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Weekend Open Thread: Trump Executive Orders Dress Up Obamacare as a Witch


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I don’t know whether people truly get what Trump has done with his Executive Orders to, in effect, bring about the destruction of the public health insurance markets that Obamacare critics have long predicted, and that Obamacare designers and defenders have long tried to prevent, but it put me in mind of a particular scene from Monty Python and the Holy Grail:

If you want it to be a witch but it isn’t one, you can always make it into one!

In this scene, in case you’ve been living in a cave with a killer bunny and have never seen the movie, villagers bring to their local nobleman a woman whom they accuse of being a witch.  (Apologies to witches for referring to them below as “monsters.”  Don’t hurt me.)  One piece of evidence: she has a long carrot-shaped nose, which is in fact a carrot they have taped to her face.  She’s dressed in witch’s garments (thanks to them) and they even have testimony from one villager that she turned him into a newt.  (He explains his not appearing to be a newt with “I got better.”  Along with a faulty scale, which appears to convince even her, this suffices to justify the woman’s execution for witchcraft.

Obamacare has its flaws — caused mostly by its not being public single-payer insurance or at least containing a default “public option” plan to which patients could turn if private sector premiums got too steep — but it has steadfastly refused to turn into the sort of monster that its critics had predicted.  People have been getting their private insurance from it — their premiums being subsidized as necessary by the state, which is in turn subsidized in some cases by the federal government, so that private insurers can afford (and will be willing) to take part in the whole system — and lots of people have finally been able to do well without employer-provided insurance.

It’s not a great system, but it works, and people have come to like it and rely upon it.  In order to prove that it is indeed a monster, therefore, Trump has decided to take affirmative efforts to break it.  This comes in two parts:

  1. Allowing “association health plans” (organized through trade groups) to offer inadequate and stripped-down “lowest common-denominator” insurance that will be sold across state lines. This will skim the healthiest customers out of the system, thus increasing the strain on those plans that serve less healthy patients as well, leading the latter to have higher premiums.  Those in the stripped-down association plans, with their lousy coverage and high deductibles. will continue to be able to use mandatory provided emergency room services, the costs of which eventually fall on both private insurers and the rest of the premium-paying public, because emergency room care is the most expensive and least efficient way to provide health care and the lack of preventative care available in Obamacare plans makes the need for such services even more likely.
  2. By cutting back on promised “cost-sharing payments” to insurers, provided to make insurance more affordable, the price of premiums will now spike and insurers will elect to leave the Obamacare markets (at least in many more states.)  Thus we will go back to a situation where one either has employer-provided insurance — or none.

In other words, Trump’s orders are designed to turn Obamcare into the monster that it has thus far avoided becoming, so that he will be able to argue that it is a monster than must be slain.

I’m going to reprint much of a piece by Indivisible on the executive orders (except for the phone scripts that they suggest that people use when calling representatives, because that seems over the top for our venue.)  The link to the original piece is in the title below, if you want those scripts.

Repeal by Executive Order—Trump’s Latest Health Care Sabotage, Explained


On October 12, Trump issued an executive order designed to destabilize health care markets, and followed that up with another announcement that will lead to higher premiums and more uninsured Americans. The first order directed various agencies to expand the availability of low-quality plans that do not offer the same critical protections as other plans under the Affordable Care Act; the second fulfilled Trump’s long-running threat to cut off cost-sharing reduction (CSR) payments, which will cause the cost of coverage to spike for millions of Americans. Ask your Members of Congress to stop Trump’s sabotage of the ACA: ensure that all health plans have guaranteed protections and that CSR payments continue.

WHAT TRUMP DID THIS TIME

After months of watching the Republicans fail to pass a TrumpCare bill, Trump decided to take matters into his own hands by undermining health care markets through executive action.

His executive order, issued in the morning, directed the Departments of Treasury, Health and Human Services (HHS), and Labor to implement new regulations that will expand the availability of association health plans (AHPs) and short-term insurance plans. While this won’t have an immediate effect because the departments still need to write the regulations and hold a rulemaking process, this will drastically reduce the number of Americans enrolled in plans that are covered by the Affordable Care Act’s consumer protections. If small businesses and others take full advantage of the new rules, they could offer their employees plans that don’t cover essential health benefits and have more leeway to discriminate against people with pre-existing conditions.

