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My ACA replacer

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I have a hard time covering efforts to change, repeal or defend “Obamacare,” and/or the Affordable Care Act, because most of the proposals I’ve noticed seem way too vague and unserious to be of any interest to people who sell, administer or develop health insurance for a living. 

Related: ACA change rules

ACA defenders continue, for the most part, to haul out people with sad or glorious stories, without showing any sign that they’ve visited an ACA public exchange contact center or tried to estimate how much the ACA as a whole affects per-enrollee administrative costs.

It’s possible that now, during the fourth ACA open enrollment period for individual major medical coverage, the ACA system lowers some kinds of administrative costs for some groups of enrollees. But I don’t see any evidence that anyone involved with national ACA program administration or defending the ACA has tried to collect or calculate figures like those.

ACA critics, meanwhile, are slightly more likely to try to tell me how much the ACA costs. But they tend not to go into much detail about what they would do differently. Even when they do, they tend to avoid talking much about what happens to people with Type 1 diabetes or hemophilia.

Possibly because those critics hate the ACA system so much, they are even less likely than the defenders to tell me anything about how the system is working now.

This is partly because the Obama administration seems to have thrown a bunch of English majors into an office building, told them they will go to prison over conflicts of interest if they talk in detail with anyone who understands health insurance, and then directed them to develop a web-based supermarket for health insurance.

The Obama administration also seems to have done more to protect any information about ACA programs from leaking out to Congress or the public than it did to keep the contents of the email inboxes of our political leaders from flowing to Moscow.

We now know a great deal more about Hillary Clinton’s old email addresses than we do about enrollment in the Small Business Health Options Program health plans sold through

The result is that Republicans in Congress are in the process of trying to replace “Obamacare” without having the slightest idea of what’s actually there.

Here’s a proposal for an ACA replacement plan:

      • Increase the odds of success by using a narrow definition of “Obamacare.” Apply that term only to provisions in the ACA that directly involve commercial health insurance. Leave anything to do mainly with Medicaid, Medicare or tanning salons for another day. Especially given that there’s no sign anyone in the public, Congress or the Executive Branch knows that the ACA includes anything but the commercial health insurance programs and, possibly, Medicaid expansion, anyway.

      • Kill all of Obamacare and replace it with a separate law consisting only of the parts stricken from the ACA that deal with Obamacare (as opposed to tanning salons.) Call the new, stand-alone Obamacare program Trumpcare. Set all that stuff to die in three years.

      • Have a long talk with Arnold Schwarzenegger, who, after all, has been governor of California, and have him create a season of “The New Celebrity Apprentice” that will focus on Trumpcare reform.

      • Have contestants with serious business and health policy training find out what the heck is in Trumpcare and report back, so we all know what’s in there, and go work with some organization that has run an actual successful insurance exchange program to make Trumpcare more like an insurance exchange program that worked.

      • Create several Trumpcare redesign proposals, let the American people choose the winner through a 900 number that helps reduce the federal budget deficit, then run the redesigned Trumpcare for two years.

Then, at the end of two years, come back and decide whether to kill the new, transparent, redesigned Trumpcare or let it live. 


Review and revision are key to ACA reform

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