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A Shrinking Marketplace
Author: BobR    Date: 08/17/2016 13:54:38

During the primary season, I was aggravated with the news media (in particular - MSNBC) for focusing almost exclusively on the Republican Clown Car (mainly tRump), and barely covering the Democratic primary. At this point, it's all tRump -vs- Hillary, with negative news about both dominating the news cycles on all the networks (cue Don Henley's "Dirty Laundry").

I have found that we here at FourFreedomsBlog are perhaps guilty of the same thing. So in an attempt to break the cycle of abuse, I am going to veer off on a tangent today - the ACA (aka: Obamacare).

Nearly three years ago, Raine wrote an excellent piece on path dependency. The term describes how we arrive at certain situations due to limited options produced by previous decisions. Think about our dependence on gasoline: we used to travel mainly by train. However, once the highway system was built, gas-powered automobiles became preferred, and the train system disappeared, making it no longer an option. The financial power of the petrol industry grew, allowing it to pressure automobile companies to produce only gasoline vehicles. Entire industries and infrastructures grew out of that dependence, making it that much more difficult to choose a different path.

Such was the path we took to private employer-provided health insurance programs (as described in Raine's blog, linked above). I won't go into the details, and simply repeat everything already written. The two main purposes of the ACA were to reign in the insurance companies' power, and ensure everyone could be covered. The former goal was pretty well handled: no more dropped coverage, no more denied coverage, no more rate hikes after a claim, and a required minimum level of coverage. These are all welcome reforms that were long overdue. No one should go bankrupt because of a health crisis.

The latter aspect of the ACA - ensuring coverage - was the part that was not so well designed. it's a kludgey mishmash of "insurance marketplaces", medicare expansion (made optional to the states), and the "dreaded" mandate. The idea behind the mandate was sound and a pacifier to the insurance companies: if everyone has to have coverage, then healthy people will help offset the cost of the mandatory coverage of the less healthy. It made sense on paper.

However, the realities of loophole-seeking-lawyers, limited options in the marketplace, and a libertarian element in the populace who would rather pay the tax penalty and risk going without insurance has made this a nightmare for the covered and the coverers alike. Insurance companies have decided they'd rather go with a smaller market share, than take on all the previously uninsurable now getting the healthcare they've been denied. Aetna is the latest to bail out of the exchanges:
Health insurer Aetna Inc. will stop selling individual Obamacare plans next year in 11 of the 15 states where it had been participating in the program, joining other major insurers that have pulled out of the government-run markets in the face of mounting losses.

Aetna will exit markets including North Carolina, Pennsylvania and Florida, and keep selling plans on state exchanges only in Iowa, Delaware, Nebraska and Virginia, according to a statement Monday evening. In most areas it’s exiting, Aetna will offer individual coverage outside of the program’s exchanges.

[...]

Next year will be Obamacare’s fourth of providing coverage in the new markets. Aetna’s decision doesn’t affect people covered by the company this year, but when they look for coverage next year, they’ll need to pick a new insurer. The decision, which affects about 80 percent of Aetna’s customers in individual ACA exchange plans, raises the prospect that some consumers will only have one insurer to choose from when they buy 2017 coverage.

Both Republicans and (candidate) Bernie Sanders have called for scrapping the ACA. The Republicans would prefer a more Ayn Rand influenced system where you're on your own. Sanders wanted to implement a new single-payer system. The Republicans' plan is cold-blooded, and Sanders's plan is unrealistic due to the previously mentioned path dependency. We couldn't even get a "public option" in the ACA when the Dems controlled both houses of Congress.

Clinton is pushing for fixing/updating the ACA with needed changes, including a public option. That wasn't achievable before, but now that we've all seen how the ACA transitioned from idea to working program, it might be more feasible, especially if Dems can win back the Senate and House (or at least narrow the Republicans' margin there). Something needs to be put in place, though, or the health insurance marketplaces will resemble the boarded-up downtown areas of small towns after Wal-Mart moves in.
 

22 comments (Latest Comment: 08/17/2016 19:47:57 by Raine)
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Comment by Scoopster on 08/17/2016 13:40:31
Mornin' all!

A fond farewell to John McLaughlin. He was the model of a conservative thinker that you could actually talk to in a reasoned manner. It's a shame that his breed died out long before he passed.

Comment by BobR on 08/17/2016 13:55:44
BLOG IS POSTED

Comment by Raine on 08/17/2016 14:05:17
Good morning.

Thanks for writing this one, Bobber.

I have been seeing a lot of people who never really liked the ACA disgusted about this set of events with insurance companies, but as you pointed out, this makes it wasier to get a public option and a PATH towards medicare for all. I have strongly held the belief that this would happen.


Comment by Mondobubba on 08/17/2016 14:14:41
Quote by Scoopster:
Mornin' all!

A fond farewell to John McLaughlin. He was the model of a conservative thinker that you could actually talk to in a reasoned manner. It's a shame that his breed died out long before he passed.


SNL McLaughlin.

