On Obamacare: If You Like Your Plan, You Should Be Able to Keep It

Recent actions by Democrats like Debbie Wasserman-Schultz point to the fact that they still haven’t accepted what is really happening. They persist in spinning the bad news about cancellations and focusing on the website when the primary cause of the problem is coming from the law itself.  

Obamacare has set off a catastrophic disaster that will result in taking plans that work for people and replacing them with substandard plans or no plan at all. That is already displeasing the American public. While the media isn’t asking the question yet, soon most folks will start asking, “What happens when the Employer Mandate kicks in?”

Theoretically, the Democrats’ self-preservation instincts will kick in and they’ll have to do what the Republicans did with Nixon.  The Senate Democrats will have to defy Obama behind closed doors for their own political survival. If they don’t, their party will be doomed — and the smarter ones already know that.

For a time frame of bad news, let’s start with what’s already happening:

  • Politics has driven the White House’s implementation decisions far more than any other factor leading to a broken website and a trail of unintended consequences.
  • New plans are costing Americans more money.
  • Big insurers are avoiding state exchanges, leaving noncompetitive government marketplaces and reducing access to doctors.
  • A California cancer patient finds that the ACA’s framework is so limiting that her scope of doctors has narrowed by counties. It’s bad enough that we don’t have interstate competition for insurance, now we have county by county insurance within a single state. Some pricing regions in California only offer one provider.  That’s the opposite of a competitive marketplace.  These stories in state exchanges are piling up faster because, frankly, their exchanges are working. But this bodes poorly for those who think that things will get better when healthcare.gov works. Likely we’ll see stories like these from the rest of the states soon.
  • Enrollment is low. So low that Day One yielded only six sign-ups.  The majority of current signups are for Medicaid, which already existed before this law was written. Yes, it’s likely enrollment may pick up closer to the deadline, but the premium prices awaiting folks for plans that aren’t as good as their previous ones is a larger barrier to uptake. This makes the administration’s comparisons to other open enrollments complete non-starters.
  • It will be worse if enrollment never hits the target, because premiums will have to rise in 2015. Those prices will be scheduled to hit the market right about election time in Nov 2014
  • And if you still don’t believe the cancellation mountain that exists, I encourage you to visit mycancellation.com.

The Democrats, like any political party, value survival above all else. Let’s hope that premise is still true. While Obama is a hopeless ideologue, he can’t politically withstand his own Senate turning against him — which is what must happen to help Americans getting hurt by this law.

Like it or not, “let it burn” cannot happen in an environment where voter outcry outweighs long-term ideological goals for either side. Obamacare will have to change before 2016.

Standing back while your enemy commits political suicide is sound strategy, but it can only last so long. When the Democrats’ survival instincts kick in, Republicans must be ready. When the time comes, Republicans will have to offer the Democrats a face-saving fig leaf. Now it’s time to decide what that will be.

The question is how you make it politically palatable to a Democratic Senate who will want to take a lifeline. Currently they’re fixated on delaying enrollment and possibly waiving the mandate fee, but that’s not going to fix what’s happening on the ground. People are being forced out of plans they like into ones they don’t want. There is no escaping that reality. If what you do to tweak the law doesn’t stop that in its tracks, you own this political trainwreck — and your party has broken the American public’s trust in a way that can’t just be limited to Obama.

The most damaging problem is the destruction of the individual insurance market. This has to be addressed — and quickly — so people can purchase plans they want again.

In order to restore a regulatory environment that allows people’s previous policies to exist, you have to create a new piece of legislation that supersedes the mandatory nature of Obamacare. Obamacare needs to be isolated to allow for an insurance market to exist outsides its bounds. The exchanges can remain, and if their plans are superior we should see customers purchase plans there instead of the private market.

If Obamacare is as good as Democrats have promised, then they have nothing to fear from allowing an insurance market to exist outside the bounds of the law.

Realistically, the logical resting place for Obamacare until 2016 is the expansion of Medicaid since that’s all it’s fundamentally capable of accomplishing. Everything else is pure fantasy or, worse, doubles down on the already-costly regulatory environment in our health system.

While I object to the Medicaid expansion for reasons I won’t get into here, it’s not likely that Senate Democrats will turn on Obama, even privately, if you don’t leave them something on the table to save face with — in this case, it’s likely the fig leaf the GOP will have to suffer.

Some fights will have to wait for another day. Other things may or may not be on the table for both sides, like increasing FSA allowances. but retaining the Medicaid expansion will be the likely option for Democrats, despite the inherent fallacy as well as a temporary solution for the folks with preexisting conditions.

Regarding the mechanics of how this gets done, likely the only way it can succeed is if a politician valued and trusted by the base — like Senator Mike Lee and a logical Democratic partner like Ron Wyden — develop a proposal that allows for insurance plans to exist outside the Obamacare mandates. In many ways, a large impediment to moving forward is how bad the GOP is at aligning to a solution that’s workable and acceptable to their voting base. This means the GOP lead for this has to be smart and appealing to the grassroots (hence my suggesting Senator Lee). The Democrats will align for political survival, at least theoretically. I harbor doubts on this still, but I believe that ultimately they’re political animals who are more cornered right now than they even realize.

This isn’t everything I want policy-wise. Believe me, nothing would make me happier than a full repeal, But I’m living in the land of “I told you so” right now, and it’s not as fun as I thought it would be. I can’t take the stories of how damaging this law is to people even when they voted for it. I take Megan McArdle’s piece to heart, and realize most people don’t see health policy the same way that I do. They basically believed what they were told.

It’s malpractice not to engage strategically, surround the law with the private working sector, and allow it quietly wither away until we can find the will in this country to address the real factors driving up health care costs in this country.

If you like your plan you can keep your plan strikes me as a promise you should likely keep with the American people. It’s unforgivable to do this to Americans in reckless pursuit of a faulty ideology. Leaders should see this as an opportunity to engage a new coalition of voters for future gain.

It’s time to restore reality and allow people to keep their plans if they like their plans. The government should not be in the business of superseding your most personal decisions.