• Ice is also great, and would suffice

    I know it makes for great media to focus on repeal, or the constitutionality of the mandate, or whether attempts to defund the law will bring about a government shutdown.  But those fights are mostly theater.  This is how health care reform could die:

    The Obama administration issued far-reaching rules Monday to carry out a controversial promise that the new health-care law makes to consumers: insurers must spend at least $4 out of $5 they collect through premiums on direct medical services and other means to improve Americans’ health…

    At the same time, the regulations make a few concessions to the insurance industry. The administration has given new and small health plans extra time to meet the standards. Insurers will be allowed to deduct most of their taxes before doing the math. And states may ask for federal permission to exempt from the rules health plans sold to individuals – a relatively small but expensive and shaky part of the insurance market – if they can prove that meeting the requirements would prompt such plans to stop doing business within the state.

    I keep arguing that the focus needs to be more on the states.  This is one of the reasons why.

    Let’s review once more.  Most of the uninsured are going to be getting their insurance through the exchanges (or Medicaid).  Those are implemented at the state level.  State level insurance decisions are made by state insurance commissioners, who are appointed by governors.  Other rules may be set by state legislatures.  And many states are far more conservative than the federal government.  In fact, Republicans control 29 states after the last election.

    So an insurance commissioner who does not like the ACA could try and force HHS to remove the restrictions and regulations they don’t like – legitimately.  There will certainly be times in the future when the White House, and therefore HHS, will be controlled by parties that don’t care for reform.  And they can – according to the law itself – allow states to roll back the regulations.

    Health care reform won’t die by repeal.  It will die slowly, by a thousand cuts.  But I guess that doesn’t work for the 24-hour news cycle.

    • This is one strategy the Republicans are employing to reduce the impact of PPACA. Then again, HHS is also undermining its own reform. Almost 2 million employees are already “exempt” from PPACA. They are doing it to themselves.


    • There is nothing controversial or counterproductive happening here. These regs were just released yesterday, November 22nd. Yet they go into effect in about 5 weeks. Pricing decisions, sales plans, insurers had to make all of these decisions months ago, yet they still didn’t know with certainty what the rules of the game were. Drastic changes of this nature can’t be made overnight, so there is a very real possibility of serious market disruption, which is why they are leaving the option open of exempting some states initially.

      This is not rolling back the regulations, this is recognizing that an insurer can’t just magically cut 5-10% of overhead in a couple of months, nor can it operate at a loss.

    • I was very young when medicine was “socialized” in Canada, but I seem to recall many similar idealogical complaints against it.

      But nowadays in Canada, any politician that talks about elimintating, cutting back, or restricting the health care system (i.e. government operated “insurance”) usually finds their political career is over within about 3 of 4 seconds of making the comment.

      Once people get a feel for the benefits proivided by the new health insurance rules in the US (slim as they might be), I imagine talking about repealling or otherwise eliminating or cutting it back could become and equally risky endeavour for US politicians.

    • @Ken

      Welcome to the Welfare State.

      John Adams
      The nature of the encroachment upon American constitution is such, as to grow every day more and more encroaching. Like a cancer; it eats faster and faster every hour. The revenue creates pensioners, and the pensioners urge for more revenue. The people grow less steady, spirited and virtuous, the seekers more numerous and more corrupt, and every day increases the circles of their dependents and expectants, until virtue, integrity, public spirit, simplicity and frugality become the objects of ridicule and scorn, and vanity, luxury, foppery, selfishness, meanness, and downright venality swallow up the whole of society.