Son of Trumpcare

Today's missive will seek to calm the fears of those suffering from PTSD (Post Trump Stress Disorder). Symptoms include saying things like "Trump is worse than Hitler!".

It is also recommended for those in the healthcare vertical who are not following the sausage making in the Swamp closely.

I think the Frankenstein meme is appropriate since, after all, Dr. Frankenstein was a physician (note the stethoscope around his neck, much preferable to the rope that adorns him later in the screenplay), and thus ties in nicely with healthcare.

Here's what we know now:

  • The GOP has scheduled a vote on Son of Trumpcare (SOT), and are making "highly confident" noises indicating a high probability of passage

  • SOT will then go to the Senate, where it is likely to languish. Once it is calendared it will emerge FUBARed (fundamentally unraveled beyond all recognition)

  • SOT will then be tossed like a ticking bomb back to the House where who knows what will happen (this oracle's crystal ball becomes as cloudy as an Irish sky at that point)

Here's my take on the substance:

  • SOT uses refundable tax credits in lieu of subsidies, which sounds like the difference between a check and cash. The distinction is that the credit empowers people to shop more independently for individual health plans and reduce the number who fall into Medicaid, which as it stands is something of a cruel joke due to low provider participation. The GOP will have an incentive to pressure insurers to stay in the market and put their money where their mouth is to keep the plans in the market or wear the jacket if the plan collapses. They break it, they own it.

  • SOT allows states to opt out of the scheme if they so desire, or stay in. To a certain extent, this defuses the pressure on the scheme from red states, functioning as a useful safety valve to allow blue states to stay in, or develop their own solutions.

  • For states that receive a waiver, SOT establishes and (unfortunately) underfunds high risk pools. This is a great idea in my opinion. It removes segregates the high cost covered lives from the general individual risk pool which will moderate premiums for those who remain. Pre-Obamnacare, such pools (known as CHIP) were a sound alternative for the otherwise uninsurable with costly pre-existing conditions. The problem was, of course, underfunding. The programs were barely publicized and constrained by draconian enrollment quotas. The GOP has allocated $8 billion which is woefully inadequate. The budget should be increased. The Feds are the only government entity that can print money, and it takes a printing press to fund programs like this that are fiscally non-sustainable through conventional tax and spend means.

In summary, SOT is dead on arrival in the Senate. However, in my humble opinion, it has some reasonable provisions given the political realities. The key to any eventual implementation is whether the House adopts the Senate version once it emerges from conference prior to the midterms or at the latest prior to the swearing on of the next Congress. After that, the GOP will almost certainly have a much tougher time passing anything in the House.