New Orleans The Republicans in the House of Representatives introduced their whatchamacallit healthcare bill which some other Republicans are calling Obamacare 2.0, and you can bet that’s not a compliment. The rest of us might take some small measure of comfort in that, but this is more of a “hold your breath and hope for the best” moment than a relief. Before anyone jumps off a cliff or heads for Canada, it’s important to understand that this hodgepodge of a bill is kind of a rough draft. The House Committees in fact are planning to try and move this bill forward without a firm estimate on the number of people it will cover or, more importantly practically and politically, the number it will not cover. Even more surprisingly, this thing breaks a cardinal rule of all card carrying Republicans: it lacks a price tag!
So, let’s take some deep breaths and a couple of pain pills and look at some of the hidden explosives in their attempt to put their finger in the wind and see what kind of gale force comes back at them. I’m going to avoid some of the easy shots, like the fact that governmental leverage on private insurers and costs seems to be going out the window or that a 30% penalty on any break in coverage is many magnitudes worse than the Obamacare 1.0 penalties or that much of the coverage is going to be catastrophic. We’ll have plenty of time to watch all that unravel as this bill is pulled in on one gurney after another into legislative emergency rooms. We’ll pass on by the deliberate and discriminatory attack on Planned Parenthood or the fact their bill seems to allow no insurance that will cover any voluntary abortion, because we’ll have to address those issues separately and soon.
I’m just going to focus on one of the more egregious and blatantly political and deliciously chicken chirping pieces of this bill. They realize that the major advance in healthcare coverage has been to lower income people through expanded Medicaid, and they recognize that politically they can’t handle the blood on their hands of just throwing people off of insurance without any alternatives. So, their proposal is that they will continue to pay the full federal freight as promised to the states through 2019, so for almost three years. Beginning in 2020 though they would red-circle those enrollees and continue to pay full sticker price for them, but for all new enrollees after 2020 they would two-tier them to a lower level of federal financing. Those of us with experience with labor contracts are very familiar with these kinds of tactics. The goal is see the red circled group gradually diminish or in this case, die, and pay less, often much less for the newcomers. As most companies could share with the Republican legislators, this is a prescription for pretty much universal unhappiness and a political gift to organizers and progressives since it creates a huge, semi-permanent second-class constituency ready to constantly demand first-class status which is the American way.
The Republicans will then be forced to defend something that is their worst nightmare: an entitlement. No matter what lipstick they try to put on this pig, funded high or funded low, it will still be an entitlement, but to their horror it will be an entitlement where the recipients aren’t grateful, but mad as wet hens.
Furthermore, just to see the whole scenario rollout here, what will keep all of the schoolhouse door governors who have been unwilling to expand Medicaid because they weren’t sure what would happen after the first couple of years to the federal-state costs from now jumping into Obamacare 2.0 while the window is open until 2020 so that their state’s citizens aren’t the last ones left behind the door when the health insurance was being given out.
The good news for poor people in the United States is that millions more would be covered, and entitled. The sweet irony would be that the cost of Obamacare 2.0 going into the 2020 election for President would be even higher, the Republicans would have to defend it, candidates would claim they were going to get rid of the two-tiered proposal if elected, and some form of publicly funded healthcare in the United States would be set in stone.