miércoles, 13 de noviembre de 2013

Can Obama fix Obamacare? [ TechSc1ence ]



Former President Bill Clinton made headlines when he suggested President Barack Obama “fix” the Affordable Care Act so that Americans who are losing their health care plans could keep their coverage.

But at this stage, is a fix even possible?

Yahoo News canvassed a number of healthcare and legal experts to find out how such a fix would work and if it’s feasible for the more than 3 million Americans and counting who have lost their plans to have their cancellations reversed.

Is an across-the-board fix to the cancellations even possible?

Probably not, according to multiple sources contacted by Yahoo News.

“In my view, as politically appealing as President Clinton’s suggestion is, it would be extraordinarily hard at this late date to reverse course, given all the changes that already have taken place in the insurance market,” said Jonathan Oberlander, a professor of Social Medicine and Health Policy & Management at UNC-Chapel Hill.

Another policy expert, who asked to remain anonymous, said they do not see how it would be done, because, in effect, it would cancel the insurance market reforms.

The Affordable Care Act, also known as Obamacare, depends on healthy and wealthier individuals paying premiums in order to subsidize the plans that cover the sick and the poor. Without those healthy and wealthier individuals paying for coverage they won’t use very often, the ACA can’t afford itself.

That means grandfathering in all individual policies now would essentially strip away funding necessary for Obamacare to survive.

“To now grandfather in policies sold in 2013 would destabilize the insurance risk pool, threatening the ability of the law to do what it was intended to do from the beginning — to end health status underwriting,” Timothy Jost, a professor at Washington & Lee University’s School of Law, told Yahoo News.

Jost adds that expanding the grandfather clause to policies sold in 2013 cannot be done without changing the law, “and such a change in the law would be inadvisable.”

“To help out the people the administration wants to help out, plans that have lost their grandfathered status would have to see that status restored retroactively,” Nick Bagley, an assistant professor of law at the University of Michigan, explains in a blog post. “The Supreme Court, however, has held that retroactive rulemaking is a no-no. I don’t see how HHS [Health and Human Services] gets around that precedent.”

Bagley told Yahoo News that “the politics of this are miserable. The administration will be quite reluctant to open the door to a legislative fix. A ‘fix’ from a hostile Congress could undermine healthcare reform, not improve it.”

What are the possible fixes being proposed?

President Barack Obama hasn’t explained what his plan is yet.

Friday, the House is expected to take up Republican Rep. Fred Upton’s bill that would allow insurance companies the option of continuing existing plans for one year. Democratic Sen. Mary Landrieu has sponsored a similar bill that extends the grandfather clause permanently as long as individuals pay their premiums on time.

Both bills relieve insurers of the obligation to adhere to ACA requirements, according to Bagley, meaning the insurers could reissue cancelled individual plans if they choose. But, Bagley adds, there is nothing in either bill that requires insurers to stay in the individual market.

As Oberlander put it, “If somehow President Obama could magically wave a wand and put things back as they were, there is no guarantee insurers wouldn’t cancel plans or dramatically raise rates the next year.

“Then again,” he added, “lots of unanticipated things have happened in health policy, so I wouldn’t rule anything out.”

How many people would a potential “fix” even affect?

Probably not very many.

When asked if any fix Obama considers would likely impact only those individuals who don’t qualify for government subsidies and whose premiums are higher than they can afford, White House spokesman Jay Carney responded, “It’s a fair characterization of people who are most affected by this problem.”

“It’s obviously not every individual in the individual market today, but beyond that I’m not going to get into defining the population here,” Carney said.

So many individuals who like their plans and want to keep them – like Edith Sundby, whose editorial in the Wall Street Journal gained widespread attention – will almost certainly still face cancellations.

What will Obama do next?

“The president has instructed his team to look at a range of options,” Carney said Tuesday. “We haven’t announced any potential fixes or moves we might make to address this problem.”

When pressed for a timeline, Carney said: “I don’t have a timeline for it, except the president asked for something, and when he asks for something, people tend to work on it pretty quickly.”

Obama may be forced to announce his plan by Friday if Congressional Democrats are to avoid backing the Upton bill.

Dylan Stableford and Jay Hart contributed to this story.

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