• Getting rid of nice things makes people unhappy

    I’ve seen a lot of chatter in the last few days on what might happen if the ACA is struck down or repealed in the future. Make no mistake about it. A lot of things about the bill are going to be missed. How angry do you think seniors will be when the donut hole reopens? How angry do you think families will be when young adults are suddenly kicked off family plans? How angry do you think parents will be when lifetime and annual limits suddenly reappear in their sick children’s plans? How angry will small business owners be if tax credits for employer purchased plans disappear? How angry will those in the high risk pools be when their insurance disappears? How angry will states be when their implementation grants go away? How angry will researchers be when PCORI money instantly vanishes?

    And that’s just the stuff that’s already going on. How angry will everyone who is currently uninsured and counting down the days until 2014 be? No more “not being denied if you have a pre-existing condition”. No more “not being gouged if you have a pre-existing condition”.

    I’m somewhat amused by reports that lawmakers might try and keep some of the “popular” pieces such as these in place. Will they keep the donut hole closed? That will be a massive expenditure. Ditto for the grants, infrastructure funding, and tax credits. With no “unpopular” offsets, it’s just deficit spending.

    And as to the “not being denied if you have a pre-existing condition”, are there really people out there who don’t understand that you can’t have that without some measure (like the mandate) preventing adverse selection?

    The reason there are unpopular parts of the law is because it was trying to be accountable. It’s easy to pass popular laws that give people things. Those laws cost money, though. What’s hard is trying to balance the popular things with less-fun measures that pay for the good stuff or regulate things so that the nice things for some people don’t affect others too badly. The mandate was for the insurance companies, after all.

    It’s easy, and fun, to serve only dessert. But it’s not healthy, and it’s not responsible.

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