Comment by wickedpam on 08/17/2016 14:15:06
Morning

Lets hope that happens - it seems ACA was always meant to be a WIP.

Comment by Raine on 08/17/2016 14:31:56
Quote by Mondobubba:
Quote by Scoopster:
Mornin' all!

A fond farewell to John McLaughlin. He was the model of a conservative thinker that you could actually talk to in a reasoned manner. It's a shame that his breed died out long before he passed.


SNL McLaughlin.






Comment by Raine on 08/17/2016 14:33:10
Quote by wickedpam:
Morning

Lets hope that happens - it seems ACA was always meant to be a WIP.

IT always meant to be just that.



Comment by Mondobubba on 08/17/2016 14:40:24
Quote by Raine:
Quote by Mondobubba:
Quote by Scoopster:
Mornin' all!

A fond farewell to John McLaughlin. He was the model of a conservative thinker that you could actually talk to in a reasoned manner. It's a shame that his breed died out long before he passed.


SNL McLaughlin.







WRONG! It still cracks me up.

Comment by Will in Chicago on 08/17/2016 14:47:46
Good morning, bloggers!!!

I hope that we do see a public option, and will ultimately move towards single payer.

What we need to do is to help ensure that there is change in Congress. The GOP does not seem to realize that we tried laissez-faire economics in the Gilded Age -- and it only worked for a few. Or they know and they do not care.

Comment by Will in Chicago on 08/17/2016 14:54:44
Bob, one concern I have about the ACA in its current forms is the power of the insurance industry. Huffington Post has a story: Aetna CEO threatened Obamacare pullout if Feds opposed Human merger.

I am not surprised by the letter from the CEO. I hate to say it, but greed has become a religion to many in this country.

Comment by Raine on 08/17/2016 15:44:47
Quote by Will in Chicago:
Bob, one concern I have about the ACA in its current forms is the power of the insurance industry. Huffington Post has a story: Aetna CEO threatened Obamacare pullout if Feds opposed Human merger.

I am not surprised by the letter from the CEO. I hate to say it, but greed has become a religion to many in this country.
One thing that is important to acknowledge, the DOJ did not cave to Aetna.

The administration called their bluff.

I consider that a good thing.


Comment by Raine on 08/17/2016 16:17:01
With all the talk of t-Rump's 3rd wife Campaign manager, I am a little sad (and not surprised that this story is not being covered.

Donald Trump's campaign chairman helped a pro-Russian governing party in Ukraine secretly route at least $2.2 million in payments to two prominent Washington lobbying firms in 2012, and did so in a way that effectively obscured the foreign political party's efforts to influence U.S. policy.

The revelation, provided to The Associated Press by people directly knowledgeable about the effort, comes at a time when Trump has faced criticism for his friendly overtures to Russian President Vladimir Putin. It also casts new light on the business practices of campaign chairman Paul Manafort.

Under federal law, U.S. lobbyists must declare publicly if they represent foreign leaders or their political parties and provide detailed reports about their actions to the Justice Department. A violation is a felony and can result in up to five years in prison and a fine of up to $250,000.

Trump shook up his campaign organization Wednesday, putting two new longtime Republican conservative strategists as chief executive officer and campaign manager. It was unclear what impact the shakeup would have on Manafort, but he retains his title as campaign chairman.

Manafort and business associate Rick Gates, another top strategist in Trump's campaign, were working in 2012 on behalf of the political party of Ukraine's then-president, Viktor Yanukovych.

People with direct knowledge of Gates' work said that, during the period when Gates and Manafort were consultants to the Ukraine president's political party, Gates was also helping steer the advocacy work done by a pro-Yanukovych nonprofit that hired a pair of Washington lobbying firms, Podesta Group Inc. and Mercury LLC.




Comment by BobR on 08/17/2016 17:29:30
Comment by Raine on 08/17/2016 18:03:00
Meet Trumps new campaign manager.

(and try to not throw up)

Comment by Scoopster on 08/17/2016 18:08:06
Yeah ummm...

So they've gone from trying to reign in T to letting him do whatever he wants and hiring several more people who are just as outspokenly OUT OF THEIR FREAKING BRAIN to run things.

Comment by Raine on 08/17/2016 18:28:55
Quote by Scoopster:
Yeah ummm...

So they've gone from trying to reign in T to letting him do whatever he wants and hiring several more people who are just as outspokenly OUT OF THEIR FREAKING BRAIN to run things.
That is exactly what they are doing.

It gonna get even uglier from here on in.


Comment by Raine on 08/17/2016 18:32:37



This is absolutely horrible.

Comment by Mondobubba on 08/17/2016 18:54:52
Quote by Raine:



This is absolutely horrible.


That is not Florida Man. Florida Man is much weirder and less murderous. Way less murderous.

Comment by BobR on 08/17/2016 19:28:11
Comment by Mondobubba on 08/17/2016 19:39:48



There is no shame in the joy I feel about this Bobber.

Comment by Raine on 08/17/2016 19:47:57

HmmHmm, I wonder how much he paid got GOD for flood insurance.

Edited for clarification.