This first order also directs HHS to extend the amount of time people can be enrolled in “short-term coverage,” which is intended as a stopgap for people in transition periods. Short-term coverage is not subject to the Affordable Care Act’s consumer protections, so unlike ACA plans they can have limits on coverage and are not required to cover the same suite of health benefits. The other would extend the time limit on short term plans from the current three months to a full year. By expanding the time limit on short-term plans from three months to a year, it is clear that Trump wants to siphon off healthy consumers from the ACA markets.

The result of these changes will be that more young, healthy consumers enroll in these skimpy plans, driving up the cost of more comprehensive ACA-compliant plans. This will result in ACA plans becoming more expensive, which will drive people with less serious health needs out of these plans, which will result in higher premiums—a cycle known as a “death spiral.” The end result will be two insurance markets: one for relatively healthy people that offers cheap but inadequate coverage, and one for sick people that offers prohibitively expensive coverage.

Finally, in the evening, the White House announced the administration would no longer make cost-sharing reduction (CSR) payments to insurers. CSRs are payments the government makes to insurers to help reduce out-of-pocket expenses like co-pays and deductibles. Trump has been threatening to cut off these payments to try to coerce Democrats to make concessions. The effects of this decision will hurt low- and middle-income Americans, and could result in insurers pulling out of health care markets—with no time left for others to fill those gaps.

WHAT THIS MEANS

Both of these decisions fit Trump’s ongoing efforts to sabotage our health care system at every turn.

The executive order that expands AHPs and short-term insurance won’t have any effect on its own, but agencies are expected to release new regulations by the end of the year. These regulations will still have to go through the regular rulemaking process, including a public comment period, so there is still time before this will result in any changes.

Cutting off the CSRs, on the other hand, will immediately result in higher premiums and fewer people covered. The Congressional Budget Office found that cutting off CSR payments would result in premiums spiking by 20%, 1 million fewer people having insurance, and a $194 billion increase in the deficit over the next decade. In other words: taxpayers will foot the bill for the privilege of kicking 1 million people off of their insurance, and driving up premiums drastically for those who remain.

WHAT WE CAN DO

Democrats have been negotiating with Republicans on a bipartisan “stabilization bill” that would include a guarantee that CSR payments continue. But merely guaranteeing those payments is not enough. Ask your MoCs to ensure that the bipartisan bill continues protections for people enrolled in association health plans, that short-term plans stay truly short-term, and that CSR payments continue.

This truly IS “sabotage” — politics at its most cynical and ugly — and people will indeed die as Trump shoves the system into collapse.  The good news, from his perspective, is that this will lead to social unrest, meaning more calls for repression, and in the event of a complete social breakdown Trump voters will get to demonstrate why having an arsenal of automatic weapons really IS so useful.

On the other hand, if people get wise to the scam, it could lead to a Democratic wave election that elects a Congress willing to pass a “Medicare for All” plan — perhaps even Trump’s veto.  (Trump likes excitement, and here it comes!)

This is your Weekend Open Thread.  Talk about that, or whatever else you’d like, within reasonable bounds of decency and discretion.   (“BRING OUT YOUR DEAD!”)


About Greg Diamond

Somewhat verbose worker's rights and government accountability attorney, residing in northwest Brea. General Counsel of CATER, the Coalition of Anaheim Taxpayers for Economic Responsibility, a non-partisan group of people sick of local corruption. Deposed as Northern Vice Chair of DPOC in April 2014 when his anti-corruption and pro-consumer work in Anaheim infuriated the Building Trades and Teamsters in spring 2014, who then worked with the lawless and power-mad DPOC Chair to eliminate his internal oversight. Occasionally runs for office to challenge some nasty incumbent who would otherwise run unopposed. (Someday he might pick a fight with the intent to win rather than just dent someone. You'll know it when you see it.) He got 45% of the vote against Bob Huff for State Senate in 2012 and in 2014 became the first attorney to challenge OCDA Tony Rackauckas since 2002. None of his pre-putsch writings ever spoke for the Democratic Party at the local, county, state, national, or galactic level, nor do they now. A family member co-owns a business offering campaign treasurer services to Democratic candidates and the odd independent. He is very proud of her. He doesn't directly profit from her work and it doesn't affect his coverage. (He does not always favor her clients, though she might hesitate to take one that he truly hated.) He does advise some local campaigns informally and (so far) without compensation. (If that last bit changes, he will declare the interest.)

21 Comments

  1. Ricardo Toro

    I’m going to propose to the new OCW editor a new word when referring to Greg : “sesquipedalian”. I learnt this word today, reading a comment in this article by George F. Will

    https://www.washingtonpost.com/opinions/sinister-figures-lurk-around-our-careless-president

    • Greg Diamond

      I ain’t that old yet!

