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On the Third Hand: Fixing PPACA

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Democrats and independents may not like everything that President Obama thinks or does, but they seem to believe that he’s trying to do the right thing.

They seem to have no confidence whatsoever that the Republican leaders in the House are making any serious effort to negotiate with Obama on matters such as addressing the federal budget deficit.

Democrats and independents seem to be convinced that the House Republican leaders would be happy to see the United States go after the fiscal cliff and crash to the bottom of the Earth, as long as they could then distribute a press release blaming the charred ruins of civilization that we were then combing through on the Democrats.

Meanwhile, only 52 percent of the House Republicans’ supporters, Republicans, seem to think the House Republicans are negotiating in good faith.

Democrats on the House Energy & Commerce health subcommittee just kind of rolled their eyes Thursday when the Republicans began talking about problems with implementing the Patient Protection and Affordable Care Act (PPACA).

One member of the subcommittee, Rep. Frank Pallone Jr., D-N.J., said he simply figured that talk about gaps in regulations are just one more strategy the Republicans are trying to use to kill PPACA, even after Congress approved it (OK: barely approved it, but barely approved it), the Supreme Court approved a key version, and the voters returned President Obama to the White House and increased the Democrats’ edge in the Senate after an election season in which debates about PPACA played a major role.

My feelings on this topic are that I have absolutely no idea whether any of PPACA will work, and that I don’t think it’s exactly meant to work for very long. I really think  that President Obama wanted a pass a bill that would provide protection for sick people and poor people — people who have no real ability to pay for coverage or care themselves or influence the policy debates — while the rest of us have at it.

The whole idea of PPACA is to get the windows, orphans and invalids into a nice safe policy shelter while the health insurers, the brokers, the hospitals, the doctors, the employers, rich people and upper middle-income people go after one another with machetes.

The Republicans, on the other hand, seem as if they would eat their own first-born children if they could some use that launch a media campaign calling Obama a Kenyan Manchurian candidate space alien zombie Pakistan station chief who, aside from not being the son of his father, is not actually the son of his mother.

The problem is that, because the House Republican leaders have gone to such great lengths to show that their main policy goal is to humiliate Obama and other Democrats, it’s hard for them to get any attention when they or their witnesses are pointing out that, um, PPACA has some problems. Even if the whole point of PPACA is just to keep the widows, orphans and invalids safe, it’s still a big, huge bill with gaping regulatory holes, and a lot of it is supposed to take effect Oct. 1, 2013.

Which, to me, seems to be totally impossible.

The state officials that the Republicans brought in to that hearing Thursday seemed to have important observations to make about, for example, why it seems pretty absurd to try to cut information about applicant assets out of Medicaid eligibility determinations.

How could we fix that problem?

Not sure if it’s possible. But, if the House Republicans actually wanted to minimize chaos, not maximize chaos and blame it on the Democrats, here’s a modest proposal:

- Let the Republican governors in states that will set up exchanges take the lead. They’re plenty conservative, but they’ve taken a political risk and agreed to help implement PPACA, not just bash it, so, assuming the Democrats actually want to minimize chaos, they should be willing to take these particular Republicans seriously. Couldn’t they come up with a PPACA implementation relief bill that a wide range of members of Congress could support?

- Make sure that U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius has the statutory authority to postpone or modify PPACA provisions that are producing truly absurd results. If Sebelius think something in PPACA is absurd, and the Democrats are willing to take her word for it, why would Republicans who were sincerely interested in minimizing chaos make her stick with that absurd provision?

- Work with actuaries, insurers, etc. to develop a temporary, “mini PPACA” that provides as much protection for poor people and sick people as quickly and simply possible. Maybe, for example, that version could impose the guaranteed-issue rules and the federal premium subsidy rules, and provide emergency risk protection for health insurers, Jan. 1, 2014, and we could wait until Jan. 1, 2015, to set up the exchange system.

On the one hand: The idea of House Republicans compromising seems pretty absurd, so,  of course, this blog entry may be just a way for me to let off steam.

On the other hand: The House Republicans could compromise. You never know.

On the third hand: Some of the House Democrats are pretty far out there, too. They just haven’t had a chance to throw their weight around for a couple of years. Guess we’ll just have to make sure we have plenty of bottled water, canned food and flashlight batteries stockpiled in advance of Oct. 1, 2013, the day Superstorm Ppacka is set to hit.

See also:

On the Third Hand: Clawblind

On the Third Hand: HRAs

On the Third Hand: Teamwork


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