james kaprada senior fellow at the ethics and policy centers a great piece of with the standard about the obama care wheels coming off uh... welcome back so glad to have you great to be with you michael thanks for having you again so i know you just wrote not long ago but we'll come up with now it's the wheels the the belts the hoses the entire thing is falling apart yeah yeah yeah well i mean i think they're gonna say well this is good news because we have all this traffic of course they've created this problem because they they built up this thing to the absolute deadline for getting coverage now with number twenty-third of the twenty fourth and so people that have gotten you canceled policy that they want to have health insurance as of january one in some ways they were forcing them into the system uh... and uh... you know a lot of middle-class families never gone on insured uh...
they've sort of made it impossible to get coverage outside of the system and so it's not the pricing of a bit of a crash of people trying to enroll in the last couple of days before the deadline are we in a position where when january first rolls around the number of people who've lost their insurance is going to be larger than the number of people who got uh... obama care coverage you know it's very likely to be that way i don't think we're going to know for sure until we see some more definitive numbers the administration is spinning otherwise but i understand from people that were closely with the insurance industry with the carriers believe that they will be a net negative that is a number of people to drop their coverage is going to exceed the number of signed up for new coverage through the obama care exchanges now that we have to prepare to plan on the country for might be not positive but overall i think it would be slightly negative uh... so they're probably starting from a hole in the beginning of twenty uh... fourteen rather than a positive uh...
reduction in the uninsured the other questions i think first are you going to have people to be walking into doctors offices saying i'm here i want to get care and they're going to find out they don't have coverage or the doctors do not know how they got their plan or whatever and the insurance companies are just expected to make this all work that's what's that's what i've been told i think it's going to be a big mess i think first of all i think the question of the called enrollment is going to be found to be much better than they're letting on right now that we get right down to a lot of folks are selecting a plan but don't know how much premium they really owe and are not really going to pay the premium when the bill comes so you know you have a lot of flippage in terms of people actually paying premium for plans moreover those who do select a plan are going to be you know many of them are realized a couple weeks and a second the doctors i go to in the hospital i want to go to if i need it are covered and they're not going to know that because that that information fairly obscure when you're trying to find out for these insurance plans and most of these websites i've been telling people i've been telling people who don't want to sign up for insurance uh... and would rather be essentially take care of themselves be selfish or you know just you know take chances and have some money and say whatever i've been telling them don't sign up because you will never pay a penalty in the first year for not being covered they'll never tax you that infamous john robert's tax do you agree with that uh... i think it's unlikely i think it is unlikely they're gonna get attacked now that you shouldn't say that that they're ruling out now because it's not as of now the president in this team and everybody else says no no no you're going to have to pay the tax if you don't get insurance coverage they're using that to try to scare people and buying the expense of insurance plans on the exchanges uh... but i think when push comes to show that very likely to have ten twenty thirty million people facing the tax next uh...
spring when they filed their income taxes that can be a huge political problem for democrats so i can imagine that they will want to stand for that number number two here is that you know they just invented anyone who had canceled insurance plans from twenty thirteen you don't you are subject to the individual mandate tax in twenty fourteen if you have canceled policy now what about the uninsured though right these are people that couldn't afford twenty thirteen insurance and i'd say they have to pay the fact they don't get twenty fourteen insurance meanwhile people that did have twenty thirteen insurance don't have to pay the fact doesn't make a lot of time and i know that there's no way i think that they'll survive either in the court or courtroom james maybe you can uh... add some more to this by step of a judge or really more administrative say what you can't charge me my neighbor to have a church in charge him you know because he lost his side is too expensive he wanted a hardship i want to share how can you possibly make that work in america yeah i mean it it seems to arbitrary unfair right i mean they announced this last week uh... you know at the early eleven hour you know after people who probably made their decisions or had to report in making decisions many of them costing them or the decision they were going to cost them thousands of dollars right now the president though never mind you didn't have to do that i mean i think it it'd be the turkey jerky you know to the pan nature of the implementation got a lot of people very upset uh... so the argument from uh...
supporters obama care is okay fine this first year is gonna be a mess but once it's in place in the math kicks in people are going to love it that's going to drive costs down people are going to get better deals is that the way it looks based on the facts on the ground today the the all-in-case is our from what i'm saying is that they're going to get a fairly uh... robust enrollment in the medicaid program in order of six or seven million people in the medicaid program that they're going around telling everybody it's re-insurance frankly when you go on the website if you're income below a certain threshold you know any choice they put you on medicaid but right there because the news for today is that massachusetts is announced as their connectors down but they're just going to put people in medicaid until they can figure out it insured later so you have a group who never had medicaid have never wanted medicaid they have money to pay for something better than medicaid and they're going to be a medicaid not going to find out until some of the future right to go to medicaid network providers probably not the provider network you would go to through commercial insurance paid on your own so yeah it's going to be a big problem i i i i i i i i would say that the uh... the uh... likely scenario you get you know pretty big medicaid enrollment in a very small number of people find a proprietary exchange is maybe on the order of two or three million people involved that and done and it's going to be mainly people that were desperate to get this kind of insurance so they were in a bad insurance plan previously they probably had some kind of problem health-wise and it is a better deal for them to know denying that you're in bad insurance and you have a pre-existing condition and so that's the kind of person who signed up for coverage so far problem is that the market will be unstable and the premium for that pool of people will be very likely to go very dramatically in 2015 the phrase true up which i'd never heard before then the white house saying well just we're just gonna cover everybody and then we'll screw up with insurance companies later does that mean i think it means which is someone walks in without insurance they thought they sign up insurance or whatever the doctor treats them on a plan they'll have the plan they'll have then covers them and then goes to the taxpayers says okay we covered them now you get to cover them is that what truing up me well i you know i do the number of different kinds of trueing up i think in the context i've understood it is that the back-end payment system to the insurance plan is going to be working anytime soon and so they're going to have the insurance plan self-disclothed to the government here's how much you owe it for all the subsidies for the people to find up our insurance please send us check they do that in january so all the big insurance they do the government here's how much you owe it the government sent them a check and then they supposedly want to get the data systems really that's what i'm saying true up uh...
any chance that you're involved something other than us writing a big check to ensure no the biggest the biggest danger here for taxpayers is that there's a provision already baked into the law that says if an insurer loses money on the exchanges that is if the premium they collect for the people they enroll is less than the claim they have to pay for all their health benefits then the insurers losses are paid for in large part by taxpayers to a prison they call risk corridors say anything above i think it's like a nine percent loss on insurance uh... the taxpayers pick up in the uh... insure pays only a very small portion of the law james kapata thanks much for time bring us a very very latest on obama care i trust will find you by the tree christmas eve as santa's coming down the chimney frantically for signing up because with the deadline to move back to eleven fifty nine