Health Care Reform: Of Zombies and Absurdities

Republicans across the country are clamoring to “repeal and replace” one of President Barack Obama’s signature legislative accomplishments: the Patient Protection and Affordable Care Act. Besides the nifty alliteration, is there any substance to this promise? Can Republicans, even if they were to take control of both chambers of Congress fulfill this pledge? No.

Any bill seeking to repeal health care reform would be vetoed by President Obama. Overriding his veto would take a two-thirds majority in both the House and the Senate. Given that it’s hard to get a majority of either chamber to agree that the sun rises in the east (let alone that it sets in the west), this isn’t very likely. And as more provisions of the legislation are implemented, repealing the law becomes increasingly awkward. How many elected officials would vote to repeal the requirement that children up to age 26 may remain on their parent’s health insurance policy now that so many families have taken advantage of this part of reform? Repealing the PPACA would result in kids being subjected to pre-existing conditions again, tax credits vaporizing, coverage for those rejected by private carriers ending, and on and on. That’s a high political price for politicians to contemplate.

But there are other tactics available to a Congress (or even one chamber of Congress) opposed to President Obama’s health care reform plan. Henry Aaron, a Senior Fellow at the Brookings Institute, in an article published in the New England Journal of Medicine describes how Republicans could use Congress’ power over the federal government’s purse strings to eviscerate the health care reform legislation. The result would be what Mr. Aaron calls “zombie legislation, a program that lives on but works badly … lead(ing) to needless resentment and confusion, and mandates that are capriciously enforced.”

Mr. Aaron notes that the PPACA contains “64 specific authorizations to spend up to $105.6 billion and 51 general authorizations to spend ‘such sums as are necessary’ over the period between 2010 and 2019.” However, Congress must specifically appropriate these funds before they can be spent. A Republicans majority in either the House or the Senate (or even a Republican minority working in concert with like-minded Democrats) could withhold much of this funding. But they can do more. “They could bar the use of staff time for designing rules for implementation or for paying subsidies to support the purchase of insurance. They could even bar the DHHS from writing or issuing regulations or engaging in any other federal activity related to the creation of health insurance exchanges ….” Mr. Aaron writes.

Imagine the impact of such prohibitions on what is already a difficult law to implement (and to be fair, even the far less extensive proposals put forward by Republicans in the past couple of years would be harrowingly difficult to implement – we’re dealing with one-sixth of the nation’s economy here). The impact of zombie legislation would be in addition to the absurdity that already surrounds implementation of the PPACA, such as that involving enforcement of the health care reform law’s medical loss ratio provisions, scheduled to take effect January 1, 2011.

So we have Secretary Sebelius, one of health care reform’s staunchest advocates, coming to the aid of limited benefit plans that she would be expected to condemn as “phantom coverage” while forcing carriers offering more substantive plans to grope through fog of uncertainty – resulting in great inconvenience and possible expense to employers, insureds, brokers and the industry at large. There’s a certain Alice in Wonderland feel about the whole thing. Throw in the havoc Republicans are likely to cause as they strive to use health care reform as a stepping stone to the White House and Tim Burton will be feeling right at home.

Mr. Aaron, in his New England Journal of Medicine article sums up the situation. Concerning the zombie legislation that health care reform could become, he writes “Such an outcome would trouble ACA opponents: their goal is repeal. It would trouble ACA supporters: they want the law to work. But it should terrify everyone. The strategy of consciously undermining a law that has been enacted by Congress and signed by the president might conceivably be politically fruitful in the short term, but as a style of government it is a recipe for a dysfunctional and failed republic.”

What’s terrifying about this zombie tale is that serious problems still need to be addressed concerning America’s health care system. Although “Affordable Care” is part of the new health care reform’s official title, as I’ve noted frequently in the past, the health care reform legislation fails to address the underlying driver of skyrocketing health insurance premiums – the skyrocketing cost of medical care.

And some of the health care reforms Republicans are likely to push in the new Congress would only drive up insurance premiums without addressing medical spending (most dramatically, the GOP’s desire to require carriers to accept all applicants without imposing pre-existing condition exclusions, but eliminating the mandate that all Americans obtain health insurance coverage).

