Playing Chicken

Bruce Springsteen was right. You really could have 57 stations with nothing on.  There were tons of reruns, and worse, the same shows were on multiple stations.  One saga looked familiar.  It was a New York production, a remake of a Hollywood classic.  Only this time we didn’t get James Dean.  Instead, the two ne’er-do-wells racing the stolen cars to the cliff were Donald Trump and Mitch McConnell.  In this version they both jumped out in time but the American public was bound and gagged in the trunk.  Dozens of stations were showing A President Without A Clue.

The Patient Protection and Affordable Care Act (Obamacare) took its first breath on March 23, 2010.  It survived over sixty Congressional assaults, but died of stab wounds and blunt force trauma on October 13, 2017.  We now have Trumpcare.

Obamacare was a failed attempt to make health insurance universal and affordable. It failed.  Millions of Americans did acquire better, cheaper coverage, but others did not.  You can trace the problems to the design, the actual language of the bill, the process (numerous Republican amendments and poison pills), or the concerted effort of the Republicans to discredit and destroy it once it became law.  It doesn’t matter.  We knew the goals and the PPACA came up short.

What is the goal of Trumpcare?

The last post of this blog covered Donald Trump’s Executive Order a few days before he issued it.  The changes, the expansion of cherry-picking association policies and the revival of short term contracts, are not immediate.  The first step is a sixty day period for the public and the stakeholders to comment.  The immediate impact is Market Instability, the hallmark of Trumpcare.  I talked with insurers on Friday.  They will be ready to roll out alternative products by January 1st.

Trumpcare was born with the elimination of the Cost Sharing Reduction Subsidy.  Trump had been threatening to do this for months even though many, including his then HHS Secretary, Tom Price, had urged him to continue the program until Congress passed an Obamacare alternative.  You may remember that these threats were the reason Anthem withdrew from the individual market.

There were four steps to individual health insurance under Obamacare, all based on the personal or family income of Americans who didn’t have access to coverage at work.

  • Income below 138% of the federal poverty level – Medicaid
  • Income between 138% to 250% of the federal poverty level – A tax credit subsidy to help pay for the premium and a cost sharing reduction to reduce the deductibles and out-of-pocket costs
  • Income between 250% to 400% of the federal poverty level – A tax credit subsidy to help pay the premium
  • Income in excess of 400% of the federal poverty level – Full premium

The insurers are contractually obligated to reduce the deductibles and out-of-pocket costs for those who qualify, but due to a failure in the wording of the law, the federal responsibility to fund it became a political football. Republicans sued and the courts let the funding continue as long as the President defended it.  I don’t know that anyone really believed that Trump would do more than threaten to upend the market.  But which insures could take a chance?

Insurers across the country are now being forced to decide whether or not to withdraw from the individual market. At the very least premiums must be increased to cover their additional exposure.  Excellent reporting by Stephen Koff in Saturday’s Plain Dealer detailed how insurers were forced through the difficult processes of preparing rates for each state and how this will impact the consumers, the insurers, and yes, the American taxpayers.

It is assumed that Trump will institute this immediately, cutting off payments due for the rest of 2017.

Medical Mutual of Ohio, based in Cleveland, says it will lose $3 million to $5 million in just those three months because of this. The company is large enough to withstand it.  Smaller companies might not have the same financial fortitude.

Consumers who qualify for a tax credit subsidy will receive a higher subsidy. The Congressional Budget Office, according to the Plain Dealer, projects that this one decision will increase the “deficit by $194 billion in the next 10 years”.  And those that don’t qualify for subsidies will see higher premiums as soon as January 1st.

Mitch McConnell and Paul Ryan have been playing chicken with 20% of our economy and the way Americans access and pay for healthcare for over seven years. It was cynical and unprincipled.  It took Donald Trump to drive over the cliff.


Picture – Cliff Straight Ahead – David L Cunix



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7 Responses to Playing Chicken

  1. Sick And Depressed says:

    It is all SO sickening and depressing, to say the least! Health insurance payments now often surpass the cost of a monthly mortgage payment! Even people like myself, with insurance, are up to our eyeballs in doctor and hospital debt due to high deductibles, insurance companies ‘nickel and diming’ their policyholders and often not paying out benefits they used to years ago, and the rapacious cost of healthcare itself! By the time we scrounge up enough money to make our monthly health insurance payments, the doctor and hospital bills that insurance doesn’t cover come at us fast and furiously, especially those with pre-existing conditions! The irony is that the very healthcare system that is stacked against us, is the one stressing us out and making us sick!

  2. says:

    From our friend Ellen:
    It seems that anything Obama tried to do to advance universal healthcare (and other issues to advance mankind) is exactly what Trump wants to undo — without regard for the consequences. I know — DUH. How do we fight such derisive attitudes? There’s talk of impeachment. There’s talk of 25th amendment. There’s talk that in 2020 Trump still has the numbers to win. How can this be and what, realistically, can we do to make sure the best care is available to Americans?’
    Dave, you’re great, but what can WE ALL do to really make a difference? I’ve called/emailed/texted OH reps.
    Portman, paid-off by the drug cos. to the tune of millions won’t vote for the best interest of Ohioans because he’s in the pockets of drug cos.
    Like millions of Americans at risk, as a senior, I feel powerless.
    What to do???

  3. […] attempts to repeal the PPACA without a concern given to the consequences.  The funding for the Cost Sharing Reduction was eliminated.  Other actions, great and small, were taken to sabotage the law.  And each time […]

  4. Chutzpah | says:

    […] Executive Orders and Trumpcare would balloon the deficit and raise premiums.  This was all explained last October.   Eliminating the funding for the Cost Sharing Reduction and the penalty for healthy people […]

  5. HOW? | says:

    […] by the president, is still a threat.  Other actions taken last year, the defunding of the Cost Sharing Reduction and the elimination of the penalty associated with the Individual Mandate, continue to disrupt the […]

  6. […] the Trump administration.  Funding for the Cost Share Reduction had been eliminated which cost the insurance companies millions of dollars.  Some insurers responded by leaving the market.  And the annual Open Enrollment was shrunk to […]

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