• 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    I’ve seen a lot of chatter in the last few days on what might happen if the ACA is struck down or repealed in the future.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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    • The largest groups of beneficiaries of the ACA will be the 15 million near-poor who will get Medicaid, and the 20 million (est) who will get subsidies to buy coverage in the exchanges.

      But neither of these groups has seen a nickel yet, and polls have shown that many persons in the groups do not even know that they will benefit.

      The uninsured and poorly insured have no organization, no national leader, and no rich lobbyists. (Families USA is great, but no Congressman trembles at their disapproval.)

      This is not new. The state of Tennessee had a massive expansion of Medicaid in the 1990′s. (TennCare) I am guessing at the numbers, but at one point I think that one million residents benefitted out of a population of five million.

      And yet the program was unpopular, largely because it threatened to raise taxes. Obviously if the one million beneficiaries were a reliable voting bloc they would have kept TennCare going. Instead, the ‘likely voters’ in all states tend to have Medicare and good employer coverage. The concept of one man one vote is not really applicable in health care.

    • My blood was set boiling as I read the first two paragraphs of this post but was cooled again by the remainder of the post.

      Yes, many people love the ability to keep adult children (up to age 26) on their parent’s health insurance policy. But many of the same people assume it is “free” or the costs will be taken simply from insurance company profits. On the contrary, all of the insurance company’s policy holders will share the costs of this new benefit. Ditto for the various other popular features of the ACA.

      Aaron asks, “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?” Yes, I believe there are millions of such people.

      I’m not opposing these popular measures, I’m arguing only that we should not pretend they are free. Their cost will be borne by the insurance company policy holders and/or by U.S. tax payers. I take that as Aaron’s argument as well. We must plan for these increased costs by reducing other health care costs (unpopular) any by increasing revenue (unpopular).

      Rule one: There is no free lunch.
      Rule two: If you find a free lunch, see rule one.

    • As a small business owner, I think back to my college days where one of my Professors droned on about “messaging.”

      The messaging/marketing/awareness campaign was pathetic. They should have introduced an aggressive campaign to communicate what was coming. Billboards, PSA’s on Radio/TV, web content, etc. They did almost none of those things so as the RW talkers trashed it and took some massive liberties with the truth about the PPACA, there was a loud silence coming from the Administration.

      They fought back too late to correct the messaging and with far too little munitions.

    • “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?”

      The GAO has recently released a report on the Small Employer Health Insurance Tax Credit for 2010, and they found that few businesses actually took advantage of the credit. From the report:

      “According to employer representatives, tax preparers, and insurance brokers that GAO met with, the credit was not large enough to incentivize employers to begin offering insurance. Complex rules on FTEs and average wages also limited use. In addition, tax preparer groups GAO met with generally said the time needed to calculate the credit deterred claims.”

      It’s also well-known that the ACA high-risk pools attracted fewer participants than expected, although they also had much higher per-capita costs than projected. Again, see the GAO for the full details.

      So the answer to your (rhetorical) question is: there will probably be very little anger over the loss of these benefits, because they weren’t very valuable for most of the intended recipients.

      Link for the GAO report:
      http://www.gao.gov/products/GAO-12-549

      • That’s like saying that 99% of people won’t be upset if we raise taxes only on the top 1% of earners. People get upset even when not directly involved.