"Synthetic Repeal" of the ACA? They will try anything.
A Tweet thread about the GOP plans for health care posted by Andy Slavitt* Thursday afternoon, October 5. He talks about "synthetic repeal" of the ACA since all of the other attempts to repeal it have not passed. I did correct some of Andy's tweets for "regular" non-140 character limits, but there were a few things that I couldn't quite understand.
Who is Andy Slavitt? Info and links at the bottom.
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| From Andy's Twitter feed |
Andy writes:
"I am leaving four intense days in DC and I now have a very different theory of what's going on in Health care. I will tweet soon. Follow if interested.
3:37 PM - Thursday 5 Oct 2017
2/ The GOP is now trying to create what I call "synthetic repeal." Before I explain what that means let me tell you why this is happening.
3/ The GOP has 7 years of promises and a lot of fundraising to pay back. Moore's win in Alabama punctuates the point that the Republican base is very unhappy.
4/ The GOP needs to compete in primaries & fundraise. Make no mistake that is a 2018 reality weighing on them.
5/ Three strategic choices:
- A- Say repeal failed & move on.
- B- Promise to try again next year.
- C- "Synthetic repeal"
6/ "Synthetic repeal" allows the GOP to say, "Sure, we didn't repeal the ACA because of RINO holdouts, but before long it will be effectively done".
7/ "Synthetic repeal" goes after ALL the big Kahunas: Huge Medicaid cuts, elimination of protections for pre-existing conditions, & the ObamaCare health insurance mandates. All WITHOUT REPLACEMENTS.
8/ CBO would score the synthetic repeal an absolute disaster.
9/ The tools for Synthetic Repeal are:
- - An Executive Order coming next week
- - The budget/tax plan
- - Sabotage of the ACA (not even denied)
10/ The Executive Order will allow "association health plans"-- ability for plans to be offered with no pre-existing protections-- It will turn ACA into a high risk pool.
11/ In states that have done things like this, such as Tennessee, premiums have skyrocketed and competitors have left the market.
12/ The Executive Order next week is a massive undermining of the states, the insurance markets, and American families.
13/ Anyone will be able to create a plan that usurps state authority. And across state lines. Graham Cassidy "state's rights". 
14/ The Medicaid cuts in the tax cut bill is the other side of the nickel. Republicans will need Medicaid cuts to deal with a $1 trillion+ shortfall towards a balanced budget.
15/ From their standpoint, either vehicle could work.
One Senator said to me tonight: "The health care bill was about hidden tax cuts. Now the tax bill is about hidden health care cuts."
16/ In fact, I've heard some say the tax vehicle will be easier for Republicans because opposition won't recognize it as a health care fight.
17/ Sabotage includes the effort to drive up prices with no CSR payments, to limit enrollment, and to deny or ignore state waivers, all designed to beat the ACA by making it unworkable.
18/ Someone in a position to know (insurer thinking) told me Association plans & sabotage will leave markets bare in '19 so people have no options.
19/ Many states will have exclusionary plans for the healthy (like pre-ACA days, big MCD cuts.) Budget also allows mandate to be cut, 
premiums.
premiums.
20/ Synthetic repeal would butcher ACA beyond recognition. GOP could go back for a draconian full repeal with Yes votes coming out of necessity.
21/ The troubling part (yeah, there's a troubling part) is that this can be done with much less public recognition of it, like the boiling frog analogy.
22/ This is "Synthetic Repeal" as I see it. No one is calling it that but that's the plan as I see it.
23/ Synthetic Repeal is the most underhanded perversion of the law I can think of with little thought for how it would impact people. But it doesn't mean it will work.
24/ So response to Synthetic Repeal? I'm working on it now. I won't be alone. Right now let's #GetUSCovered. One win at a time. End.
*Andy Slavitt was the Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), a position he held from March 2015 to January 2017. How did he become one of the most vocal defenders of the ACA? Check out this article at Politico.
Thank you for this information. I know the administration has cut ACA outreach, and am concerned about delaying or eliminating subsidy payments. Can the CSR payments be stopped without congressional approval? I will have to study Association plans.
ReplyDeleteNow I re3member Association plans. For a couple of years my husband and I, both self-employed, got health insurance from our college alumni association. We were both young and healthy. He told me every year the association changed providers, and the coverage was less and cost more. They also required new applications, and someone from the school's office said that was done to eliminate sicker members. Hubby found individual policies with a regional insurance carrier, which had a high deductible and increasing premiums, but would prevent financial disaster.
ReplyDelete