal,

The main point about this election year is that no one should believe Democrats when they say that impeaching Donald Trump isn’t on their agenda. It’s their only agenda.

As an example of the constant pressure on the president and his supporters, see (1) President Trump’s constant attacks are divisive, Ted Kaufman, News Journal, 8/19/18; and (2) Political civility goes both ways, William Whipple, News Journal, 8/26/18.

If the political conversation shifted to policy matters, healthcare – an issue on which the GOP started out in a strong position in early 2017, yet has thus far managed to boot – wouldn’t be a bad place to begin.

I. Background – Since 2010, Republicans had been promising to “repeal” GovCare. In 2017, having won control to the House (2010), the Senate (2014) and the White House (2016), they were finally in a position to do so. To make good on this commitment, however, the GOP needed to say – and mean – that it was not the federal government’s job to ensure healthcare insurance (HCI) coverage for all Americans.

Otherwise, as was astutely noted at the time, Republicans risked committing the same blunder that had made GovCare a political disaster for Democrats – promising results that couldn’t conceivably be delivered. GOP will fail on Obamacare if they can’t admit a simple truth, Philip Klein, Washington Examiner,

[Republicans] are having a tough time stating a simple truth, which goes something like this: "We don't believe that it is the job of the federal government to guarantee that everybody has health[care] insurance." State this simple truth when asked about coverage levels, and there's plenty of room to make the case for the benefits of replacing Obamacare with market-based solutions that bring down costs, offer more choices, and don't force individuals to purchase government-designed health[care] insurance policies.

Apparently, no one was listening. Republicans were never able to unite behind any specific plan to repeal and replace GovCare, perhaps due to excessive concern for ensuring that no one would be disappointed with the new plan that was to be put in place. “[Try to] please all, and you will please none.” Aesop (620-564 BC).

Within a year, GovCare had regained favor with the American public and was handily outpolling the alternative plans Republicans had been working on (but failed to pass). Rethinking the healthcare system (part one),

We would favor an overhaul of the healthcare system, which would give patients more choices in what kind of healthcare arrangements they would be allowed to make, foster more competition between healthcare service providers, and empower patients to make informed choices about their own treatment

here is currently more support for expanding the government's role in healthcare, however, than there is for cutting it back. And if "single payer" healthcare wins out, as it has in most advanced countries, healthcare services will necessarily be rationed (by manipulating wait times for treatment, imposing age limits on expensive procedures, etc.) to blunt the fiscal effects on government.

Evidence continues to accumulate re the power of wishful thinking, which causes people to credit politicians’ promises to deliver things that are wildly impracticable.

Recent polls indicate, for example, that the idea of single payer healthcare is supported by well over half of the population. Big majority, including Republicans, support “Medicare for All,” Diana Stancy Correll, Washington Examiner,

But the added cost for the federal budget – at a time when existing social programs are already threatening to crowd out traditional government functions like national defense – would necessitate tax increases certain to tank the US economy and shortchange payments for healthcare providers to boot. New study [Mercatus Center] pegs cost of Sanders’ “Medicare for All” at $32 trillion, Robert King, Washington Examiner,

“A doubling of all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan,” [the study] said.

Doctors and hospitals would be paid far less under Sanders’ bill. The bill would pay all doctors and hospitals under the same rate as Medicare, which pays about 40 percent less compared to reimbursements from employer-sponsored plans.

Sorry, but it’s time for the politicians (on both sides of the aisle) to get real and level with the American people about what sort of healthcare programs this nation can support.

II. Damage control – Glossing over their responsibility for passing GovCare in 2010, Democrats will seek to blame Republicans with any and all deficiencies of the healthcare system as it now stands. Look, the GOP tried to repeal the Affordable Care Act (ACA), did repeal the individual mandate (in the tax bill enacted last December), cut off subsidies to insurers, etc., so no wonder premiums (for qualifying HCI plans purchased on the government-run exchanges) have been skyrocketing. See, e.g., Repealing Obamacare didn’t work, so Republicans are trying sabotage, Catherine Rampell, thespectrum.com, 7/10/18.

