The New York Analysis of Policy and Government continues its review of the reasons Obamacare had to be replaced.

Government mandates for the inclusion of coverage for treatment modes unwanted and unneeded by many serves to unnecessarily increase costs.

A Cato Institute study notes:

“Like the federal government, all states increase the cost of health insurance by requiring consumers to purchase certain types of coverage, whether or not they want it. Many states require consumers to purchase coverage for services that many consider quackery, such as acupuncture (12 states), chiropractors (44 states), and naturopathy (4 states). Thirty-three states require consumers to purchase at least 40 types of mandated coverage. States have also required consumers to purchase coverage for medical treatments that later proved harmful to health, such as hormone replacement therapy (4 states) and high-dose chemotherapy with autologous bone marrow transplant for breast cancer (at least 1 state, Minnesota). States impose many additional regulations on insurance pools, from premium taxes to rules limiting insurers’ ability to manage utilization. The Congressional Budget Office estimates that, on average, state regulations increase the cost of health insurance by 13 percent. States prevent individuals (and employers) from avoiding unwanted regulatory costs by prohibiting them from purchasing health insurance from states with more consumer-friendly regulations.

Another approach ignored by those who enacted Obamacare was tort reform. A study by the South Carolina Policy Council analyzed the problem. “…medical malpractice tort reform…seeks to obtain a better balance between holding doctors accountable for mistakes and protecting physicians from frivolous lawsuits. In practice, medical tort reform seeks to cap the amount of monetary damages awarded in medical negligence cases. The impetus for this is escalating costs for doctors and insurance companies, on the heels of multimillion dollar settlements to individuals and multibillion dollar settlements to states…Estimates of the cost total of medical malpractice civil cases range from $252 billion (by the Tillinghast-Towers Perrin actuarial firm) to $865 billion by the Pacific Research Institute (PRI). PRI’s estimate includes $589 billion in wasteful spending that accounts for lost future productivity and lost sales ($367 billion) caused by less innovation. While not all tort costs are wasteful — tort law is imperative in a free market system to maintain the rule of law — there is plenty of room for reform…doctors feel they must practice defensive medicine in order to avoid being sued. This practice entails prescribing tests or treatments for patients whose symptoms would not ordinarily require such procedures…Dr. William Jackson, a radiologist at Beaufort Memorial Hospital, says most people would be amazed at how many defensive medicine lab tests are ordered every day.”

As the Republican majority in Congress moves to address the Obamacare crisis, conservatives are asserting that marketplace concepts such as interstate competition, tort reform, and consumer choice in treatment coverage is not being emphasized in the initial phase. GOP leadership is emphasizing a gradual approach, centered around tax credits for purchasing private policies.

The Wall Street Journal reports that “Sen. Rand Paul (R., Ky.) reintroduced… a bill to repeal most of the 2010 health law without replacing it, a measure that cleared the last Congress when President Barack Obama, a Democrat, was in office. Conservative groups view that bill, which Mr. Obama vetoed, as a gold standard. GOP leaders’ decision to back away from that bill now that Mr. Trump is president is causing friction. Sen. Ted Cruz (R., Texas) amplified the message when he left a Thursday afternoon meeting with Senate Majority Leader Mitch McConnell (R., Ky.) and a handful of other Republicans and said the House bill couldn’t pass the Senate and needed to be changed.”
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But Congressional leadership favors a three-part approach, notes the Wall Street Journal. “The leaders plan to first pass the current bill repealing much of the law and offering some Republican-backed elements in their place…The second phase would have Health and Human Services Secretary Tom Price use his administrative power to undo other ACA provisions. The third step would be the hardest—persuading enough Democrats to go along with a set of non-budget health-care bills that would take 60 votes to pass the Senate.Mr. Trump has said letting insurers sell policies in every state would be part of the third phase. But conservatives insist that proposal should be included in the current legislation, since they doubt the likelihood of winning over enough Democrats to pass it.”

Conservatives do approve of portions of the reform bill, reports Townhall, “Compared to Obamacare, GOPCare reduces the role of the federal government in the healthcare system, gives more authority and flexibility to states, spends less, taxes less, regulates less, and coerces less. The individual and employer mandates are gone. Infamous tax hikes like the medical device tax are gone (and in other cases, delayed or reduced). Obamacare’s subsidy system is dismantled by 2020 and supplanted with refundable tax credits for lower-to-upper-middle-income individuals and families, ranging from $2,000 to $14,000 annually…Caps on tax-free contributions to Health Savings Accounts are also raised considerably, almost doubling under this bill.  The conservative Republican Study Committee is out with a pretty balanced memo on the positives and negatives of the draft legislation, noting several shifts towards more coverage and more spending over the weekend.”

