Maximizing Health Coverage Enrollment Amidst Administration Sabotage,

 WM, Oversight, Maximizing Health Coverage Enrollment Amidst Administration Sabotage, October 20, 2020

With the election of the Democratic ticket, this problem will take care of itself. The Administration will do its duty to defend the Affordable Care Act and point out that when the provisions cutting all Medicaid funds for states who did not adopt Medicaid expansion were ruled unconstitutional, the remainder of the law was allowed to stand. That precedent controls this case. 

The Fifth Circuit does not seem to learn its lessons about respecting precedent, but the normal churn of retirements and being repeatedly reversed by the Supreme Court should temper their enthusiasm. 

If the unthinkable happens on Election Day, this Committee must become a party to suit, which the decision of October 15th by the D.C. Circuit makes possible as far as standing, to advance the cause of precedent. It should ignore basing its case on the policy outcomes of the Affordable Care Act, which are not at issue.

The ultimate cure for any overturn of the Act is enacting some version of Medicare for All (which is actually Medicaid for All, starting with current beneficiaries – who would all essentially become dual eligibles without having to sell their homes. This would rely on winning the Senate. We have added our standard attachment on Single Payer healthcare.

Even if Trump were elected, he would likely sign what is given to him. He has not real spine, nor does the Vice President who lets him remain in office. Enacting bicameral rules to establish a commission to invoke the 25th Amendment would fix this lack. 

The Raskin bill must come to the floor and be passed. Jamie was once my attorney for a constitution law issue before he became the Acting Dean of the Washington College of Law at The American University and I joined the Barry Administration as the Ombudsman for Ward Three and later, a program analyst in the Office of the City Administrator. His work on this matter is flawless.

The Second District has also green-lighted Cy Vance moving forward in his effort to subpoena Trump’s financial records. The Supreme Court has already ruled on this matter and will not likely hear the case again. I predict the outcome will be a plea bargain which has Trump resign. A President Pence has shown the ability to compromise, especially with a bipartisan legislature, as he did as Governor of Indiana.

The next round of health care reform must include a tax supported public option (rather than simply a separate risk pool). It should be paid for by broad-based and employer-paid subtraction value added tax (see the second attachment), with the ACA taxes repealed. With a robust public option, pre-existing condition provisions could be repealed.

Those who are refused coverage automatically enrolled in the Public Option. This would restore individual mandates and make individual coverage affordable. The co-pays on the Silver Plan of the current Act are too high. When I broke my ribs in 2018, I simply ignored the bill because I could not afford to pay it. There are many others in the same boat. 

The Affordable Care Act, as implemented, is a failed experiment from the point of view of hospitals who must be paid enough to cover their capital and malpractice costs for themselves and their employees.

Over time, the Public Option would become a single-payer insurance plan as the drive for profits will continually shrink the acceptable risk pool for private insurance until it cannot be sustained. It is the more likely route to universal coverage without the taint of social democracy (what Senators Sanders, Warren and Markey propose is not socialism by any definition of the term that Marxian economists would agree with).

For the purpose of employer mandates, especially for franchised businesses, employees who are under 26 who are covered under their parents’ or spouses’ policies should either be excluded from the employee count or considered as covered under the requirement of the plan. 

By the same token, franchise employees not otherwise covered could be covered under the franchising company’s insurance rather than by the franchisee. This will lead to less, not fewer hours. If an employer-paid subtraction VAT includes a deduction for insurance coverage for gig and franchise employees, there will be no resistance to such a mandate.

The main driver behind ACA repeal has nothing to do with the Act itself. Rather, it is a reaction to how the Act was funded through a tax on unearned income paid only by the upper middle class. Frankly, Vice President Biden’s approach to tax reform is no better. The use of “bubbles” where the middle class is held harmless is a fool’s errand. Anyone making over $145,000 a year can and should pay more in taxes.

Our plan proposes equal crediting of a Value Added Tax funded employer contribution with equal dollar crediting for each payee, a $16,000 floor for the employee contribution (to go with repeal of the EITC) and an $85,000 ceiling, with no personal income taxation until that ceiling is reached.

Attachment One - Single Payer

Attachment Two - Tax Reform