So This is ‘Heart’?

Terry H. Schwadron

The new Republican plan for health care is out, the Senate version that is considered less “mean.” It is a somber day.

We all understand that It is a bill crafted for passage by 50 Republican senators, that it was drawn up in secret, that it follows the basic logic of the earlier House bill — stirring promises of lower prices and lower deductions from insurance by stimulating competition, vastly cutting government contribution to Medicaid, allowing employers to avoid penalties if they do not provide coverage, providing tax breaks biggest for the rich, and letting insurance companies and states decide what not to cover to achieve lower cost.

Oh, and it lines out any reimbursements for women’s health services by Planned Parenthood for at least a year, certainly not the key obstacle in providing health care (and not money that covers abortions anyway).

Even at that, early indications were that the bill very well could fail to draw the necessary votes, both from conservatives and moderates.

Medicaid currently pays the health costs for one of every five Americans and lots more of poorer or disabled Americans. So much for “heart.”

Republican reject independent assessments that show millions of people losing their access to physical and mental health care, and seem inure to the idea that drug costs are untouched or that their own actions have hastened the rise of insurance costs as companies try to protect their profits with the loss of Obamacare.

The Republican Senate will achieve a victory of ideology, not health. Even then, Republicans including Rand Paul, said it was not an actual repeal, just Obamacare Lite and thus he would oppose it as not ideological enough.

Nevertheless, the bill eliminates virtually all taxes that pay for Obamacare, effectively delivering a tax cut that will favor the wealthy. It also eliminates the “individual mandate” for participation.

I encourage you to read the bill here, (though I warn that it is almost incomprehensible in its form of amending various income tax regulations) and to reach out to the Senate Republicans most concerned about the cuts — Lisa Murkowski of Alaska, Susan Collins of Maine, Dean Heller of Nevada, Bill Cassidy of Louisiana, Rob Portman of Ohio and Shelly Moore Capito of West Virginia. The Republicans can afford to lose only two votes.

As with the House bill, under the Senate version, if you are older, poorer or sicker, after a few years, your costs will go up with a more money for deferring costs than the House provided only in the short-term. But at least you won’t be forced to buy health insurance, as we are forced to buy liability insurance to drive a car.

From all description, the bill cuts more deeply into Medicaid by 2024 rather than 2020, past the reelection terms of sitting senators, and virtually takes the government out of ensuring access to health. At the same time, the federal government will cut monies for health and environmental programs. As an opiates epidemic rages, the government talks about saving money on social services; as we try to deal with unrelenting public bouts of cancer, heart disease, obesity, diabetes and other illnesses, the government cuts money for scientific research; as we wrestle with how to keep people healthy, our government representatives just attack each other with verbal pillows.

None of this will stop uninsured people — and there will be a lot more of them — going to the hospital emergency room for coverage — at taxpayer expense. None of this will provide as much preventive health. None of this will lessen mental health issues, or addiction or the growth of new public health issues. None of this will stop the uninsured kid in your child’s classroom from sharing viruses. None of this will reduce infant mortality, provide solutions to chronic illness or fight cancer and diabetes issues.

None of this will explain away the actions of Republicans to knee-cap the current exchanges. None of this even will reduce abortions, which were already barred from federal reimbursement.

What it does do is move the fight for your health care to the state level. Clearly Mississippi will provide little, and California and New York will maintain current standards for health insurers to do business in the state.

Whatever else results, the cost of most insurance packages that are actually useful will continue to go up. Even employee health programs will suffer, because it is likely that the fine print in this bill will require caps on employer responsibilities, and tax anything covered beyond the minimum.

My standard for this administration has been simple: Judge the effects more than the talk, although I do believe that words matter. The results here will be catastrophic for millions of people.

The political pundits have us looking at a few select questions — but only as guideposts for reaching 50 Republican votes:

Individual Mandates? Eliminated.

Subsidies for insurers: Continued at lower rates through 2019.

How does it handle Medicaid? As outlined, the cuts are deeper than the House version if starting four years later. In the short-term, the bill continues subsidies based on age and income, much like Obamacare, but with less money — cuts that will hurt the poor and disabled. McConnell is betting that delay will win over wavering Republican votes. There would be structural changes to Medicaid to change the current open-ended benefit.

Is anti-abortion language included? Yes. It proposes to withhold any payments to Planned Parenthood, even for non-abortion procedures.

How does it deal with pre-existing conditions? This is not entirely clear. The issue is whether localities can “waive” such requirements, and make payments from state Medicaid funds based on a combination of age and income

Are there tax credits? Yes. Those not receiving health care coverage through work or government program can be eligible for a tax credit. Clearly these benefit wealthier citizens more. There also is a provision to bar recent immigrants from eligibility.

Does it address opioid addiction? No.

Notice that few of these questions really assess health; they are meant to win votes, not solve the problems we face.

I look forward to a debate that helps me understand how this represents “heart.”

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