Some of the very few popular portions of Obamacare would be maintained. “People with pre-existing conditions are protected…Also, lifetime expenditure caps from carriers remain disallowed, and adult children are permitted to remain on their parents’ plan through age 26.

 On the other hand, conservatives are concerned that the growth in Medicaid may be unchecked. “Fiscal conservatives opposed the expansion…Obamacare’s status quo would remain in place until 2020, at which point the new law would ‘transition Medicaid into a system in which each state receives a certain amount of money for each of its residents in the program and has more flexibility over how the program functions. That allocation would revert to per person spending levels from 2016 and then grow each year at the rate of medical inflation. However, states would still receive enhanced Obamacare-levels of spending for individuals who were grandfathered in by having enrolled in expanded Medicaid before 2020…Many conservatives want the Medicaid expansion done away with entirely.”

One conservative source, The Daily Signal, emphasizes: “The key problem with the draft House health care bill is that it fails to correct the features of Obamacare that drove up health insurance costs. Instead, it mainly tweaks Obamacare’s financing and subsidy structure. Basically, the bill focuses on protecting those who gained subsidized coverage through the law’s exchange subsidies and Medicaid expansion, while failing to correct Obamacare’s misguided insurance regulations that drove up premiums for Americans buying coverage without government subsidies.”

As we went to press, The House of Representatives has announced that it will delay its vote on repealing and replacing Obamacare.

The debate over how to replace the already collapsing Obamacare system has been one of the most contentious in the current Congress. There is little dissent in the need to undo the Affordable Care Act, (ACA) passed in relative secrecy. (Former speaker Nancy Pelosi’ comment “We have to pass the bill before you can see what’s in it” ranks as one of U.S. history’s most memorable examples of legislative incompetence.)

The reality is, no matter which party took control of the federal government in 2016, Obamacare would have required major surgery—or perhaps even a mercy killing. A Heritage analysis outlines the massive problems:

• 5 million lost prior insurance plans—President Obama’s promises that “you can keep your plan” and “you can keep your doctor” were completely untrue, and private sector enrollment increased by only 2.7 million, and exchange enrollment is only half of what was projected.
• Average deductibles are $12,000
• Premiums have increased by 25%
• 70% of counties have no choice of insurance providers
• 78% of Obamacare co-ops have failed, at a cost of $1.9 billion
• Medicaid spending has increased by $1 trillion—paid for by an equal amount of tax increases. Medicaid patients under Obamacare have received a lesser quality of care
• 5 million full time jobs were lost because the Affordable Care Act actually serves as a disincentive to hire full time employees

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Obamacare hurt both young and old.

Although allowing young people to remain covered under their parents’ coverage until age 26, once they aged out, they were forced to buy policies that were overpriced due to mandated coverage of issues not typically affecting them. Indeed, a key part of the financing strategy for Obamacare was the subsidization of young, healthy individuals for the rest of the covered population.

At the other end of the age spectrum, seniors were hurt because, as Heritage outlines, Obamacare cuts $716 billion  from Medicare over the next 10 years, according to the Congressional Budget Office (CBO), and uses these “savings” from Medicare to fund other entitlement expansions mandated by Obamacare. Medicare becomes a cash cow for Obamacare, and the Medicare “savings” from payment cuts are not put back into making Medicare solvent. Such massive payment cuts do impact Medicare benefits, as well as seniors’ access to those benefits.

Dissent against Obamacare by seniors, unless repeal occurs, is expected to grow dramatically. As noted by Modern Healthcare:  in December: “A bipartisan coalition of hundreds of healthcare organizations is urging the new Congress to immediately repeal an advisory board that has not yet been filled but would be charged with finding cuts to Medicare. The Independent Payment Advisory Board was created by the Affordable Care Act. During debate of the ACA, some opponents labeled the board a ‘death panel’ that would make decision about end-of-life treatment. It is actually meant to make cuts to Medicare in the case that spending growth exceeds projections.”

It is reasonable to assert that Obamacare’s failure is attributable to the imposition of government-centric solutions to a health insurance affordability problem significantly caused by government action.

Laws and regulations that prohibit competition by health care insurers across state lines guarantee monopoly practices and prices. The National Conference of State Legislatures  reports that “Insurance firms in each state are protected from interstate competition by the federal McCarran-Ferguson Act (1945), which grants states the right to regulate health plans within their borders. …The result has been a patchwork of 50 different sets of state regulations; the cost for an insurer licensed in one state to enter another state market is often high.”

The Report continues tomorrow