Looks Like Federal Government Control of Healthcare Is Here to Stay

I'm glad people who understand legalese have figured out what the new Republican healthcare bill says.

The federal government still mandates what your policy will include.

While some of the regulations are tweaked with more flexibility, the 800-pound gorilla in the room — guaranteed issue mixed with community rating* (which is responsible for almost all of the premium hikes) — is left in place. Nor does this bill repeal the mandated essential benefits, which require insurers to cover a specific number of people and sex change operations, maternity care for men, etc.

And even the repeal of actuarial value “metal” requirements (platinum, gold, silver, bronze) — the most positive of the outlined changes — would not take place until the 2020 plans. 

Instead of penalty money going to the government, your healthcare insurer will be required to charge you 30% more for your coverage (Sec. 2711).  This will undoubtedly be just as effective as the Democratic penalties were in forcing young, healthy people to pay sky high prices for medical coverage.

By maintaining guaranteed issue, healthy individuals will just go without insurance, and then if they get sick, anyone can still demand a policy. It’s worth taking the risk of paying an extra 30 percent when you really need it in exchange for avoiding paying the equivalent of another monthly mortgage for nothing when healthy.

Moreover, the new premium penalty for those gaming the system won’t begin until 2019, but the individual and employer mandates will be repealed immediately. This will further hurt the solvency because, again, the bill would maintain the exchanges and the regulations. Therefore, higher prices mixed with fewer people paying into the system will result in a nightmare scenario.

I'm not sure that mandate will meet Justice Roberts requirement that it's only constitutional if it's a tax. Not too many taxes go directly to private businesses. Wouldn't it be ironic if Obamacare was constitutional but Trumpcare is not?

Lots of money will be lobbed at the states for Medicaid expansion.

As for Medicaid, the draft plan grandfathers in the entirety of the Obamacare expansion. Worse, it doesn’t freeze future enrollment for another two years, which will incentivize states to massively expand Medicaid before 2020. It also throws another $10 billion to states that never expanded Medicaid.

Federal taxpayer subsidies to health insurance buyers will continue in a fire hose manner.

. . . this House bill replaces the income-based subsidies with age-based subsidies – ranging from $2,000 for younger people to $4,000 a year for older enrollees, and as much as $14,000 for a family. It is a massive new entitlement for middle-income and lower-income Americans. It would apply in full for families earning up to $150,000, and then phased out $100 per thousand dollars earned over that threshold. Thus, a family could theoretically get some sort of subsidy well into the $200,000-plus income level. [emphasis added]

Does anyone think this will bring down healthcare costs? Or that limited healthcare insurance options will increase? Or that people angry about Obamacare will be happy about Trumpcare?

The key takeaway is that there is to be no repeal of the essential idea of Obamacare that the federal government should regulate how healthcare functions in the United States. Both parties and their leaders now agree with this. If the Democrats are smart, they will vote for this and then tweak it back to Obamacare when they get in power.

The only hope, and it is mighty slim, is voter anger. Rising healthcare insurance costs and dwindling choice of healthcare providers may keep that anger strong. But where is an angry voter to go?
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*Community Rating: "A rule that prevents health insurers from varying premiums within a geographic area based on age, gender, health status or other factors."