"If They Want To Blow It Up, They Can" - How Republicans Can Hobble Healthcare Without Repeal

Tyler Durden's picture

Following President Trump's clarifying tweet yesterday that "Obamacare will explode" on its own...

It is becoming increasingly clear that, even without the 'repeal', the Trump administration has already begun using its regulatory authority to water down less prominent aspects of Obamacare.

The Republicans' failure to repeal Obamacare, at least for now, means it remains federal law. But as Reuters reports, newly confirmed Health and Human Services Secretary Tom Price's power resides in how to interpret that law, and which programs to emphasize and fund. Earlier this week, Price stalled the rollout of mandatory Medicare payment reform programs for heart attack treatment, bypass surgery and joint replacements finalized by the Obama administration in December.

Hospitals and physician groups have been counting on support from Medicare - the federal insurance program for the elderly and disabled - to continue driving payment reform policies built into Obamacare that reward doctors and hospitals for providing high quality care at a lower cost. The Obama Administration had committed to shifting half of all Medicare payments to these alternative payment models by 2018. Although he has voiced general support for innovative payment programs, Price has been a loud critic of mandatory federal programs that dictate how doctors should deliver healthcare.


Without the backing of Medicare, the biggest payer in the U.S. healthcare system which Price now oversees, the nascent payment reform movement could lose momentum, sidelining a transformation many experts believe is vital to reining in runaway U.S. healthcare spending. Price "can't change the legislation, but of course he's supposed to implement it. He could impact it," said John Rother, chief executive of the National Coalition on Health Care, a broad alliance of healthcare stakeholders that has been lobbying the new administration for support of value-based care.


The move Friday to pull the Republican bill only reinforces the risk to the existing law.

"It seems that the Trump Administration now faces a choice whether to actively undermine the ACA or reshape it administratively," Larry Levitt, senior vice president at Kaiser Family Foundation, wrote on Twitter.

As a painful reminder, the United States spends $3 trillion a year on healthcare - more by far than 10 other wealthy countries - yet has the lowest life expectancy and the highest infant mortality rate, according to a 2013 Commonwealth Fund report.

Health costs have soared thanks in part to the traditional way doctors and hospitals get paid, namely by receiving a fee for each service they provide. So the more advanced imaging tests a doctor orders or pricey procedures they perform, the more money he or she makes, regardless of whether the patient's health improves.

"We have a completely broken economy in healthcare," said Blair Childs, senior vice president at hospital purchasing group Premier Inc. "Literally, all of the incentives in fee-for-service are for higher cost."

As Reuters concludes, President Trump has already signed an executive order directing the HHS to begin unraveling Obamacare. In the early hours of his presidency, Trump directed government agencies to freeze regulations and take steps to weaken the healthcare law. The order directed departments to "waive, defer, grant exemptions from, or delay the implementation" of provisions that imposed fiscal burdens on states, companies or individuals. These moves were meant to minimize the costs and regulatory burdens imposed on states, private entities and individuals.

David Cutler, the Harvard health economist who helped the Obama Administration shape the ACA, said Price could do all sorts of things to undermine the law.

"If he wants to blow it up, he can," Cutler said in an email. But if they do, he added, "they alone will own the failure."

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.
benb's picture

I'm happy the Rhino plan flopped. Definitely works in Trump's favor. Let's have some ARRESTS to get things rolling. A little justice wouldn't be bad.

chunga's picture

You and your fucking spam.

benb's picture

I know but the blurb about the bitch being deported is, well, invigorating.

NidStyles's picture

There is only one failure associated with Obamacare.


That is that they let it become law in the first place.

Clint Liquor's picture

Yep, now it's like giving a dog a bone and then trying to take it away.

New_Meat's picture

Nid, there wasn't any "let it become ..."

It was murdered into existence.

- Ned

Arnold's picture

In the middle of the night on Christmas eve.
Christmas Day we got to open the package to see what was in it.

StychoKiller's picture


Price "can't change the legislation, but of course he's supposed to implement it. He could impact it," said John Rother, chief executive of the National Coalition on Health Care, a broad alliance of healthcare stakeholders that has been lobbying the new administration for support of value-based care.


"Value-based care" is Progressive-speak for complete care without the patient having to do anything to change their health!

Sorry folks, but ye best get "responsible" for your own health care, 'cause "Big Brother" can't do anything except fsck things up even more than they are now!