Given this situation, pessimism is a natural response. This results from the tendency to see current trends as continuing in a straight line. Fortunately, nature abhors straight lines nearly as much as it hates a vacuum. America has a history of overcoming the foolishness we, through our duly elected leaders, seem to bring down upon our ourselves. We’ll see a lot more absurdity in the months ahead concerning health care reform. We’ll see political battles that will be stunning in their demagoguery and mauling of the truth. We’ll see generally bad ideas emerge with awesome and frightening frequency. But we’ll also see the equal-and-opposite reaction these dynamics generate. And, I predict, we’ll see some meaningful and sensible changes made to the PPACA. As I’ve written before, in the end things will likely be worse than we hoped, but not as bad as we feared they would be.

6 thoughts on “Health Care Reform: Of Zombies and Absurdities

  1. Alan, great article, thank you.

    Wouldn’t it be amazing if someone running for office would speak the truth? Republicans seeking power by telling voters they will repeal PPACA when they know very well it’s not possible, is just as bad as the Democrats cramming the legislation down our throats knowing well that it is just a tool to drive us into a single payer system. All of it is a sick lie. None of it really addresses the supposed goal of “Affordable Care.” Remember back in 2009 the discussion was all about “Bending the Curve, to Address Long-Term Health Care Spending Growth?” You are right, we seemed to have curved off that road and ended up in Alice in Wonderland.

    The underlying problem with healthcare cost-control is that patients seldom have any “skin in the game.” As long as it’s not the patient’s money being spent, we will continue going down the road to full government control. In the end I see only two choices for affordable care, single payer where the government controls us or consumer driven where we citizens decide.

    Since I’m not happy with the government controlling my life, I’m advocating for a different solution. There is a new business model which puts the consumer in control of their health insurance decisions and will work very well within PPACA. Jason Shafrin of The Healthcare Economist has a good discussion on this system at http://healthcare-economist.com/2010/09/15/health-insurance-for-part-time-workers/ , Or, http://www.youtube.com/watch?v=NzDNYD7f54c&feature=related

    thanks again.

    .

  2. Well Alan you certainly got the title right: Zombies and Absurdities – because here’s the real absurdity: The legislators here in CA wouldn’t give a darn IF a Republican controlled Congress was able to turn the Affordable Care Act into a walking zombie. They would simply fund the Exchange themselves with MORE CA taxpayer money and push this state further towards the abyss. Actually we are in the abyss Alan – but the fools in Sacramento are hellbent to push it still deeper into the abyss.
    I understand California has already hired the guy who crafted the Mass Exchange and as far as I’m concerned; the train has left the station here in CA – if there was suddenly nothing coming out of the Federal ‘tap’ the folks in Sacramento would appropriate funds we don’t have from somewhere else and redirect it towards the furthering of the Exchange.

    If memory serves, MA certainly didn’t need federal funds to get their ‘connector’ going and as such, fed $$$ or not, the guys in Sacramento are going to get what they want: An incredibly anti insurance industry Exchange.

    Alan, every once and while you post something like this that offers a glimmer of hope but after the initial “high” has worn off I start putting the pieces together and the results are always the same: Despite all logic this state will continue to drive itself of a Big Sur-size cliff every day of the week thanks to the folks in Sacramento. As a character said in a movie I just saw called ‘Ride with the Devil’: “It Ain’t Right and It Ain’t Wrong. It Just Is”

    Man, THAT says it all about our state legislators.

  3. Plan B for the Rs after they try to repeal (and before they get to budgetary strategy would be to allow what’s already been done (D26, first dollar for preventive, no pre-existing for under 19 etc. and to get rid of whatever has not happened yet. That still invites a veto but reduces political reaction against the Rs. Of course that may depend on the courts (given the plus for the anti’s in VA and the minus in MN.

  4. Alan,

    You said, “Any bill seeking to repeal health care reform would be vetoed by President Obama. Overriding his veto would take a two-thirds majority in both the House and the Senate. Given that it’s hard to get a majority of either chamber to agree that the sun rises in the east (let alone that it sets in the west), this isn’t very likely.”

    I agree, though it irritates me no end that the Democrat Controlled Congress, against the wishes of the majority of the electorate, passed this abortion of a HCR bill, guaranteeing that they could get their names in lights, and not a single one of them has mentioned this historical fact in their campaigns for reelection. Why is that?

