Many believe state resistance is then the coup de grace of Obamacare, especially since 17 states have already refused to set up a state-run exchange by the federal government's deadline. However, state resistance also provides another manipulative chess move by the Obama administration to bully, coerce and cast blame on the states and Republican governors in particular who refuse Obamacare.
Mark my words: If Obamacare continues on its present course, the president and his minions will blame states for denying affordable healthcare via subsidies and tax credits to citizens, "forcing Washington's hand to implement the law of the land at unaffordable and higher-priced health care premiums."
I pray Republican governors and other state officials don't fall prey to this laden political folly and pressure. Rather, as sheep before wolves, they should be as shrewd as snakes and as innocent as doves, especially when finely typed print among a hospital's privacy disclosure statements (which patients are asked to sign) included the words that the treating medical facility may disclose your health information to federal officials "in order to protect the President, other officials or foreign heads of state." So much for HIPAA privacy laws!
What state officials (and our conservative representatives in Washington) need to do is leverage (jiujitsu) Obamacare's next chess moves and offer more fiscally responsible and freedom-loving alternatives or reforms, such as some version of Avik Roy's "Obamacare jiujitsu" and his four-step solution to tackle the U.S. health care behemoth. It includes:
Step One: Replace or fix Obamacare's exchanges.
It starts by improving the market orientation of Obamacare's insurance exchanges. With the states' pressure and even the leverage offered them via last summer's Supreme Court decision, they and Republicans in Congress can reduce the excessive mandates, regulations and subsidies in Obamacare. Utah, for example, created a health care exchange that is far more palatable and market-oriented than the one offered through Obamacare.
Step Two: Migrate Medicare enrollees into the exchanges.
The next step would be to move Medicare patients into Obamacare's (reformed) exchanges. Roy explains, "For example, Congress could agree to raise Medicare's eligibility age by three months every year for the foreseeable future (and) transfer the 'dual eligible' population -- seniors who are enrolled in both Medicare and Medicaid -- onto the exchanges." Roy adds, "In effect, over time, this would gradually introduce premium-support-style reforms into the retiree population, without requiring Congress to get bogged down in complicated reform legislation."
Step Three: Let more people buy insurance on their own.
The third step would be that "Congress could consider reforms of Obamacare's employer mandate -- for example, exempting businesses with fewer than 200 employees or eliminating it entirely -- so as to stimulate economic growth while improving the market for individually purchased health insurance."
Step Four: Offer Medicaid patients a way out of that broken system.
The last step would be to "move the Medicaid population into the (reformed) exchanges. ... Another approach could be to give Medicaid's long-term care program back to the states, in exchange for federalizing Medicaid's acute-care, pediatric and dual-eligible populations."
As Roy concludes: "Conservatives have lost the battle to repeal Obamacare. But they haven't yet lost the larger war against out-of-control health spending. The opportunity to seize the mantle of reform is theirs for the taking."
When I think of Obama and Obamacare, I can't help but think of the words of Rickson Gracie, retired Mixed Martial Arts World Champion and a member of the renowned Gracie family, who once said, "If size mattered, the elephant would be the king of the jungle."
Let's continue to fight and show Washington that we, the people, are the kings of the jungle.
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