American Psycho's picture

Beetlejuice, Beetlejuice, Beetlejuice!!!!

johngaltfla's picture

The author misses the biggest point. Trump, as I wrote back on Feb 28th, could simply withdraw the appeal of House v. Burwell by his AG and cease paying any subsidies to insurers immediately. The entire thing collapses within 6 months then.

President Trump Should Kill Obamacare on February 28, 2017
benb's picture

I think you are right in that having been an option. But the game Trump is playing out is probably the shrewdest move. Had they wacked the A.D.A. and put in the chickenshit replacement, the Democommies serving the NWO would have hung the healthcare breakdown /consolidation which they created on Trump. It is inevitable in the near future that the A.D.A. will implode and financially rape millions more on the way down. The Albatross will be hung around Schumer, Pelosi, and the rest of the swampthing's necks and they aren't getting out of it...priceless... (plus Ryan just took a big political haircut)

N2OJoe's picture

Why do you guys act like Trump is somehow against Obamacare? He was all for Trump/Ryan care which was the exact same law with a different name!

I was willing to give him the benefit of the doubt and see what his actions were, but this one clearly outed him about socialized medecine.

benb's picture

"Why do you guys act like Trump is somehow against Obamacare?"

He defininately was against but because of the impending ADA collapse he went along with the stop gap measure which was bad but not quite as bad as the ADA. He even explained how it would be better politically to let it collapse but would cause too much suffering so he would hold hid nose. That was about three weeks ago. In the end I think it worked out quite well no matter what the Amazon Post was shoveling.

American Psycho's picture

I'm sitting here laughing at my desk like the lunatic I am.  Thanks for the chuckle Benb!

oldguyonBMXbike's picture

Is that how he drains the swamp? By supporting slimy Ryan and his BS health bill?

oldguyonBMXbike's picture

Oh I'm sorry you're butthurt because Trump hasn't actually done anything he said he would do.  Hey, just like every other lying, psychopathic politicians. 

New_Meat's picture

here I was, just a-strollin' by and there you were on the side of the blog, mumblin' and babblin' to yourself.  You should seek out an ObamaCareEmergencyRoom--the kind that doesn't turn anyone away.

Then look at what happened this past week on other fronts.

'sOK, duude, I know that you are old and trying to regain that youthful vigah'  Even those pretty blue and green pills won't help you, though.

- Ned

deepfriedbrain's picture

This was Trumps plan all along.

Ryan looks weak....may get shit canned
Freedom caucus (paid by CoC and the Koch bros) look like assholes.

Now obama care Has not changed and everyone's price goes through the roof. More insurance companies pull out. .
Trump & price do nothing. Obamacare implodes.

Ryan, freedom caucus and dems take it up the ass
Come crawling back to Trump.

He fixes by having the preexisting people separately like Medicare while everyone else in the insurance pool has very low rates and boom. Problem solved. Zero money for towelheads in foreign donation used to pay for the existing condition people.

mkkby's picture

Fail.  You are a health care shill.  A high risk pool just shifts the costs, it does nothing to reduce them.  NOTHING.

Providers can still refuse to give price quotes.  You have to agree UP FRONT to pay anything billed, then wait for your surprise at the end.  And, of course, that surprise is a rape job.

This kind of abuse was fixed in the auto repair business 4 decades ago.  They have to give you a price quote, then not go more than 10% over.  That allows you go next door and comparison shop.  THAT is what controls prices.  Free market competition.

Health care is the only business that completely resists price discovery and competition. The reds and blues are both owned by lobbyists, and Trump is stangely silent on this obvious fucking fact.

StychoKiller's picture

That's only one aspect of this clusterfsck, look into CON's (Certificates of Need), which artificially limit the number of Hospitals in a given area, then look into how the AMA (American Medical Assoc) limits the number of students studying to be Doctors (another source of Monopoly!)

No matter which way you look at it, a lot of "Rentiers" are in the medical/Insurance industries, protecting their fiefdoms!

Solar123456's picture

Does anyone know what happens if a state has no insurance companies offering insurance for the ACA? Some states only have one insurer so it doesn't seem like much of a stretch to imagine a state having none. 

oldguyonBMXbike's picture

BS. Tom Price has no power to interpret law. This is why the Rule of Law is a joke, because corrupt pieces of shit "interpret" however they want. Laws need to be clear as to their intent or eliminated completely. This is nothing, but a tyranny of beaucracy.

Lonesome Crow's picture

What of prescribed expectations of behavior that ought not to be law at all?

Is it just that ANY confiscation be applied as the means no matter what the end?

oldguyonBMXbike's picture

Sorry, I'm really not sure what you're asking.

