On Some Day in Healthcare
It’s been hard to keep up with the healthcare fight. Every time I sit down to write about it, something has changed — a new Senator has expressed reservations, a vote has been canceled, an amendment introduced. It’s a legislative system designed for social media, and you can tell because some of the best writing on the subject has come from Andy Slavitt’s twitter.
But it’s the weekend now; most of the new version of the Senate’s Better Care Reconciliation Act is with the CBO and the rest of it, the Cruz Amendment is with the Department for Health and Human Services for its own grade. It’s unclear whether, in a move they certainly learned from their high school aged children, the GOP simply forgot to submit the Cruz Amendment to the CBO, or more likely and more sinisterly, they left it out on purpose knowing that the CBO would give the amendment a pretty devastating score. Regardless, we’ve reached the eye of the storm. It’s time to take a deep breath, summarize what we know, and figure out how to move forward.
In many ways this new version of the BCRA is the same as the old one. Vox gets into greater detail here, but in sum the bill cuts Medicaid expansion, cuts the federal government’s open ended Medicaid funding agreement, provides smaller subsidies for less generous health insurance plans, defunds Planned Parenthood for one year, and essentially tries to reduce cost for the healthy and the wealthy while ignoring the by-product of higher healthcare costs and reduced coverage for poorer and sicker Americans. The original BCRA was universally panned by Senators, Governors, healthcare providers and advocates, and the American public in general.
When this bill unsurprisingly failed to get the necessary votes on a “motion to proceed,” Mitch McConnell did not go back to the drawing board. Instead, he tacked on a few handouts to states with more “moderate” Republican Senators, squeamish at the idea of depriving the most vulnerable voters in their states of affordable, accessible healthcare. Additionally, the bill may or may not also include the so called Cruz Amendment which allows insurers to provide plans that do not meet essential health benefit requirements as long as they offer at least one plan that does. The theory is that this would allow young, healthy people to buy cheaper plans with less coverage. In practice, as pointed out by the two largest representatives of insurance companies, “it is simply unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market.” In essence, this amendment rolls back government regulation, and insurance companies are acknowledging the devastating impact of that plan.
The new version of the BCRA contains several other disastrous components, adeptly summarized by the LA Times, that conservative Senators would rather we didn’t notice. These nuggets include no longer mandating coverage of birth control and women’s health screenings and exempting Senators from any loss of consumer projections caused by the bill. Furthermore, the insurance plans allowed by the Cruz Amendment would not count as “continuous coverage” according to the BCRA’s regulations. This means that anyone who had one of these plans and then got sick would have to wait 6 months before they could enroll in a plan that covers essential benefits.
Perhaps my favorite part of the new BCRA, however, is the attempts to buy off “moderate” Republican Senators. According to that same LA Times article, this bill creates “several slush funds to moderate the costs to states of various repeal provisions, especially the drastic cutback in Medicaid funding.” But access to these “slush funds” would be determined by Health and Human Services Secretary Tom Price, who could distribute funds at will — pulling from blue states to give to red states, pulling from states that cover abortion and giving to those that don’t. This provides healthcare by patronage, encouraging states to kowtow to the party in power regardless of what their voters want.
The bill also contains the exact amount requested for addressing the opioid epidemic by West Virginia Senator Capito and Ohio Senator Rob Portman — up from $2 billion over one year in the original bill to $45 billion over ten years in the new version. Senator Lisa Murkowski from Alaska gets access to $1.3 billion as part of a provision that provides 1% of a $132 billion bailout fund to states where premiums are more than 75% over the national average. (source)
These state specific handouts are the clearest evidence of the craven attitudes of the GOP towards healthcare. Each handout acknowledges that this bill reduces the quality of coverage, the amount of people covered, and the affordability of coverage and the Senators on the receiving end of these handouts will be making their decision with the full knowledge that whatever they accept for their state will come at the expense of millions of Americans who will lose their health insurance or see their healthcare costs skyrocket.
In some cases, these handouts do not come close to covering the cuts made by the bill. Most victims of opioid addiction are also Medicaid recipients, so regardless of the $45 billion, many will lose their insurance and thus their access to treatment. In others, states like Alaska, with only 0.2% of Medicaid recipients would essentially receive a hefty bribe to look the other way while millions of lives are impacted for the worse.
But honestly, none of this matters. Because the populations of states like Alabama and Missouri, whose Senators never considered not voting for this bill, get nothing. The populations of states like California and Virginia, whose Senators never considered voting for this bill, also get nothing. Access to healthcare for millions of Americans is in the hands of a few individuals who have to decide if they can stand up to their party and their voters in the interest of people whose votes and money they will never see.
I’d say it’s a hard choice, but at the very least, it shouldn’t be. They are worried about losing their donors, members of the moneyed class who would see a tax benefit from this bill and who never has to worry about healthcare coverage. They are worried about losing their jobs, forgetting perhaps that they are all well educated, well-connected individuals who will find it much easier to find another job than the person with a high school diploma and a pre-existing condition whose health insurance they are taking away. The idea that they are more afraid of donors than they are of the 83% of Americans who think this bill is a bad idea is astounding; that they are more willing to listen to those donors than to the thousands of people calling their offices is appalling.
They are worried about ad buys while millions of Americans wait anxiously to find out whether or not they will be able to take their kid to the doctor.
So what can we do? Keep calling. Not just your Senators, but your friends in other states, your local papers, your Representative in the House. Write letters, write blog posts, write tweets and statuses and instagram comments. Talk about it in the grocery store. If you live near your Senators’ local offices or you can to one, make an appointment. Film them saying no. Film your story, film your kid, film your cat playing with a “Save the ACA” sign. Take a picture of a cute dog holding the phone number to Congress’s switchboard. Tell your story. Tell your friends’ stories. Write it on your car, on your backpack, on your t-shirt. Talk to your mom, your dad, your cousin. Talk to strangers.
There are plenty of resources out there to help you focus your efforts if you need it. You can look at Trumpcare Ten to get resources for calling vulnerable Senators. You can email us at email@example.com for state specific call scripts. You can download the 5calls app. But more importantly than any of that is to be as loud as possible, in as many directions as possible.
Republicans have abdicated their responsibility, blinded by fear and privilege or eyes wide open to the imbalance of their moral calculations. It’s time for us to pick up the mantle, and so I leave you with this: 202–224–3121.