In the popular HBO series “Game of Thrones,” a never-ending chess game is played by competing factions for power in a mythical world of political intrigue and warfare.
The “Iron Throne” of the king is constantly under pressure to keep a multitude of constituencies with conflicting ideologies and economic interests happy. Who is ultimately pulling the strings and really in power is always in question; while shifting alliances makes the balance of power an always-precarious proposition.
Whether you are a fan of the show or not, this description may seem familiar because we have watched this game develop to now dysfunctional levels in Washington, D.C., for the last two decades. Moreover, the game has reached a crescendo point in the action surrounding the on-again, off-again repeal-and-replace efforts around the Affordable Care Act (ACA).
It is doubtful that the current party in power can deflect the blame to the minority party for failure to deliver on the repeal and replace “on-day-one” pledge.
Further, it is a very risky strategy if the Trump administration were to sabotage the ACA by stopping subsidy payments and allow the current health care system, already teetering, to fall into collapse and not suffer devastating consequences at the polls.
For the minority party, it is always easier to oppose than to legislate. However, they should not misinterpret the current state of affairs as a mandate for single-payer “Medicare-for-All,” or that the ACA is without problems. The best approach from this point forward for both parties is to work in bipartisan fashion through the true legislative and committee process to fix problems with the ACA and build from the current platform.
After defeats on the Senate floor and in the halls, it is now time for partisan fighting to be set aside, and both parties to come together to find ways to improve the current system. This is now our health care system and it’s time to fix the bugs and make it work.
Assessing the battlefield
Twenty years ago, Medicaid was the poor step-sibling to Medicare. But today, it has become the default payer of long-term care in this country and it has risen to considerable power. It is interesting to have watched the influence exerted by state governors, many of whom are members of the majority party, over this debate because of how Medicaid funding would impact their states.
An amazing array of consumer, medical and insurance groups were all united in stopping the proposed bills coming out of the House and Senate.
The White House handed over control of the entire effort to House and Senate leaders, and pretty much stayed on the sidelines waiting for a final bill to be delivered for signature. And then, it only took a couple of senators from some of the smallest and poorest states in the nation and a maverick to stop the entire effort dead in its tracks.
Like it or not, but this is exactly the kind of decentralization of authority that forces negotiation and consensus the framers of the Constitution wanted. In this Game of Thrones, the Founding Fathers and the Constitution stood firm again.
A path to victory or defeat
Medicaid has become the new third rail of politics — a once vulnerable program lacking an unorganized constituency now has become very popular and well protected.
The unintentional result of “Obamacare” has been Medicaid’s rise to prominence and power. The entire repeal-and-replace effort hinged on what would happen to Medicaid — and it died on that sword. The path to victory in the future for both parties is to find ways to amend the ACA without pillaging Medicaid.
Therefore, it’s important to recognize the fact that Medicaid is the nation’s primary payer of long-term care services, in the same way that Medicare is the nation’s payer of hospital and doctor visits for anyone over the age of 65, and it now has considerable support protecting the program.
To create fiscal balance, more must be done to educate and incentivize people to use private pay resources for long-term care.
Tax incentives to purchase long-term care insurance, save for future long-term care costs, and repurpose assets such as exchanging life insurance policies for tax-free long-term care benefit accounts are examples of how people could be less reliant on Medicaid.
At the end of the day, any tax incentives that delay the need for someone to go onto Medicaid will create savings from dollars not spent on expensive care, which should be everyone’s shared goal.
Chris Orestis, Executive Vice President of GWG Life, is an over 20-year veteran of the insurance and long-term care industries and is nationally recognized as a health care expert and senior care advocate. He is a former Washington, D.C., lobbyist who has provided legislative testimony; the author of two books: “Help on the Way” and “A Survival Guide to Aging”; a frequent columnist with a currently popular series entitled “The Healthcare Hunger Games”; and has been a featured guest on over 50 radio programs and in The New York Times, The Wall Street Journal, USA Today, Kiplinger’s, Investor’s Business Daily, PBS, and numerous other media outlets.
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