Lonesome Crow's picture

We are confiscating your earnings because others need them.

Is this a good law? The intent is clear.

earleflorida's picture

sadly, the law has always been 99% interpretation!

it's always been black and white pertaining to the plebs however.

but[t], in todays' america, there are two sets of laws... the high (99% of Grey) order for the priviledged and the vast blanket of inequities for the lowly peons!

oldguyonBMXbike's picture

The law is and always has been arbitrary. Those who know this can do whatever they want. 

New_Meat's picture

"as the Secretary may direct/deem/figger out/..."

t'ain't no interpreting there.  Just an appointee of the current Regime vs. the "expected" Regime.

Wage Slave 927's picture

Those with the ability to splash out campaign cash can have their friends in black robes help to interpret the law the way they want.... meanwhile the rest of us get bent over the table.

TBT or not TBT's picture

The text of the ACA law says, hundreds of times, "the Secretary shall decide....".  Enormous bureaucratic leeway built in.   Where do you think the tens of thousands of regulations camemfrom?   How about those thousands of waivers to special friends under Obama?    

Peacefulwarrior's picture

Unfunded Ponzi schemes always die.

AlexCharting's picture

Who should hold this bomb... GOP or Dems.? I say the latter. 

wisehiney's picture


Tea Party will gladly own the "failure".

Tastes like great success to me.

Crash and burn oBUMMercare.

nmewn's picture


Leave nothing.

Lonesome Crow's picture

The precedent was set long ago.

There will be confiscation no matter to what end.

coast1's picture

I cant see anyway out of this, as I mentioned before, well, are you ok with tens of millions of poor people losing their healthcare?  at the same time obamacare is utterly destroying the middle class?  but at the same time, the poor are also on EBT and buy candy and sodas and GMO etc.  Dear lord, I truly believe nothing can be fixed anymore, the satanic bankers have been in control for too long, and there is no cure.....we are terminally ill, and almost on life support...there is no way to fix anything anymore..its too far broken.  All we are doing now is rearranging the chairs on the titanic...Trump? bless his soul maybe, I dunno if he was put in or is compromised, seems like he is trying tho.  But there is no cure, everything is too far gone.

FredGSanford.'s picture

There is no way out. The mess is too big to fix. It must implode

Omen IV's picture

The lower and upper middle class are supporting the premiums for the poor  with high costs coupled with their taxes which pay the premium for the poor via Medicaid- the poor dont have the genetics nor the attitude to preserve their own health  - they get it all for free  - so they dont have to care about the cost  - they can PROTEST for free

This was a way for the DNC to MURDER the white middle class  - they cant afford the premiums now  - so they will die faster  and -  they have to support their familes with a job - the poor do not have a job all welfare based   - so the costs destroys the middles class - the blacks and browns take over with the hyper birth rate supporting the liberal democrats

the end!


StychoKiller's picture

Fortunately (subject to how you view "fortunate"), "The Great Implosion™" will arrive BEFORE enough "babies of color" can support the Progresssive-Socialists!

jm's picture

Whoever writes this stuff has no clue.  Vet your material, this post makes you look stupid.


Providers like hospitals benefit from obamacare because they can bill non-collectable receivables to uncle sugar and get funding dollar for dollar. Providers are for Obamacare.  States have expanded Mediaid to millions more poelple that can't pay for healthare.  States are for Obamacare. There are millions of employees that have no coverage through employment.  Their employers aren't picking up the tab if Obamacare goes away.

This explains the politics.  Forget the rhetoric. 

The other side is that the economics for exchange plans are so poor that there is no way to keep them viable.  so providers will be happy, Medicaid recipients will be happy.  And ONCE AGAIN, people that work for their insurance... wait for it... lose. 



Peacefulwarrior's picture

This may be a "Darwin" survival of the fittest moment in history

oldguyonBMXbike's picture

The Quickening is upon us. Sort of like the Singularity, except all those AI worshiping transhumanist fags will all be sacrificed.

Peacefulwarrior's picture

The Human race is a lay down customer for at least one or more of the 7 Capital Vices. Every point of known and un-known history plays a version of this same movie until we get another great collapse and have to press the start/reset  button again.

oldguyonBMXbike's picture

I'm trying to destroy it all for eternity. 

Peacefulwarrior's picture

LOL how do you really feel! However, there is certainly a bad loop in the program needing a re-write so we can evolve or dissolve.

oldguyonBMXbike's picture

It's an act of mercy. Someone needs to put these poor fools out of their misery. I was hoping the Jews would exercise the Samspon Option, but they have no balls.