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Thursday, May 04, 2017


Due negligence

by Tom Sullivan

They hate Obamacare almost as much as they love tax cuts for wealthy donors. Repealing the first swiftly and without care for the impacts to provide cover for the second is the Republicans' game. They plan a vote today.

Stunned that the bill will go to a vote without scoring by the Congressional Budget Office, Sarah Kliff wrote yesterday at Vox, "Republicans will vote tomorrow for a health care bill without knowing how many people it covers or how much it would cost."

To clear up some of the mist, Jonathan Chait details some of the known features of TrumpCare. It sounds as if Republicans plan to repeal the ACA and replace it with what we had before:
The heart of the bill is the same one that was polling at under 20 percent and failed two months ago: a near-trillion dollar tax cut for wealthy investors, financed by cuts to insurance subsidies for the poor and middle class. They have added a series of hazily defined changes: waivers for states to allow insurers to charge higher rates to people with preexisting conditions and to avoid covering essential health benefits, and a pitifully small amount of money to finance high-risk pools for sick patients. The implications of these changes are vast. The Brookings Institution notes that, if a single state eliminated the cap on lifetime benefits for a single employee, then employers in every state could actually follow suit, thus bringing back a horrid feature of the pre-Obamacare system, in which people who get hit with expensive treatment suddenly discover that their insurer will no longer pay for their care. This would affect not only those getting insurance through Medicaid or the state exchanges, but also through their job.
The reason for that is this: Because the president insists on insurers having the flexibility to sell plans across state lines, large insurers could base their coverage on the state rules most favorable to their bottom lines. States can obtain waivers on what they include as part of the ACA's “essential health benefit,” that is, what plans must cover. Thus, Brookings' Matthew Fiedler explains:
In particular, a single state’s decision to weaken or eliminate its essential health benefit standards could weaken or effectively eliminate the ACA’s guarantee of protection against catastrophic costs for people with coverage through large employer plans in every state. The two affected protections are the ACA’s ban on annual and lifetime limits, as well as the ACA’s requirement that insurance plans cap enrollees’ annual out-of-pocket spending. Both of these provisions aim to ensure that seriously ill people can access needed health care services while continuing to meet their other financial needs.


Thus, the most likely outcome is that any state’s waiver of essential health benefits under the MacArthur Amendment would weaken the ACA’s guarantee of protection against catastrophic costs for people working for large employers in every state.
Chait continues:
They are rushing through a chamber of Congress a bill reorganizing one-fifth of the economy, without even cursory attempts to gauge its impact. Its budgetary impact is as yet unknown. The same is true of its social impact, though the broad strokes are clear enough: Millions of Americans will lose access to medical care, and tens of thousands of them will die, and Congress is understandably eager to hasten these results without knowing them more precisely. Their haste and secrecy are a way of distancing the House Republicans from the immorality of their actions.
The less you know, the less resistance they face.

TrumpCare 2.0 is getting the bum's rush through the House with the expectation that corrections will be made later. A potential No vote from Rep. Fred Upton (R-Mich.) got turned around after an amendment added $8 billion over five years to cover expenses of people shoved into a high-risk pool in states that obtain waivers. Upton tells reporters:
“Is it enough money? I don’t know. That’s the question that I asked,” Upton told reporters. “I was led to believe that $5 billion would be enough, which is why it’s $8 billion, to make sure that in fact it’s more than enough.”

“If it’s not,” he said, and CBO comes back with a report that shows that, “then a number of us, including me, will seek more money.”