Wednesday, November 30, 2016

What does Tom Price's nomination say about the future of Obamacare?


OK, I'm done now, right?  Trump will pick Tom Price to head the Department of Health and Human Services.  Price, like all Republicans, hates Obamacare, but unlike most Republicans, has proposed outlines of replacement plans.  According to conventional analysis, that seems to mean that the chances of an Obamacare repeal just went up because Trump is somehow more focused on repealing it.

Um, no.  That's not how legislation works.  Once a piece of legislation is signed into law, repealing it requires new legislation.  That starts in Congress.  Would Trump repeal Obamacare?  Yes.  His governing philosophy can be summed up thusly...

Congress, however, is not necessarily so brazen.  Good reference: Thomas Mann's Unsafe at Any Margin.  Catch the reference to famed George W. Bush supporter, Ralph Nader?  Actually, Mann wrote the piece much earlier, back when Nader was actually a hero to liberals.  The premise of Mann's work is that Members of Congress tend to overestimate the electoral danger they face, and they might not be as brazen as Trump.

The problem is that while a lot of people would see premium reductions under an Obamacare repeal, millions more would lose coverage entirely with the elimination of tax subsidies, the elimination of the Medicaid expansion and the return of denial of coverage for pre-existing conditions.  None of the sketched replacement "plans" would do much to cover them.  Taking away health insurance for millions could be risky, and if Mann's thesis is still right, then congressional Republicans might not be so ready to repeal the whole thing.

Trump?  Sure.  Price?  Yup.

Ryan?  McConnell?  Everyone in their caucuses?  They need almost full party unity, because they aren't getting any Democratic support for a full repeal...

As I have said before, the risk-averse strategy is as follows.  First, make an announcement that Obamacare is a cancer that has metastasized to the point that it must be removed surgically rather than all at once.  Then, repeal the employer but not the individual mandate.  Then, repeal the medical device tax.  At each stage, make a big deal of it.  Then, start repealing smaller and smaller parts, with the announcements getting progressively smaller, and eventually just let it fade away, making more and more marginal tweaks.

Then again, Republicans could be doomed in 2018 anyway given midterm swings, and they may never get another chance.

Still, this is what I was saying before Price.  What does Price indicate about the future of Obamacare?  Nothing.

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