Republicans work to 'fix' ObamaCare

The latest change to the Affordable Care Enabling Act – which gives the Administration limitless power to do whatever it wants in the name of keeping ObamaCare alive, and Democrats in office – eases up on Medicare Advantage cuts that would have organized senior citizens into a Democrat-slaying phalanx in the midterm elections.  From The Hill:

Under cuts planned by the administration, insurers offering the plans were to see their federal payments reduced by 1.9 percent, which likely would have necessitated cuts for customers.

Instead, the administration said the federal payments to insurers will increase next year by .40 percent.

The healthcare law included $200 billion in cuts to Medicare Advantage over 10 years, in part to pay for ObamaCare.

Here’s the public-relations spin for rescinding these cuts:

The Centers for Medicaid and Medicare Services (CMS) on Monday said changes in the healthcare market meant it did not need to make those cuts to Medicare Advantage this year.

It cited an increase in healthy beneficiaries under Medicare, which it said has lowered projected costs for that program.

CMS separately is delaying a risk assessment proposal that was set to take affect under ObamaCare.

Here’s the real reason:

The announcement comes after insurers spent millions on a public relations blitz seeking to head off the cuts, and after dozens of Democrats joined Republicans in calling on the administration to keep MA rates flat to avoid cutting benefits for seniors.

The Administration used to claim that cutting Medicare Advantage would “strengthen” it and “guard against waste” – arguments which, you will note, are completely separate from the reasons CMS gave for canceling the cuts.  Ah, the joys of central planning, in which a team of political geniuses designs 10,000-page plans for spending trillions of dollars… and then rewrite them on the fly, every time the ruling Party’s poll numbers go sour.  Nothing unsettles the “settled law of the land” faster than a string of bad polls.

As The Hill notes, this particular change is something Republicans wanted, and Democrats simply became too frightened to oppose.  We learned this week that Republican leaders have very quietly gotten in on the fun of rewriting the People’s Glorious Five-Year Health Plan, with a secret “fix” slipped into a law the House Republican rank-and-file didn’t even get to vote on.

The fix in question is small, sensible, and according to its advocates, not at all inconsistent with the GOP drive to repeal and replace ObamaCare.  But as described by the Associated Press, it was indisputably passed in a very odd way, which seems designed to avoid giving the full House a chance to weigh in:

Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make, and Obama signed it into law. Republicans are loath to agree, given the strong sentiment among the rank and file that the only fix the law deserves is a burial.

“Maybe you say it helps (Obamacare), but it really helps the small businessman,” said Rep. Phil Roe, R-Tenn., one of several physician-lawmakers among Republicans and an advocate of repeal.

In a weekend statement, House Speaker John Boehner’s office characterized the provision was “just one part of Republicans’ larger effort to repeal the full law and replace it with better solutions focused on lowering health care costs for families and small businesses.”

Until the statement was issued, no member of the House GOP leadership had sought to draw public attention to the fix, which was tucked at Republicans’ request into legislation preventing a cut in payments to doctors who treat Medicare patients. The bill cleared Congress more than a week ago.

It is unclear how many members of the House rank and file knew of it because the legislation was passed by a highly unusual voice vote without debate.

As for the fix itself, the AP describes it as “relatively minor”:

It eliminated a cap on deductibles for small group policies offered inside the law’s health care exchanges as well as outside; the cap was set at $2,000 for individuals and $4,000 for families.

Republicans said they sought it so small businesses can offer high-deductible plans that could be purchased by individuals who also have health savings accounts. These tax-preferred accounts are a long-time favorite of many Republicans, who say they give consumers greater control over their own health care.

The health law contains no deductible caps for individual plans or those offered by large employers, and the Department of Health and Human Services already had waived them for small businesses through 2015. The legislation means they will never go into effect.

So it’s really more about ratifying a mutation King Barack and his court already induced.  It would be interesting to hear the brain trust that designed this bloated health-care plan explain why the arbitrary caps were included in the first place, but of course the media won’t ask questions like that – they’ll be too busy writing stories about how Republicans have given up on ObamaCare repeal, followed by hit pieces portraying repeal-minded Republicans as so much less reasonable than the leaders eager to work with Democrats on making ObamaCare better.

Politically speaking, these changes – one demanded by Republicans, the other actually implemented by them – don’t necessarily have to dilute the repeal effort.  As mentioned above, Republicans can trumpet how badly-written the law was to begin with, and how all these hasty fixes are making a mockery of the original cost and benefit promises from 2010.  The permanent repeal of the small-business cap is designed to allow more choice for small- business insurance customers.  If a little more choice in a decrepit statist system is a good thing, why not get rid of the decrepit statist system and have choices blossom from coast to coast, as would be the case under something like Governor Bobby Jindal’s Freedom and Empowerment Plan?

Also, none of this marginal tinkering addresses the uncontrollable problems at the heart of ObamaCare.  Forbes writes today of a new survey that shows premium increases of 100 percent in Delaware, 53 percent in California, 37 percent in Florida, and 28 percent in Pennsylvania, to name some of the worst findings.  Another report speaks of 90 percent premium hikes in New Hampshire.  The primary ObamaCare-related causes cited by Forbes for these increases are “commercial underwriting restrictions, the age bands that don???t allow insurers to vary premiums between young and old beneficiaries based on the actual costs of providing the coverage, the new excise taxes being levied on insurance plans, and new benefit designs.”

None of those problems can be “fixed” by anything less than effective repeal of the Affordable Care Enabling Act.  (This may all ultimately boil down to a political debate between Republicans and Democrats over whether the ACA has been essentially repealed, or “improved” into something that bears little resemblance to the non-law passed in 2010.)  The task for Republicans is to sell a plan that offers the increased insurance coverage Americans say they support – it shouldn’t be tough to beat the laughably paltry progress ObamaCare has made in that regard, since we’re probably still not up to a net gain of 1 million people – without the massive premium hikes and crushing bureaucracy of the existing regime.  Making the repeal of small-business insurance caps permanent should not present any great obstacle to making that case; the Republicans can reasonably argue they don’t want to make life pointlessly difficult for Americans just to reap political rewards.  That’s a page from the Democrat playbook they shouldn’t want to steal.

But we all know how the media narrative is going to flow, and some statements from the GOP leadership make it sound like they’ll once again be wearing expressions of surprise when they’re washed away by the tide.  The way the small-business fix was passed doesn’t speak well of inter-party GOP coordination.  Frankly, if they’re going to do anything that “fixes” any part of ObamaCare, they should get out in front of it, not wait for news reports to burble out a few days later.  They should be trumpeting every time Democrats embrace a Republican idea to keep this disaster afloat.  Keeping things quiet will result in only political damage to the Republican cause, including anger from within their own voting base, without commensurate political reward.

Update: There was some discussion of the strange “voice vote” used to pass the Republican’s small-business ObamaCare fix at the Heritage Foundation’s monthly “Conversations with Conservatives” conference today.  The assembled conservative Republican representatives were very unhappy with this technique.  Rep. Mick Mulvaney (R-SC), who sits on the House Small Business Committee, said it was the most betrayed he’s ever felt by his party’s leadership… which, he ruefully noted, was a rather high bar to clear.