    “And as more provisions of the legislation are implemented, repealing the law becomes increasingly awkward. How many elected officials would vote to repeal the requirement that children up to age 26 may remain on their parent’s health insurance policy now that so many families have taken advantage of this part of reform? Repealing the PPACA would result in kids being subjected to pre-existing conditions again, tax credits vaporizing, coverage for those rejected by private carriers ending, and on and on. That’s a high political price for politicians to contemplate.”

    The companies are already dealing with this, by refusing to insure children, period. What protections are there, short of the mandates that the public carry coverage (which is farcical), for the companies against a heavily slanted risk pool favoring children who have congenital defects making the US a “Magnet Country” for all kinds of born high risk children? What protections are there to make certain that the companies won’t end up going deeply into the RED in accepting this kind of risk (No risk to the parents or children, only to the companies…I.e., not Insurance, but an Entitlement, for which we all pay?

    Secretary Sebelius acts as though she is a Socialist Dictator who threatens those who are under her regulatory power. She is also Barack Obama’s “tool”, doing his bidding. She is also, per Obama’s dictates, trying to find reasons to waive the regulations for over 50 Companies who now carry “Mini-Meds” for their employees so that the Democrats won’t need to “fuss” with that mess, and over a Million uninsured employees, one month before the mid-term elections. What are we to make of that? That the law is only the law when Obama says it is, and is not to be applied equally, without discrimination?

    And you said, “And some of the health care reforms Republicans are likely to push in the new Congress would only drive up insurance premiums without addressing medical spending (most dramatically, the GOP’s desire to require carriers to accept all applicants without imposing pre-existing condition exclusions, but eliminating the mandate that all Americans obtain health insurance coverage).”

    We will have to agree to disagree. Whatever reforms, amendments, or other means of “correcting” this ill thought out, poorly researched and “Jammed down the electorate’s throat” with nary a thought to a government doing what it wishes with not a thought to representation of its constituents, that may be proposed, the cost of premiums are going up, dramatically, with the Democrats in charge. We haven’t, and won’t save, we are in a deep ditch that is growing deeper day by day. “$500 Billion for Medicare; $16Billion from Small-business; Countless Billions from those companies being given Waivers so that they do not have to follow the law, ad-nausea. And that’s only what we currently know, forget about the next four years.

    Added to this miasma; countless Agents and Brokers put out of business by the CA Exchanges law, bound to work itself to many other states. Other countless Agents and Brokers put out of business because they are over 50, have long established books of business which they have endeavored for decades to service with care and feeling for their clients, now too old to start over or “adapt” to a new system that is making the role of the Professional Insurance Agent akin to the role of an “Information Jockey” sitting at an “Information Desk” of an Exchange. How are these genuine good people, who have worked hard all of their lives to create strong clientele, who have strong assurance and respect for their Agents and Brokers, to survive in this “Not so Brave New World” created by Obama & Company? My answer: They won’t survive, and will join the multi-millions of unemployeds, left to fend for themselves, by an uncaring and thoughtless Democrat Administration and Congress who have put their own self-aggrandizing priorities ahead of the best interests of the country. 85% of a very well insured public are now at great risk, just so that Obama & Company could say to the country that they have now provided insurance to the other 15% of the country, half of whom CHOSE to go without insurance, only they are so ashamed of the damage they have wrought to the country as a whole they refuse to bring it up in their campaign ads, period.

    Alan, the Obama Administration and the Democrat Controlled Congress have demonstrated a frighteningly great lack of a courage of their convictions, and are leaving the Agent/Broker Community, and the Electorate at large, to pick up the pieces of our politicians’ massive egos.

    We don’t really know what a slight change in political balance may be brought about should the Republicans gain a House, but we do know what the Democrats in political power have done to this country, our colleagues, and our clients.

    • Alan and Spencer —

      Very salient points. As an insurance agent, I find that this new environment challenges my very core. I have to keep reminding myself to let go of the resentment I have for the short-sighted politicians and deal makers and the feeling that in trying to adapt for professional survival, I am being taken advantage of by the system.

      By keeping the public informed about what is really going on, I am finding allies one by one. By trying to find whatever positive I can in our new situation, I am finding hope that the value agents and brokers bring will be utilized for everyone’s benefit.

      Cautiously — Onward!

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