Health care after the Obamacare repeal

The Cato Institute’s Michael Tanner provides a helpful guide to the changes we can expect after Obamacare repeal in a three-part article at the New York Post.

The first installment explores the general contours of a replacement health care plan:

  • More choices in types of plans, with “more of an à la carte approach,” as opposed to mandated benefits.
  • More choices of insurers, with shopping “across state lines” bringing “much-needed competition.”
  • Greatly expanded Health Savings Accounts (HSAs) for employer-based insurance, allowing payment of premiums through HSAs, thereby increasing choices and portability of coverage.

In a separate article posted at cato.org, Mr. Tanner observes that “purchase of health insurance across state lines” would challenge “both the insurance cartels and overzealous state regulators.”

The second part of the Post series looks at replacing the more expensive drivers of Obamacare – coverage for low-income people and for pre-existing conditions:

  • Tanner says there is “ample evidence to suggest that Medicaid provides little if any benefit” and that in any case, “repeal of ObamaCare is unlikely to have any short-term impact on Medicaid.”  It is unclear, however, why Tanner thinks the repeal of the Medicaid expansion embraced by 31 states would have no “short-term impact.”
  • Subsidies for Obamacare exchange plans “will almost certainly be cut back or eliminated,” partly offset by reduced insurance costs.
  • Approaching pre-existing conditions with “continuous coverage” requirements or “limited open-enrollment periods,” as some Republican plans suggest, would just “encourage people to game the system, jumping to more comprehensive plans” after they get sick.
  • “The number of truly uninsurable people is actually quite small” and will “decline further” as costs decrease and portability increases.
  • “The only workable answer is to take otherwise uninsurable people out of the traditional insurance market altogether” and cover them through subsidies for state high-risk pools (which existed in 35 states before Obamacare) or through a “reformed Medicaid program.”
  • Tanner says “it’s important to realize that no one is going to have their health insurance suddenly snatched away.”

In a separate column last week, also posted at cato.org, Mr. Tanner expands on pre-existing conditions:

Pretty much all the problems with ObamaCare flow from the decision to require insurance to cover people with preexisting conditions.

Republicans are now attempting to stop all those falling dominoes, but are reluctant to go back and deal with the originating problem. 

That means killing ObamaCare in its entirety, including the preexisting condition provisions. Instead, Congress should provide funding to help states set up high risk pools.

Taking on ObamaCare’s biggest flaw directly will be politically difficult. But as a matter of good health policy, it is the only way to undo the harm that ObamaCare has [d]one to the U.S. healthcare system.

If Republicans take the easy way out, they will soon find out that half a loaf of ObamaCare won’t work any better than the whole thing.

In the third Post installment, Mr. Tanner reviews the outlook for the medical professions:

  • Repeal of Obamacare’s steep and unrealistic cuts in Medicare payments to doctors and hospitals will relieve some of the cost pressures, but the Obamacare-driven acceleration of “consolidation in the health care industry” is “likely to remain.”
  • The controversial “Independent Payment Advisory Board (IPAB), which was to have started imposing those cuts next year, would be out of business.”
  • Insurance companies have reacted to Obamacare by “squeezing physician payments” and restricting their network coverages.  That may change as patients gain “more choices and more control.”
  • “And, the day of the small independent medical practice is over. Physicians will increasingly work directly for hospitals or other organizations,” with “nurse practitioners and physician assistants” continuing to take bigger roles.

Earlier in the series, Mr. Tanner observes that the repeal of the Obamacare individual mandate would “re-establish a fundamental limit to state power over the individual.”

Breach of that fundamental limit is arguably the most dangerous aspect of the Democrats’ health care law.

As Tanner labels it, “killing Obamacare in its entirety” is the only way to ensure that future Democrats cannot use any dormant vestiges of Obamacare to again breach that limit.

The Cato Institute’s Michael Tanner provides a helpful guide to the changes we can expect after Obamacare repeal in a three-part article at the New York Post.

The first installment explores the general contours of a replacement health care plan:

  • More choices in types of plans, with “more of an à la carte approach,” as opposed to mandated benefits.
  • More choices of insurers, with shopping “across state lines” bringing “much-needed competition.”
  • Greatly expanded Health Savings Accounts (HSAs) for employer-based insurance, allowing payment of premiums through HSAs, thereby increasing choices and portability of coverage.

In a separate article posted at cato.org, Mr. Tanner observes that “purchase of health insurance across state lines” would challenge “both the insurance cartels and overzealous state regulators.”

The second part of the Post series looks at replacing the more expensive drivers of Obamacare – coverage for low-income people and for pre-existing conditions:

  • Tanner says there is “ample evidence to suggest that Medicaid provides little if any benefit” and that in any case, “repeal of ObamaCare is unlikely to have any short-term impact on Medicaid.”  It is unclear, however, why Tanner thinks the repeal of the Medicaid expansion embraced by 31 states would have no “short-term impact.”
  • Subsidies for Obamacare exchange plans “will almost certainly be cut back or eliminated,” partly offset by reduced insurance costs.
  • Approaching pre-existing conditions with “continuous coverage” requirements or “limited open-enrollment periods,” as some Republican plans suggest, would just “encourage people to game the system, jumping to more comprehensive plans” after they get sick.
  • “The number of truly uninsurable people is actually quite small” and will “decline further” as costs decrease and portability increases.
  • “The only workable answer is to take otherwise uninsurable people out of the traditional insurance market altogether” and cover them through subsidies for state high-risk pools (which existed in 35 states before Obamacare) or through a “reformed Medicaid program.”
  • Tanner says “it’s important to realize that no one is going to have their health insurance suddenly snatched away.”

In a separate column last week, also posted at cato.org, Mr. Tanner expands on pre-existing conditions:

Pretty much all the problems with ObamaCare flow from the decision to require insurance to cover people with preexisting conditions.

Republicans are now attempting to stop all those falling dominoes, but are reluctant to go back and deal with the originating problem. 

That means killing ObamaCare in its entirety, including the preexisting condition provisions. Instead, Congress should provide funding to help states set up high risk pools.

Taking on ObamaCare’s biggest flaw directly will be politically difficult. But as a matter of good health policy, it is the only way to undo the harm that ObamaCare has [d]one to the U.S. healthcare system.

If Republicans take the easy way out, they will soon find out that half a loaf of ObamaCare won’t work any better than the whole thing.

In the third Post installment, Mr. Tanner reviews the outlook for the medical professions:

  • Repeal of Obamacare’s steep and unrealistic cuts in Medicare payments to doctors and hospitals will relieve some of the cost pressures, but the Obamacare-driven acceleration of “consolidation in the health care industry” is “likely to remain.”
  • The controversial “Independent Payment Advisory Board (IPAB), which was to have started imposing those cuts next year, would be out of business.”
  • Insurance companies have reacted to Obamacare by “squeezing physician payments” and restricting their network coverages.  That may change as patients gain “more choices and more control.”
  • “And, the day of the small independent medical practice is over. Physicians will increasingly work directly for hospitals or other organizations,” with “nurse practitioners and physician assistants” continuing to take bigger roles.

Earlier in the series, Mr. Tanner observes that the repeal of the Obamacare individual mandate would “re-establish a fundamental limit to state power over the individual.”

Breach of that fundamental limit is arguably the most dangerous aspect of the Democrats’ health care law.

As Tanner labels it, “killing Obamacare in its entirety” is the only way to ensure that future Democrats cannot use any dormant vestiges of Obamacare to again breach that limit.