It’s a day later and I have a number of running thoughts:
1) I can’t believe how many times I’ve been asked, “what changed with the bill” with respect to the mandate. Um… nothing? With the exception of the medicaid expansion becoming optional, do people not understand that what the Supreme court did was decide NOT to make a change? They don’t write laws. The ACA does today what it did last week. Everything else is the same.
2) On that note, I’m disappointed, but not surprised, to see that opposition to the bill wasn’t in the end about “freedom”. I challenged many of you in the long, long ago to voice your support for an ACA with a “tax” instead of a “mandate” if the tyranny offended you so. And now that it’s happened, I’m getting a lot of email and such angry about the “tax”. Nothing changed. The law reads just as it did yesterday. This “tax” isn’t new. I understand the political spin of calling the law a “tax increase” now, but we’re not going to engage that here.
3) While I’m concerned about the potential new Medicaid problems, I lump them in with the many issues I still think need resolving. There are exchanges to set up. There are ACOs to regulate. Lots of work to be done. Unfortunately, I bet we’ll still just keep talking about repeal/not repeal instead.
I’ll add more as they come to me.