Opinion: Bipartisan health deal won’t cure what ails Obamacare

Sens. Patty Murray (D-Wash.) and Lamar Alexander (R-Tenn.) confer during a Health, Education, Labor and Pensions committee hearing on Capitol Hill in Washington, Sept. 6. (Pete Marovich / The New York Times)

We still need to see more details, but there’s a pretty good chance the bipartisan health deal announced Tuesday by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) is not going to stabilize markets as advertised.

The gist of the deal, which covers only the next two years, is an agreement for Congress to fund so-called cost-sharing reductions (CSRs) in exchange for a relatively vague promise of flexibility for states to manage their health-insurance markets. The CSRs are subsidies for insurance companies to subsidize out-of-pocket expenses for lower-income Americans buying health insurance on Obamacare exchanges; the Trump administration last week announced it would not continue to fund them without a congressional appropriation as the Obama administration had been doing unlawfully.

But the bark of taking away CSRs was going to be worse than its bite. For one, as I pointed out last week when the Trump administration announced it wouldn’t fund them, the amount of premiums most exchange shoppers actually paid wouldn’t have changed. That’s because, according to a Congressional Budget Office projection in August, the higher premiums would have been offset by larger tax credits, which are tied to premiums. That was a bad deal for taxpayers, because the CSRs were less costly to the government than the higher tax credits would have been. And it was a bad deal for the roughly 15 percent of exchange shoppers who don’t receive the tax credits, some of whom might have decided to drop their insurance and pay the tax for not complying with the individual mandate. But the vast majority of those with Obamacare plans wouldn’t have noticed a difference — and some of them, according to CBO, might have been better off. So it’s unclear that taking away CSRs would have reduced the number of people buying plans on the exchange — CBO said the number buying Obamacare plans would have fallen slightly in the short term and increased slightly in the medium term — which is what would have been most destabilizing since it would have accelerated the nascent death spiral we already see.

Second, the big jump in premiums this year, according to the health insurers themselves, wasn’t related to the uncertainty about CSRs. In Georgia, insurance plans on the exchange were going to go up by 23 percent to 41 percent for next year, depending on the insurer, independent of any decision about CSRs. Those amounts were even larger than the increase for 2017. To the extent higher premiums drive away those non-subsidized buyers, it was most likely going to happen regardless of what happened with CSRs, because premiums were going to soar either way.

If the Alexander-Murray deal is going to stabilize markets, the best chance has to do with the state regulation. The one bit of detail we have about that comes in this piece by Politico, which reports there will be a new “copper” level of insurance on the exchanges, amounting to catastrophic coverage, available to those over 30 years old (those under 30 were already allowed to buy such plans, along with others who qualified for certain exemptions from the individual mandate). This could encourage people who have stayed away from, or recently left, the exchanges to buy coverage because it would be more affordable. Combined with something like a direct primary care arrangement, such plans would allow most people enough coverage to prevent their health from becoming a financial burden. Still, it’s unclear if this deal comes too late for most insurers to offer such a product for 2018, given that open enrollment starts in a couple of weeks. So, it might not offer much stabilization in the immediate future. (Other proposed changes, such as increased flexibility in the waivers states can seek for insurance offered on their exchanges, are too vague at this point to evaluate.)

In all, I still believe Alexander-Murray was never going to be the kind of deal to either save or reform Obamacare’s individual market. Whether it provides even enough breathing room for Congress to work out something better also remains to be seen.

Reader Comments 0

224 comments
bendedknee
bendedknee

Love it how Kyle and the Cons go beserk when they smell a compromise with the Dems. Party uber alles.

breckenridge
breckenridge

October 19 - Tony Perkins, radio host and president of Family Research Council, blamed the military’s acceptance of gay and transgender service members for creating “moral confusion” that cost a two-star general his job.

During yesterday’s episode of “Washington Watch,” Perkins commented on a USA Today report that a two-star Army general had been fired after an investigation revealed he had sent inappropriate “sexy” text messages to the wife of a soldier. Naturally, Perkins used the story to continue pushing his anti-LGBTQ agenda.