  2. Tara Galvin

    Sad news. Booze and poor judgement cost anotherOC Blogger his job.

    Last time I saw Gustavo, he was Hemingway like (in a small town shithole barrio kind of way)yelling at people, expousing his MeCHA drivel.

    Put down the bottle and shut up.

    • Greg Diamond

      The story seems to have nothing to do with booze and poor judgment. The Yachting owners of the OCW apparently demanded that he cut staff expenses in half. As a critic of many at the OC Register who had done so, Gustavo apparently refused and presented an alternative plan — including reducing his own pay — which they rejected, leading to his resignation. That’s sound judgment on his part, and even a bit noble. So we’ll see how (and what) Nick Schou now does in his place.

      Gustavo is welcome to tell his side of the story here anytime — with only enough editing to keep us on the right side of the law if need be. (I hope that we won’t have to make a similar offer to Schou anytime soon.)

      • *I* would like to write something comparing him to Chris Epting, who is taking great glee in whatever happened to Gustavo. I like the comparison: Epting was fired from his column by the Times for being a psycho stalker who pissed off way too many people; Gustavo (if what I hear is true) fell on his sword for his writers.

        • Greg Diamond

          Seeing Epting writing on Lib OC warms my heart a bit. (And my esophagus.) He really does belong there — and Chumley seems so happy to have another named commenter!

        • Stanley Fiala

          Gustavo banned me too.

          Another one bites the dust
          Another one bites the dust
          And another one gone, and another one gone
          Another one bites the dust, yeah
          Hey, I’m gonna get you too
          Another one bites the dust

          • Greg Diamond

            You should go comment on HB Sledgehammer, with which Chris Epting is affiliated. I’m seriously curious as to whether they will ban you.

  3. Stanley Fiala

    I am not really interested to comment on any activist (“BLOG”)!

    However, I am searching for an answer why: A BLOG can ban me, claiming that the first amendment applies only to the government, yet if a BLOG would be banned by a private provider it would rely on the first amendment in opposition to its ban.

    Can you explain this phenomenon to me Esq. Diamond (anyone?)

    • Greg Diamond

      I’m willing to do the research for you at a discounted rate of $100/hour I’ll cap it at $500, paid in advance, including the report. Deal?

      • I was under the impression that such answer would be rendered pro-bono in the spirit of the first amendment as this blog promotes.

        Obviously, I was wrong.

        However, I believe that you have no clue since your legal education was acquired in the left-liberal-antifa madrasa.

        • Greg Diamond

          The “left-liberal-antifa madrasa”? You mean Columbia Law School? You mean the majority of the madrasa you have in mind is composed of people wanting to become corporate deal-makers and federal prosecutors? I’m surprised.

          No pro bono for you.

          • You should have it tattooed on your forehead, “I have Columbia Law School” otherwise you are missing the benefits of it, especially if you need too look-up the First Amendment based on which you are promulgating your drivel here.

          • Greg Diamond

            What I need to look up is the Supreme Court case that, I believe following on the precedent in “Heart of Atlanta Hotel” regarding public accommodation, deals with the rules regarding “common carriers.” Now that I think of it, though, hosting services, social media services, and email services ban people’s account all of the time without them having First Amendment recourse, so I think that your initial premise was itself faulty. But I’m not thinking about it too deeply until I see your cash on the barrelhead.

          • I should add that Columbus is banned by your progressive antifa so your proud “Columbia” will be renamed to Obamia Law School.

          • Greg Diamond

            Roiling the Ivy League would indeed be a treat.

          • FYI Esq. Diamond, I am only the Bitcoin payee where you have no clue what it means. You probably believe that it is some form of the bigoted ant-Semitic reimbursement to Jews. No gold no diamonds!

            There is simple answer to my question. which does not require Obamia (x Columbia) law degree. The internet gave the power to losers, alcoholics and felons to deny the unalienable, the GOD’s given, rights to the people.

            Think about it Esq. Diamond while you still have your IQ only partially damaged by the TIA.

          • Greg Diamond

            If anybody reading this really wants to continue to hear this sort of crap from Stanley, please speak up while there is still time.

  4. Tara Galvin

    You heard the wrong story. It very much has to do with nad behavior and alcohol fueled diatribes, which are often hard to recover from the next day.

    Theres always “Ask Jeeves”!

    • Greg Diamond

      If you’re referring to “Monty Python and the Holy Grail,” it is rarely “the wrong story.” Please elaborate on (or just flat-out explain) your comment. (I’ve already figured out that “nad” was supposed to be “bad.”)

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