If Mandate Falls, What About Exchanges?

[djs]

So if the mandate is trashed, and exchanges survive, it may be only in theory unless someone finds a way to make money grow on trees.

The good news is, I have found a way to make money grow on trees. The cost per tree is about $1,000,000, the estimated yield of cash, if conditions are very good, is between $0 and $500,000. If conditions aren't perfect, you might get apples.

I'm working with the White House to provide these to everyone. Due to volume, the price might be slightly higher though, since demand will outstrip supply. I'm working with the President on his speech about a money tree in every yard.

The real hold up to this plan isn't the cost (we'll plant some trees so in 20 years, it will appear to be revenue neutral). The presidents advisors are afraid it might appear improper to subsidize trees only for those fortunate enough to be homeowners with yards. I have suggested replanting a few national parks for those who don't have yards. We'll see how it goes.

The other problem we are having with money trees is the environmentalists are afraid that planting this many trees will lower CO2 levels, lowering the corn crop, which means less ethanal and therefore more fossil fuel burned, which would raise the CO2 levels. Because of this, they are against money trees.

After all of these discussions, I'm not sure even money trees will save the exchanges.

Dan

 

[somarco]

Dan, you are truly a renaissance man.

 

[Ann H]

Good questions and answers. My take on it is that the whole law will collapse if the mandate is ruled unconstitutional. A congressional repeal, Secretary of HHS's delays, possibly a new Secretary of HHS, more lawsuits, and a variety of tactics to stop the funding will essentially grind the dinosaur to extinction.

However, it's true that a brutal political war brings revolutionary changes even if the war is lost. As another poster mentioned, after Clinton's attempt, some real reforms were enacted anyway (Kennedy/Kasselbaum, Portability, GI for groups...).

I see the next stage as being State-by-State reforms, and I don't see the Feds trying national reform again for a decade or more. Even Barney Frank has said this was a massive mistake for Obama to take on.

In any situation, I don't see exchanges or any other major portions of the law's new health care structure for 2014 being implemented nationally unless a particular state (like California) initiates it on their own.

 

[HealthGuy]

HHS delays I dont see...but Ann I do like your analysis...HHS seems like nazis with this bad boy..full speed implementation baby !

 

[apeckinsphere]

The exchanges only need to exist to facilitate the Federal Government subsidizing individual health insurance premiums.

If the mandate is struck down, but the GI for all health insurance stands, then the carriers are going to have a big problem. They cannot cover everyone who is sick, unless everyone who is health is on board.

It will be a big mess.

 

[djs]

Not "It will be a big mess"
Is IS a big mess.

But, hey, who would have seen this coming a few years ago?

 

[somarco]

Obamacrap gave virtually unlimited power to HHS. If the law goes away so does the power given to HHS. If it survives, those powers will go to the next HHS Sec.

The exchanges only need to exist to facilitate the Federal Government subsidizing individual health insurance premiums.

The govt doesn't need an exchange to provide subsidies. We don't have a food or housing exchange yet folks get food and rent subsidies from the taxpayers.

 

[GreenSky]

Not "It will be a big mess"
Is IS a big mess.

But, hey, who would have seen this coming a few years ago?

In all fairness, you did warn us about this. I found this post from January 7, 2010:

It will be a big mess.

You need to give yourself credit when credit is due.

Rick

 

[Yagents]

Well, the guy in charge of exchanges, just quit to join the private sector. Either ppaca really is that bad of a mess, it really sucks to work in the gov't, or he knows he's out of a job with SCOTUS decision. I'll bet that this was a pre-advance leak, and SCOTUS decision happens this monday!! See 1 cockarocha, there are always others around.

HHS' Larsen Resigns Top Post | LifeHealthPro

One health care lobbyist, not a fan of PPACA, asked if folk were jumping a "sinking ship in advance of a Supreme Court decision?"

 

[AllenChicago]

He knows that he's going to be out of a job after the SCOTUS ruling AND working for the government (if you're a go-getter) is HELL.

I suspect that every health insurance company that is not in the the top 5 in size and public exposure will leave the health industry. If you look at healthcare.gov for a local insurance carrier, you have to scroll through 226 results just to get to AETNA, our state's 4th largest carrier.

Even if Obamacare is 100% upheld, small to moderate sized health insurers probably don't stand a prayer. For some reason, they're hopeful that they will get a decent share of the 40 million new insureds expected to purchase coverage via an exchange in 2014. It's an empty hope if consumers don't delve deep enough into the hundreds search results/quotes. If healthcare.gov is any indication, the big boys will dominate the first couple hundred results.