“I think this is wrong, but who says it’s wrong? The military code of conduct? True, but that also said that homosexuality is wrong, but that prohibition is no longer being enforced. In fact, people are punished for not celebrating homosexuality,” Perkins said. “Same was true of transgenderism.”

Perkins went on to say that the officer’s conduct was not wrong because it violated the military code of conduct, but instead because it “violates the moral law of the creator,” which Perkins says is instilled in every human being by God.

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Tony Perkins. Former water boy for James Dobson and part and parcel of the garbage that destroyed the republican party.

SGTGrit
SGTGrit

Where in the hell do we get such scum bag politicians in the congress of the United States such as Congress woman Fredricka Wilson. Other Democrats piled on including our far-left media. Thank Goodness for General Kelly, whose a Gold Star parent himself to come forward and shame these people. We truly do have trash in this Republic that's in sad need of sweeping.

breckenridge
breckenridge

@SGTGrit 

You neglected to mention the draft dodging scum punk responsible for disallowing the coffins of dead soldiers being returned from overseas to be shown on television.

Goddam you right straight to hell Richard Cheney you gutless coward.

bendedknee
bendedknee

@SGTGrit Yeah all those darkies like the former president should be banned from  high level positions except Clarence on SCOTUS

RoadScholar
RoadScholar

@SGTGrit You mean the same Congresswomen who mentored the dead soldier from when he was 6 yrs old, having no parents (raised  by an uncle and aunt), providing him opportunities, and he blossomed into one of our finest?

SGTGrit
SGTGrit

@RoadScholar @SGTGrit 

The congress woman who listened into a private telephone conversation between a president offering condolences and the Gold Star widow and then editing what he said to politicize the conversation. Gutter politics that was called out by General John Kelly, a Gold Star parent of a son killed in Afghanistan.

breckenridge
breckenridge

@SGTGrit @RoadScholar 

Gutter politics? Trump has taken the office of president to lows we've never seen in this country. He is a complete disgrace.

SGTGrit
SGTGrit

Mark says one hour ago, "another idiotic question, after so many already. "My version of single payer?" Where have I indicated that I had any "version of single payer?" 

Good grief this idiot has been condemning posters all day long for not knowing what a single payer H.C. system is and then he says duh "where have I indicated that I had any version of a single payer."


Talk about stuck on stupid. Geez.

breckenridge
breckenridge

October 19 - The 43rd president of the United States -- and the last Republican to hold the office before Donald Trump -- didn't mention the 45th president by name in his speech at the George W. Bush Institute. But Trump -- and his views -- were ever-present in the former President's address.

Bush condemned "nationalism distorted into nativism."

He derided "discourse degraded by casual cruelty."

He acknowledged that "our politics seems more vulnerable to conspiracy theories and outright fabrication."

 And, most importantly, Bush said that "bigotry seems emboldened."

============================================

Well bullies and racists are cowards. Those that blame their inability to make a decent living on the influx of foreigners are stupid losers.  The problem with being a serial liar is that it's impossible to take anything said at face value. And conspiracy nuts? They are the most foolish among us.

breckenridge
breckenridge

re: Trump and the troops


The call placed by Trump to the widow in Florida......Trump may have handled it awkwardly, but it was not mean spirited.


What is really a disgrace, and a policy that should be reversed, is not showing the coffins of American troops killed overseas being unloaded upon return to the states.  That was a policy instituted at the insistence of Richard Cheney, a scum sucking punk draft dodger. 

MarkVV
MarkVV

Te sad part is that there is so difficult to decide who has been writing the most ignorant and stupid posts lately, Doomy, SGTGrit, waitaminute 3210? Neither of them can argue himself out of a paper bag.

MarkVV
MarkVV

@waitaminute3210 @MarkVV Why don't you go and get some education first, before you ask your stupid questions? Which "single payer system" you ask about?  T here is no "generic single payer system." There are many "hybrid single payer systems," such as those in many European countries, each with their own detailed conditions There are a few countries with what one can truly call "single payer system," but still different in details. Here in the debate we usually use a shortcut using the expression "single payer system" to indicate a system like "Medicare for all," but still with many details that would have to be filled in.

