This tweet tree is an interesting indicator of the behind the scenes Replace state of play:
— Harris Meyer (@MHHmeyer) December 15, 2016
The first thing in health policy is to always follow the money. Covering sick people means spending money. The question is always how much money and who is spending that money. We’ll know very quickly if there is an actual replacement plan that is way too heavily focused on HSAs but actually tries to provide some useful coverage to a reasonable number of Americans or if it is a Potemkin plan by looking at the top line CBO scoring of the expense of the coverage provisions. This runs into a potential Norquist problem but the money is the big thing to review.
This piece from the Washington Examiner is interesting regarding the Norquist problem:
Republicans are searching for a way to capture savings from repealing Obamacare in a piggybank they could later use to fund a replacement.
It’s not clear how or if such a maneuver would work, but if Republicans are successful, it could overcome the tricky political problem of paying for whatever health reform they try to put in the Affordable Care Act’s place….
If Republicans find a way to set that money aside, in a bank account of sorts, they could use it to pay for measures that are more palatable to conservatives but still expensive, such as the age-based tax credits House Speaker Paul Ryan has proposed to help Americans buy health insurance.
If this is a convoluted work-around of a self-imposed constraint, then there is a chance in hell that there could be a vaguely adequately funded bill. I am not betting the house on it, but I might bet one soccer game referee fee on it.
Republicans are considering up to a 4-yr transition period for Obamacare repeal https://t.co/cqvtVqtVVP
— Jennifer Haberkorn (@jenhab) December 15, 2016
There have been numerous wonks tearing their hair out about the mechanics of implementation. My estimate derived from my time spent as a low level plumber :
Any big bill will have major rule making. Any big bill will require insurers to reconfigure and retweak their systems. I worked 70 hour weeks from roughly July 2012 to October 2013 to get my little part of the QHP Exchanges to a point where the user facing chunk was minimally functional. I then spent another six months getting all of the back-end mechanics of directory and network information working cleanly in an operational, no human intervention sense. (I was up 53 of the 60 hours before October 1, 2013 launch date getting the final network directory ready to launch).
The ACA had roughly a 45 month ramp up period from signature to going live on the major components….
If the Replace Bill is anything more than a rebranding of the law and a dropping of subsidies, required actuarial value and essential health benefits, insurers need at least eighteen months from the signature to get something together and preferably 18 months from when CMS issues the big rules to get a good launch
IF the discussion is now on a four year transition period, some semblemance of reality may be at least temporarily be injected into the conversation. Three years after a signature on the Replace Bill is a bare minimum and four years is a reasonable build-out time.