Fifty shades of Obamacare…whoopee😂

CMS of­fi­cials have told some states that waivers could be ap­proved quickly and seem open to some of the pro­posed changes, peo­ple close to the dis­cus-sions said. A spokes­woman for the agency pointed to a March let­ter that Health and Hu­man Ser­vices Sec­re­tary Tom Price sent states en­cour­ag­ing them to look at the process. The Trump ad­min­is­tra­tion has al­ready ap­proved a waiver for Alaska, which cre­ated a rein­sur­ance pro­gram to limit in­sur­ers’ claims costs. WSJ 8-25-17

What the heck are they talking about?

Well, the article talks about a mishmash of changes to Obamacare being sought by a number of states, the likely result being scores of different approaches to health care coverage driven more by politics and solving nothing.

Some of these approaches would set up high risk pools to limit losses for insurance companies (while passing these as costs to the states taxpayers). Others would change subsidies of various types thereby shifting costs to patients.

It’s a big, stupid game of moving costs around to give the appearance of fixing Obamacare and the insurance markets. Sooner or later it will all collapse under the weight of rising health care costs.


  1. To reconfirm, any/every state has the ability to pursue innovation waivers – as specifically authorized by the Patient Protection and Affordable Care Act of 2010:
    o Section 1332, State Innovation Waivers, allows states to pursue alternative/innovative strategies so long as they meet certain requirements. The basic requirement is that the plan must cover as many individuals as under health reform’s mandates, and must qualify under health reform’s requirements. My suggestion above meets those requirements because every legal resident of a state is covered, the preventive coverage (plus routine medical expenses with respect to clinical trials) is sufficient to qualify as Minimum Essential Coverage, and the resulting draw on the federal treasury from this innovation is deficit neutral. If approved, the waivers could have taken effect as early as January 1, 2017.
    o Section 1115 of the Social Security Act gives the Secretary of HHS authority to waive certain provisions, including certain Medicaid requirements, and allow a state to use federal Medicaid funds in ways that are not otherwise allowed under federal rules. This includes testing and implementing new enrollment and coverage approaches that do not meet federal program rules.
    The ACA created new Section 1115A requirements. And, monies are available to coordinate innovations pursuant to 1115 and 1332.

    It is not too late to innovate. Better that than the crap offered by Republicans and better that the initial design for PPACA. Think Medicare Modernization Act of 2003. The better coverage option today is not the initial design, with its donut hole – but the various Medicare Advantage options offered in most states.


  2. Actually, these are the same rules that Vermont was expected to use to create its single payer system – an experiment encouraged by Bernie where the fully Democratic state government first priced then rejected the option as not financial feasible – actually, they decided it would be a fiscal disaster for the state.

    Tom Price is encouraging states to create different models, to experiment, to become a “laboratory of democracy”. Back 100 years ago, the concept of federalism actually meant something – before the court extended the 14th Amendment (1868) so many different ways as to emasculate the 10th Amendment.

    As confirmed by U.S. Supreme Court Justice Louis Brandeis in New State Ice Co. v. Liebmann, a “state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.”. Supposedly, within the federal framework of the United States Constitution, as confirmed by the tenth Amendment, (“all powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people”), states are free to create and test policies and initiatives using the scientific method without affecting the other 49 states.

    Think MA Health Reform in 2006, which became illegal after PPACA 2010 (unless the state asked for and the federal government offered a waiver – extensive waivers were not available under PPACA until 2017 without new legislative action – that is, the Democrats did not really believe (and still don’t believe) in laboratories of democracy. Actually, I am not sure the Republicans believe in it either, if they ever did.

    So, I had suggested such an alternative for a governor of a state to use in his bid to be president of the United States in 2016. He could have proposed and had it implemented effective January 1, 2017. However, as much as he fashions himself a health care expert, lecturing all of us on what health care should be, he was not interested.

    Here is my waiver candidate. While simple, it is also straightforward. Society (the state) insures that which is not within the financial capability of individuals or employers – catastrophic losses, perhaps $25,000 a year per individual. Society (the state) provides for mandated preventive services under PPACA. Everyone is covered. So, it meets the PPACA requirement that coverage be equal to or greater than that which PPACA achieves (in terms of the number of individuals covered).

    Then, individuals buy coverage (through their employer or from a marketplace (where the marketplace is now free of catastrophic loss potential)) to fill the gap between preventive services and catastrophic expense. Insurers, free from the potential of catastrophic loss, sell coverage freely in the individual market and probably at lower levels of expense. The subsidies for the individual marketplace decline significantly, because the state spent its money in paying for catastrophic and preventive coverage. But, employers see their coverage costs decline (while the taxpayers shoulder the cost of catastrophic and preventive services) – prompting increases in employment and perhaps even wages in that state (indirectly reducing the number of uninsured)..

    Try it, experiment, become a laboratory of democracy. My state ignored my suggestion. How about your state?

    Finally, Price is going about it all wrong. He should put together a proposal that he will approve as a waiver, and make it known and available – and see if he gets some takers.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s