MarkVV
MarkVV

@waitaminute3210 @MarkVV I have answered it the only way it can be answered. If you do not understand that, do not blame others and get some education.

waitaminute3210
waitaminute3210

@MarkVV Nope. You failed to differentiate the difference in single payer to cover all and single payer to only cover some, which was most pertinent to our points. You lose. 

waitaminute3210
waitaminute3210

@MarkVV Single payer for all is also known as universal heath care and term is used interchangeably. 

MarkVV
MarkVV

@waitaminute3210 @MarkVV One does not need more about the level of education of someone than to read an expression “to differentiate the difference,” as well as the whole inanity of the question. And one does not need more to grasp the level of intelligence of someone, who proclaims himself a winner and the opponent the loser. Of course, Donald Trump has elevated such illiteracy and boasting to an art. So it does not come as a surprise.

MarkVV
MarkVV

@waitaminute3210 "Single payer for all is also known as universal heath care and term is used interchangeably. "

You do not have to repeat what I have explained in more detail above.

MarkVV
MarkVV

Doomy: “The Scandinavians know the truth- which is that if you want single payer then the middle class and even the lower middle class are going to have to pay an extra 20% of their income in taxes.”

US:  middle class median income ~$60,000

http://money.cnn.com/2017/09/12/news/economy/median-income-census/index.html

extra 20%:  $12,000

And how much would they save not paying private insurance premiums?

Average family premium (without subsidies) 2017: $1,021 x 12 =~$12,000

https://www.zanebenefits.com/blog/affordable-care-act-policy-costs-up-in-2017

waitaminute3210
waitaminute3210

@MarkVV It's 20% of your income, not 20% more than you've been paying, Genius. And Zane is controversial at best.

SGTGrit
SGTGrit

@waitaminute3210 @MarkVV 

The guy keeps digging the hole that he's in deeper. Have you noticed that the other libs aren't coming to his rescue.

Starik
Starik

@waitaminute3210 @SGTGrit Where do you get these numbers? Not from a bipartisan study, because there hasn't been one. How many of you work in insurance, like Doom?

Doomy
Doomy

@Starik @waitaminute3210 @SGTGrit


What does being in the insurance business have to do with anything, Starik? I'm not even going to be writing ACA business this year because the commissions are now so pitiful. On top of that there's only one carrier left in most of the counties I deal with and I refuse to sell that carrier cause their coverage is so bad and their network is so skinny, skinny, skinny. The same rationing we have in public systems.  I can do without it. So you can eliminate salesman's commissions all you want. Its not going to reduce premiums, sir. 


And if you think that the reason premiums are so high is because sales agents or insurance companies are making a bundle then I wouldn't even know what to say to that kind of foolishness. 


Insurance companies aren't making bundles of money, sir. If they were then they wouldn't have pulled out of many major markets left and right. They are pulling out cause they've been losing their arses. Duh! 

MarkVV
MarkVV

@waitaminute3210 @MarkVV Tell that to Doomy, I have quoted him. My calculation is for 20% of the income. Genius for sure you are not, quite the opposite, if you do not understand that.. And if "Zane is controversial," tell us your data for average family premium with a source.  It is people like you, who have been yelling about high premiums

waitaminute3210
waitaminute3210

@MarkVV Answer my previous question, Mark. Does your version of single payer cover everyone?

waitaminute3210
waitaminute3210

@MarkVV @waitaminute3210 Seriously? You can't grasp the difference in premium costs versus upping people's federal income taxes to between 20% and 40%? It is simple math, man. 

MarkVV
MarkVV

@waitaminute3210 @MarkVV Another idiotic question, after so many already. "My version of single payer?" Where have I indicated that I had any "version of single payer?" I am disputing the lies and stupid things you and others like you have committed here.

Starik
Starik

@Doomy @Starik @waitaminute3210 @SGTGrit Much of the opposition to single payer is from people, like you, who make or have made a good living from the health insurance industry. The biggest hurdle will be the disruption of the very good living made by Tom Price type MDs, Pharmaceutical and hospital companies and all the associated businesses. I don't blame them for objecting, but we need to start in that direction. How many of the anti-single payer links come from trade publications?