Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Confronting Obamacare: Health Savings Accounts
Repeal and Start Over, or Step-Wise Revision?


The Republican Congress which immediately followed the Democratic majority which had enacted the Affordable Care Act without reading it, voted to repeal the act at least fifty times, only to encounter a Presidential veto. Most of them campaigned in 2016 on a platform of immediate repeal. But now they have a Republican President to sign it, but there is a question whether that is really possible. Hundreds, if not thousands, of Obamacare subscribers, are lying in beds, expecting their bills to be paid. No matter how much a Congressman may hate the legislation, there is a question whether immediate, total, repeal would be practical.

In the first place, the Law may be booby-trapped. It was two thousand pages long when it was passed, and ten times that number of Regulations have been signed into having the force of law. Even if a team of lawyers had the tenacity to read it all through, they could easily miss the significance of a phrase, or its relevance to another regulation under a different heading. More likely, there are many sensible modifications which have been made for reasonable purposes. The news media, which were notoriously in favor of Mr. Trump's opponent during the campaign, would surely love to explain these clauses and their sensible purpose since the authors would be glad to leak the tips to them. It probably would take months to find them all.

As a matter of fact, five hundred-bed hospitals regularly shrink down to six or eight lonesome souls in beds on Christmas morning, but they are deluged with elective admissions the Monday after Christmas. By inaugural day the typical hospital is choked with patients, and the typical backlog is not worked off until February. This year, that rebound will probably be particularly bad. You can play national games with this situation, but it would probably require more time to plan it than exists after a surprise election. It could be done for an atom bomb attack, but it would not be smoothly executed for a political contrivance.

So, let's assume a political problem is addressed with political words, fixing up the temporary change-over mess after it has occurred. "With the exception of" or "In the case of" should serve the purpose.

Originally published: Saturday, December 17, 2016; most-recently modified: Monday, June 03, 2019