Terry H. Schwadron
Well, our Republican-majority government has done it: The House narrowly has repealed Obamacare, and started the replacement with something that will worsen health care in all respects.
As you know well by now, the approval came about because of a last-minute infusion of more billions of dollars towards state-run high-risk pools that, by the time it is parceled out, will not be enough to guarantee coverage for all who need it, that will tilt much more cost toward the sick and aging Americans, punish Planned Parenthood and that provides a good result only for wealthier, younger citizens.
The concerted effort to get through the House with only Republican votes means the bill will go on to the Senate, where the politics for passage are dicier.
Needless to say, the talk was all self-promotional and the sports-win analogies out of control. The best argument for the bill was the threat, which Republicans are worsening by their actions, that insurers are fleeing rural areas where they are having trouble making a profit, and to eliminate government mandates that force participation to balance costs more fairly. There has been absolutely no attempt to try to address through the full variety of governmental means to shore up the inadequacies of Obamacare.
The bill has lots of side swipes, including cutting school monies for the disabled and likely forcing states to raise taxes if they want to maintain Medicaid spending. In general, it trades the mandate for all for a mandate to stay young and healthy.
I’m angry for myself, for people without health care, for a government that cannot follow logic and cares more about ideology of tax cuts than the health of its citizens. I am angry at a bill that means it is on sick and aging individuals to have to fight for themselves or simply die trying. I’m angry that we need to rid ourselves of our health care system only because it has Obama’s name on it. I’m angry that our society does not recognize that profit-driven insurers have no incentive to make health coverage available to the sickest of our people.
The bill was passed without full review by the Congressional Budget Office, but every medically oriented group in sight, every group concerned with health and aging, including AARP, doctors, nurses, hospitals and even most insurers opposed the bill.
My friend, Los Angeles Times columnist Mike Hiltzik was among those who added up the worst elements of “a nasty bill that will harm you and your neighbors.” You can see it here. As both he and I have written, this version of the bill is worse than the original in a variety of ways:
Hiltzik argues that the AHCA guts protections for those with pre-existing conditions by allowing states to opt out of coverage rules prohibiting insurers from charging sick people higher premiums. Of an estimated 129 million with such conditions, the ratio rose sharply with age — from about 35% of Americans 18 to 24 to 86% of those 55 to 64. The protection are guaranteed only if there has been continuous insurance coverage, something often abridged as customers move from one plan to another.
Secondly, state-run high-risk pools are supposed to step in if insurance runs behind cost. Obviously, the high-risk pools which will be administered by the states as the states themselves decide, is finite. The main problem with this idea: The amount of money assigned to the pools, a total that was boosted by the last-minute amendment. Hiltzik’s details show that even minimal coverage numbers would require more than $18 billion annually; they have appropriated much less than that. Hiltzik notes that high-risk pools have been tried and abandoned in most of 35 states that tried it, commonly for underfunding.
Third, even people with employer plans could lose coverage. The same state waivers could gut safeguards against catastrophic costs for people with coverage through large employer plans. Among other things, employers with workers in several states could choose which state’s regulations to comply with for all its employees.
Fourth, the bill kills Medicaid expansion and cuts traditional Medicaid by a massive $800 million. Under the GOP plan, Medicaid expansion, which currently provides coverage to some 10 million low-income Americans, would be killed as of 2020. It also converts Medicaid into a block-granted program, stripping more than $800 million from the program over 10 years. Because block-granted program can’t keep up with the needs of beneficiaries, this means that states would have to respond to fiscal stringencies by cutting benefits or throwing enrollees out.
Fifth, it defunds Planned Parenthood and threatens abortion protections in many states, renewable each year. Hiltzik says the bill could also render enrollees in health insurance plans in states such as California and New York, where abortion coverage is a required benefit of all health plans, ineligible for premium subsidies.
The review of the original bill showed that more than 24 million Americans could lose their coverage. Moreover, premiums would rise by 15% to 20% in the first two years after repeal, the CBO said. They would fall thereafter, compared with their level under current law. But that’s largely because the repeal measure would allow insurers to offer junkier insurance by eliminating requirements that qualified plans cover a specified percentage of medical costs.
Lastly, the bill is really a poorly disguised tax cut for the rich. Any money saved would go to wealthier taxpayers.
Let’s hope the Senate does better.