. . . the Republicans' latest sabotage effort came Saturday. That's when the Trump administration abruptly announced it was halting yet another program, called "risk adjustment," designed to stabilize the individual and small-group insurance markets. This program sounds dry and technical, but it is crucial for making sure people with pre-existing conditions maintain access to care. Basically, it's a tool for evening out costs among insurers.

Two weeks later, the “risk adjustment” payments were reinstated, no doubt to the delight of the insurers concerned. Trump administration to resume Obamacare insurer payments, Robert King, Washington Examiner,

#LITIGATION - Another attack was triggered by a Department of Justice decision not to oppose a 20-state-lawsuit seeking to attack big chunks of the ACA (including protection against hiking insurance premiums for preexisting conditions) on grounds that repeal of the individual mandate (effective in 2019) will undercut the “taxing power” rationale on which the US Supreme Court originally upheld the law. Insurers, Democrats slam Trump administration for Obamacare lawsuit, Kimberly Leonard, Washington Examiner,

“With this decision, the Trump administration has taken their quest to sabotage our health care system to a whole new level,” Senate Minority Leader Chuck Schumer said. “Rather than trying to find any way they can to raise rates and harm those with pre-existing conditions, President Trump and congressional Republicans should be working with Democrats to make healthcare more affordable.”

Many Republicans are unenthusiastic about this fight, as evidenced by the comments of Rep. Greg Walden (R-OR), chairman of the House Energy and Commerce Committee. Key House Republican supports pre-existing coverage after Justice Department sues to gut Obamacare, Robert King, Washington Examiner,

"I don’t want to go back to the days when you can be denied insurance based on a pre-existing condition," Walden said. “I will make sure that people with pre-existing conditions can continue to get access to health[care] insurance."

See also this recent report of
ten Republican senators seeking to endorse the pre-existing conditions ban just in case the 20 states in the lawsuit prevail. Senate Republicans introducing bills to protect Obamacare, Warner Hudson, godfatherpolitics.com, 8/25/18.

#FEDERAL LEGISLATION - Generally speaking, GOP administrators at both the federal and state level have been doing their best to prevent an eye-popping round of increases in HCI premiums shortly before the mid-term elections. The initial strategy was to enact a “stabilization bill” that would provide additional federal funding for GovCare subsidies, but this effort fell short.

#WAIVERS – When Democrats withdrew support for the stabilization bill after protracted negotiations, the focus shifted to state-level initiatives supported by federal administrative waivers. States scramble to avert Obamacare sticker shock after Democrats balk at stabilization effort, Tom Howell, Washington Times,

With federal policymakers sputtering, states are plotting their own steps, seeking federal permission for “reinsurance” program that subsidize pricey customers or waiting for final instructions from the Trump administration on short-term plans that don’t fully comply with Obamacare’s strict coverage requirements.

The 2019 premium adjustments for HCI plans will vary from state to state and it’s hard to predict the national trends, but some states have reported encouraging progress – including anticipated premium reductions in Alaska, Wisconsin and Maryland. States are offering relief from healthcare costs; here’s how Congress can help, Robert Moffit, dailysignal.com,

In the First State, it’s been announced that HCI premiums will rise in 2019 – but not by much. Delaware finalizes 3 percent rate bump to Obamacare plans, Robert King, Washington Examiner,

Delaware’s insurance commissioner announced on Tuesday that it approved a 3 percent rate hike for Highmark insurance plans sold on Obamacare’s exchanges, which are part of the individual insurance market used by people who don’t get coverage through a job or the government. Highmark is the only Obamacare insurer in Delaware. The insurer had originally proposed a 5.7 percent rate hike for 2019.

#OPTIONS - Another tack being taken by the Trump administration is to launch alternative HCI arrangements that would be less costly than the ACA-qualified plans, albeit not necessarily providing equivalent coverage.

