GOP strategy for 2018: "We're increasing your premiums *another* 10%. You're welcome!"

2018 MIDTERM ELECTION

Time: D H M S

Last December Congressional Republicans, having mostly failed in their quest to take healthcare coverage away from 24 million Americans, decided to settle for half a loaf and simply kill off the ACA's individual mandate by itself.

It's important to keep in mind that they knew damned well that killing the mandate penalty without replacing it with some other type of "negative inducement" to encourage people to enroll in a fully ACA-compliant policy was a really, really bad idea. Proof? Both the GOP House and Senate versions of their ACA "replacement" bill included an alternative to the mandate penalty:

The American Health Care Act ("AHCA"):

Under the AHCA, the individual mandate is wiped out...except it's replaced with a 30% premium surcharge for people who don't maintain continuous coverage for more than 2 months.

In other words, the GOP's Obamacare replacement bill simply substitutes a different financial penalty for not being insured than the ACA's. If you go uncovered for more than 2 months in a year, you have to pony up an extra 30% on top of whatever the regular premium is for whatever policy you do sign up for...for a solid year. In many (most?) cases, this would likely end up being a higher penalty than the Individual Mandate tax already is! Let's say the policy you're looking at runs $300/month. 30% of that is $90, so you'd have to pay an extra $1,080 for the policyfor a year before it drops back to the normal rate. If you have a family plan for, say, $1,000/month and your whole family went without coverage, you'd have to pay an additional $3,600.

..."Best" of all? Unlike the ACA, where the mandate penalty is paid to the IRS (that is, to the federal government, so at least it might go towards something useful, like funding the law itself), under the AHCA, you pay the penalty directly to the for-profit, private corporation. I'm honestly not even sure if that's legal--technically what you have here is the federal government legally mandating that private companies charge a specific amount for a service to their customers.

The Better Care Reconciliation Act Plan ("BCRAP"):

Senate Republicans are expected to revise their health bill early next week, adding in a provision that could lock Americans out of the individual market for six months if they fail to maintain continuous insurance coverage.

...The six-month waiting period would fill a big policy gap in the current Better Care Act, which requires health plans to accept all patients — but doesn’t require all Americans to purchase coverage, as the Affordable Care Act does. Experts expect that this would cause a death spiral, where only the sickest patients purchase coverage and premiums skyrocket.

Everyone get that? The Republican leadership in both the House and Senate were very much aware that if they ripped away the "red leg" of the 3-Legged Stool without replacing it with some other "stick" to counterbalance the tax credit "carrot", the stool would topple over. Here's an explainer to refresh your memory:

Yet iin the end they decided to do just that anyway, damn the consequences.

And now that unsubsidized premiums in 2019 are indeed expected to jump 10% on average specifically due to them repealing the mandate penalty--just as they were warned by every expert under the sun and just as they themselves KNEW would happen--they've come up with an ingenious defense (via Caitlin Owens of Axios):

Republicans are planning to campaign aggressively on their repeal of the Affordable Care Act's individual mandate, despite the high likelihood that insurers will announce a big round of premium increases just weeks before Election Day. They're counting on the mandate's unpopularity to shield them from Democrats' claims of "sabotage."

Both parties are right: The individual mandate was the most unpopular feature of the ACA, and its repeal will surely contribute to significant premium hikes.

...Although the October premium hikes will be a "big problem," they can be spun: "Premiums going up is a 'hey let's chat about tax reform' moment. But if mandate [repeal] contributes to higher premiums, it means that they were artificially made lower on the backs of low income individuals," the aide said.

..."[If] anybody’s going to get premium hikes, it’s because Obamacare isn’t working," Rep. Tom Cole said.

Ah yes: "We sawed off the leg of the stool, but it toppled over because it was poorly designed in the first place." Got it.

Reality check: The mandate included a hardship exemption. If the cheapest ACA policy available to you would have cost more than about 8% of your income, you were exempt from the mandate. But lower-income households did make up a large share of the people who paid the penalty.

The other side: Some Republican aides and strategists acknowledge this strategy could backfire, by either reminding voters of the unpopular ACA repeal effort or by linking vulnerable members to premium hikes — which Democrats will already be trying to do.

Put another way:

"Apparently Republicans think it's a good idea to tell voters that they really wanted to fully repeal health care but only got the first chunk, which will raise premiums 10%. Good luck with that," said Jesse Ferguson, a Democratic consultant. "The only thing worse than voting for rate hikes is trying to convince voters it was a good thing."

I should note for the record that assuming the projected 10% "Mandate Repeal-specific" rate increase proves accurate, it would average around $60/month per enrollee, or $720 per enrollee for 2019. I should further note that this would come on top of the ~$960/person being tacked onto around 6.5 million people's annual bill this year specifically due to various ACA sabotage efforts by the GOP last year.

I'm guessing that'll eat into that $1.50/week tax break that Paul Ryan was boasting about a couple of months ago.