By Mario Loyola
Thursday, December 17, 2015
Since it fell into GOP hands, the House of
Representatives has voted more than 50 times to repeal Obamacare, in whole or
in part. The exercise was worthwhile, because political theater is sometimes
worthwhile. But with the Senate in the way, and a presidential veto as certain
as night follows day, there was never much hope that a “frontal assault” on the
fortress walls would succeed.
As Senator Marco Rubio has shown, a careful study of how
Obamacare works suggests a much better strategy: Besiege the program until it
surrenders. Establish a cordon around Obamacare so that it can’t expand, cut it
off from its main sources of support, and use sappers to undermine the
defenses.
Obamacare has the same congenital weakness as every other
law that seeks to “guarantee” issuance of health insurance to all who apply for
it: It starts by imposing huge losses on insurance companies that are
absolutely vital for the law to function properly. Any program of guaranteed
issuance must therefore find a way to subsidize the participation of insurance
companies, or they will exit the market altogether. Once insurance companies
exit the market, the jig is up, and there is no choice but to repeal the law.
That’s precisely what happened at the state level in the
1990s, after the failure of the Clintons’ health-reform effort. Some eight
states adopted guaranteed-issue reforms for the “individual market” (the 10 percent
or so of health insurance not purchased through employers and hence not
federally regulated). Almost immediately, those laws produced what health-care
analysts call “adverse-selection death spirals”: Increasing numbers of healthy
people chose to wait until they were sick to get health insurance. Despite
provisions that allowed insurers to exclude those with pre-existing conditions,
the per-unit costs of health insurance rose dramatically, driving premiums
sky-high, thus driving still more healthy people off the insurance rolls.
Health insurers quickly exited the market.
That’s why most of the states legislatures that adopted
individual market reforms in the 1990s voted overwhelmingly to repeal them just
a few years later. That is not likely to happen with Obamacare, for only one
reason: While the law imposes major losses on insurance companies at almost
every step, it puts the federal government (meaning taxpayers) on the hook for
compensating those losses.
Obamacare wouldn’t have passed without the support of
insurance companies, and it can’t exist without their support. They supported
it to start with only because of the tens and eventually hundreds of billions
they were offered in bribes. But virtually every element of Obamacare was
guaranteed to cost much more than the law’s original cost projections. The
insurance companies therefore now face much greater losses than Obamacare
advocates claimed. If the federal subsidies aren’t enough to make up for those
losses, insurers who previously supported the law will exit the market — and if
that happens, legislators who previously voted for the law will vote against
it, as happened in the states in the 1990s.
That’s why Senator Marco Rubio’s strategy of targeting
“risk corridors” is so important. It was in a November 2013 Wall Street Journal op-ed that Rubio
first revealed the potential problem with risk corridors to the broader public,
warning that the Obama administration might try to pull a fast one on American
taxpayers, through a backroom bailout.
The idea of risk corridors is that insurers in the
individual and small-group market are protected from excessive losses by
cross-subsidies from those insurers who are deemed to be making “excessive
profits.” Because Obamacare plans were not that attractive to the young and
healthy, the risk corridors were bound to operate at a loss. If the federal
government couldn’t backstop the losses through increased bailouts, the
insurance companies would exit that part of the market.
In response to Rubio’s warnings of a potential backroom
bailout, the Obama administration pledged that risk corridors would be
implemented in a “budget neutral” manner, meaning they wouldn’t add a dime in
net federal spending. In December 2014, Congress inserted a simple provision
into an omnibus spending bill that essentially codified that promise. Democrats
voted for it, and the president signed it.
Now, according to Brian Blase of the Mercatus Center, it
turns out that the insurers selling Obamacare plans indeed incurred significant
losses, on the order of $4 billion in 2014, and are on track to produce similar
losses again this year. Losing insurers were hoping for $2.9 billion in
compensation under the law, but their profitable competitors could pay in only
about $362 million. The expected profits never materialized. Without a (now
illegal) federal subsidy, insurance companies were forced to accept significant
losses. The omnibus spending bill currently before Congress continues the
prohibition on a backroom bailout for risk corridors, and the president will
have to sign that, too.
Meanwhile, yet another major subsidy in Obamacare (a
“re-insurance” mechanism meant to protect insurers from the medical costs of
extremely sick people) has resulted in subsidies to the tune of nearly 23
percent of all insurance-company premiums. That subsidy is to be phased out in
the next few years, which means that premiums will have to rise by at least
that much over the increases last year and this year. That will push more
healthy people off the insurance rolls, particularly among the top two-thirds
of income earners.
The amount of money that Rubio helped save taxpayers is
significant, but not huge — certainly not large enough to bring down Obamacare
altogether. What’s important is the demonstration effect. By strategically
targeting a weak link between Obamacare and the insurer companies necessary to
the law’s survival, Rubio has scored a direct hit on Obamacare. He demonstrated
that there is a politically realistic way to get Democrats to undermine
Obamacare: Force them to vote their own cost projections into law.
It’s not the end of Obamacare, but, we hope, the
beginning of the end. As the 1990s show, heavy-handed attempts to socialize
health care on the cheap, without rationing, can unravel with spectacular
speed. Just weeks ago, the nation’s largest health insurer, UnitedHealth,
announced that it will probably exit the Obamacare exchanges in 2017. “We can’t
sustain these losses,” CEO Steve Hemsley explained. “We can’t subsidize a
market that doesn’t appear at this point to be sustaining itself.” Think about
that. Even on top of enormous federal subsidies, which include huge direct
payments to the insurers, the market created by Obamacare is failing to sustain
itself.
There’s one thing we know for sure about Obamacare: It
cannot work without blowing the deficit sky-high. That’s particularly true of
the Medicaid expansion. The GOP’s strategy should be to carefully stage the
conditions for the law to unravel on its own. Cap federal spending on the law,
and eventually Democrats will have no choice but to vote for repeal.
As Rubio has demonstrated, Obamacare is more vulnerable
than most people think.
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