As advocated by Michael Cannon of Cato in January, short-term HCI (up to nearly a year and potentially renewable) can avoid many of the ACA requirements, e.g., the preexisting conditions ban. Final rules on this subject were recently announced. Trump administration delivers on promise of more affordable health[care] insurance option, hhs.gov,

Short-term, limited-duration insurance [renewable for not more than 36 months] which is not required to comply with federal market requirements governing individual health insurance coverage, can provide coverage for people transitioning between different coverage options, such as an individual who is between jobs, or a student taking time off from school, as well as for middle-class families without access to subsidized ACA plans. Access to these plans has become increasingly important as premiums have escalated for individual market plans, and affordable choices for individuals and families have dwindled.

Critics slam the temporary insurance coverage as a big step backward. Junk insurance plan proves Trump doesn’t care about your health, Andy Slavitt, usatoday.com,

Health and Human Services Secretary Alex Azar’s plan would allow insurance companies to sell the same junk insurance plans that existed before the ACA was passed. They are called junk plans because they allow insurance companies to deny coverage to people with pre-existing conditions, exclude expensive conditions, and place caps and lifetime limits on policies.

Another workaround rule – this one issued by the Department of Labor – will allow small businesses and individuals to contract for “association” healthcare plans that would provide HCI coverage similar to that provided by most larger employers for their employees. The number of people enrolled in individual HCI plans purchased on exchanges would be reduced – probably with a marginal increase in premiums. Trump administration to allow businesses, individuals to band together for health[care] insurance, Kimberly Leonard, Washington Examiner,

Six million people are expected to enroll in these plans, according to the Congressional Budget Office. CBO projected that these plans, and short term-plans that are another type of alternative health[care] insurance that will be offered by the Trump administration, will increase premiums on the exchanges by 2 to 3 percent.

Critics also labeled the association plans as “junk insurance,” although in this case the preexisting conditions ban would not be circumvented.

Finally, as previously reported, the administration has unveiled a plan for attempting to bring down prescription drug prices without resorting to mandatory or de facto price controls. We’re not convinced that the plan will work, but it seems worth a try. Rethinking the healthcare system (Part 2), section A,

#THIS FALL – All things considered, Republicans seem to have a pretty good story for the voters about their efforts to mitigate the worst effects of GovCare. This is mainly thanks to administrative versus legislative efforts, but given the lack of cooperation from the other side of the aisle it’s hardly surprising that Congress didn’t accomplish much.

On the Democratic side, congressional candidates will be neatly split between defenders of the GovCare status quo and advocates of Medicare for All. So long as the mid-term elections are seen as a series of individual contests based on appeals to the voters of the several states, this strategy will work. It could potentially backfire if – perhaps fueled by the president’s commitment to attend a lot of campaign rallies this fall - Republicans succeeded in converting the elections into a national contest.

Some observers have suggested that running a national campaign would be the best GOP strategy, notably former House Speaker Newt Gingrich whose "Contract with America" campaign was a rousing success in 1994. Republicans win by restoring faith of Americans, Adam Brandon, the hill.com,

The Republican base does not want any more “balanced budget” show votes, “ObamaCare lite” health care proposals, or bloated omnibus spending bills written in secret. They want to see action on the small government campaign promises made repeatedly by Republicans.

III. Path forward – It’s too late to worry about a longer-term fix for healthcare, that subject will have to be deferred until after the elections and addressed in accordance with the political situation that then exists.

When the time comes, healthcare should be dealt with in conjunction with a meaningful review of the government’s overall fiscal situation rather than treated as an unrelated subject. Otherwise, emotional impulses will continue to lend credence to massive, ineffective programs that the government (and this country) can’t afford. Being a socialist means never having to say you’re sorry, Ben Shapiro, townhall.com,


# Re suggestion that Republicans should push for a moratorium on the political attacks in favor of debating the issues. You must be joking. Politics is a dirty game and Trump is attacking those who need illumination. Nice guys lose in politics. – SAFE director

Comment: No, not joking. By offering a coherent policy agenda, Republicans could differentiate themselves from the other side. Newt Gingrich and President Trump (by his campaign rally strategy) are not the only observers who have advocated a “national campaign.” See also Forget the GOP: It’s up to conservatives to nationalize the 2018 midterm election[s], Richard Viguerie, conservativehq.com, 8/21/18.

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