Saturday, June 24, 2017

Gaming Out the Politics of Trump Care

I don't mean whether two Senators will defect and allow it to pass, or three will defect and defeat it, whether all the objections now are real or just for show.  I mean the electoral politics assuming it does pass.

This is a matter of timelines of elections and effects of the new legislation.

The electoral time table is clear enough.  There is a Congressional election coming up next year.  All House seats are up for election.  Because of a combination of gerrymandering and natural concentration of Democrats in a small geographic area, the outline of House seats innately favors the Republicans and it will take something strong to overcome that.  Of the 33 Senators up for election, 25 are Democrats, including some in vulnerable states, and only eight are Republicans, most of them in safe states.  That means that in the normal course of things Democrats would lose seats, it would take something fairly strong for them to hold their own, and something even stronger to take control of the Senate.  It also means that even in the highly unlikely event of Democrats winning every seat up for election, they would control only 56 seats in the Senate -- not enough to overcome a Republican filibuster, let alone override a Presidential veto or remove Trump from office.

Here is my understanding of the time table for the Senate bill.

Its changes in subsidies, changes in regulations, and repeal of the individual mandate will take effect next year.  The effects, however, will be felt at different times.

The change in subsidies will be felt immediately next year.  The maximum income for receiving a subsidy will go from 400% of the federal poverty line to 350%.  I don't know how many people are in the gap and will lose their subsidies, but presumably we will hear from them, a lot.  Also, under current guidelines older consumers who receive a subsidy cannot be required to pay more than 9.5% of their income for health insurance.  That amount will go up to 16.2%.  We should be hearing a lot from people who experience that as well.  All of this will take place in 2018 -- Congressional election year.

Regulatory changes allow insurance companies to charge older customers five times as much as younger customers instead of three times as much.  They will also allow states to allow insurance companies to opt out of offering the essential health benefits required by Obamacare and and to allow states to allow a return of lifetime payments caps.  As our side frequently points out (1) allowing insurance companies to limit the benefits they offer can allow them to offer cheaper, skimpier plans to healthy customers -- but also to charge prohibitive rates for essential care to sicker customers, (2) there will be strong financial pressure on states to allow insurance companies  to opt out.

Presumably these regulatory changes, though on the books next year, will not actually come into effect until 2019.  The reason for this is that companies have already prepared and submitted their plans for next year under the old regulations.  So, these changes will not be in effect at the time of the 2018 election.  But news of premium hikes for seniors will be starting to hit the news shortly before the elections (just as rate hikes hit the news shortly before the 2016 election).  Of course, younger customers will get lower rates.  But remember, you always hear more from losers than winners.  And losers (older consumers) are disproportionately Republican.

I have no idea how many states will opt out of the Obamacare regulations, but presumably the deep red states eager to do anything to spite Obama will do so.  In those states people with pre-existing conditions will see immense spikes in insurance that covers essential medical care.  Healthy people will have access to cheaper and skimpier plans.  Again, we will hear more from losers than winners.  Again, this will start to break just before the election (and continue to crescendo afterward).

People will not start having their insurance payments cut off when they reach lifetime limits until after the 2018 election.  Over time, the same phenomenon will spread to more and more state.

The individual mandate will end.  This will please people who don't think the expense of health insurance is worth paying although, again, keep in mind that you hear more from losers than winners. Over time, this will induce the death spiral that Republicans have been seeking from the start, but this sort of thing will take time.

Rollback of the Medicaid expansion begins after 2020, i.e., after the next Presidential election.  So people will not actually be kicked off Medicaid until after the 2020 election -- or will they? Apparently the states of Arkansas, Illinois, Indiana, Michigan, New Hampshire, New Mexico and Washington accepted the Medicaid expansion on the condition that it would be rolled back if the federal government cut funding.  So those seven states will see people kicked of Medicaid before the 2020 election.

Presumably the threat of cuts to Medicaid and people being kicked off will be a major issue in the 2020 election.  Presumably also, even if Democrats win the triple crown, it will be too late to stop the rollback at least for that year -- and Republicans will attack Democrats for letting it happen.

All in all, I would be inclined to think that this would hurt Republicans at the ballot box in the next two elections.  Or will it?  Maybe Republican voters who aren't hurt by these changes will be just thrilled to see all that insurance taken away from the undeserving and eagerly vote Republican again. Maybe even ones who are hurt will consider loss of health insurance an acceptable sacrifice for pissing off liberals and will vote for people who passed this outrage rather than admit they made a mistake.

The four special elections, all won by Republicans, make me think that this just might be so.

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