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Friday, July 07, 2017


Skimpier health care? Freedom!

by Tom Sullivan

The July 4th recess in Washington and Donald Trump's trip to the G20 summit has back-burnered reporting of some of the protests of the Senate health care bill. But they are still out there. Liz Plank writes at Vox:

Worried about the proposed cuts to Medicaid in the Senate Republicans’ version of the health care bill, several activists with disabilities staged a sit-in at the Phoenix office of Sen. Jeff Flake (R-AZ) on Wednesday. One protester, Anastasia Bacigalupo, live-streamed her arrest on Facebook as she and two other women being arrested shouted, “I’d rather go to jail than die without Medicaid.” According to AZ Central, four other people were arrested for trespassing.
It matters. Turning Medicaid into block grants to states and capping its growth could easily place cash-strapped states in the position of severely restricting aid to people with disabilities whose freedom to live and work as part of their communities, rather than as outcasts, was a long time coming. Freedom is a popular shibboleth on among conservatives, but amorphous and somewhat Darwinian in practice.
“We fought so hard to have our right to live in the community recognized, and now … we’re still fighting for our freedom from incarceration in institutions,” Gabrielle Ficchi, one of the protestors at Sen. Flake’s office, told Vox. “Home and community services are what allow us to do our jobs, live our lives, and raise our families,” she continued.
Amanda Marcotte highlights this morning how McConnell's plan strips the essential health care benefits in Obamacare as a way to lower premiums. Citing Timothy Jost, a health care expert from the Washington and Lee University School of Law, Marcotte writes, it is "a back-door way to deny coverage to people with pre-existing conditions, limit important and life-saving health services." Marcotte explains:
Under various versions of the Republican plan, states would be able to apply for waivers to exempt plans sold in their state from this mandated list of essential health care benefits. Republicans have repeatedly insisted that their bill bars discrimination against patients with pre-existing conditions. But as Jost explained, ending essential health care benefits creates a mechanism that allows insurance companies to deny coverage of those pre-existing conditions. You’d be allowed to buy insurance, but it might not pay for the things you really need it for.

“So you got a mental health problem, sorry, we’re happy to insure you, but we don’t cover mental health problems,” Jost said, describing the logic. “You’ve got cancer? We’re happy to insure you. We don’t cover any chemotherapy drugs or we don’t cover radiation therapy.”
Plus, Obamacare prohibits insurers from placing lifetime or annual caps on care covered under essential benefits. Repealing that brings back the threat of bankruptcy for a single illness or accident. Obamcare attempted to circumvent that.

As more people get wind of what is and is not in the Republican plan, the heat is rising on Republican lawmakers to reject it even as fractures in the Republican caucus make that more likely. Mike Lee of Utah and Texas Senator Ted Cruz believe in freedom, just a different kind from one that would help Gabrielle Ficchi. They are promoting including a Consumer Freedom Option in the bill that would allow insurers to offer plans with the full suite of Obamacare's essential benefits as well as "skimpier plans" with less coverage. (The Club for Growth backs the plan, just so you know.) But such provisions would surely alienate Susan Collins of Maine who heard nothing but healthcare from constituents on July 4th. “I don’t want to see insurance that’s not really insurance,” Collins said.

Over the break, Senate Majority Leader Mitch McConnell is warning of the consequences of the Senate bill failing. Republicans may have to work with Democrats to stabilize insurance markets, he told supporters in Kentucky, reinforcing the Trump narrative that Obamacare is collapsing:
"If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur," McConnell said at a Rotary Club lunch in this deep-red rural area of southern Kentucky. He made the comment after being asked if he envisioned needing bipartisan cooperation to replace Obama's law.

"No action is not an alternative," McConnell said. "We've got the insurance markets imploding all over the country, including in this state."
McConnell will try to keep up pressure on his caucus and twist arms. The scare tactics might still work. We thought the most unpopular piece of legislation in two decades was dead months ago and it's back again. A Morning Consult/Politico poll released this week shows what Republicans might be hearing while at home:
Overall, 44% said that the US healthcare system would be worse off under the GOP legislation, while 28% said it would improve.

Forty-five percent of people believed the Republican healthcare plan would increase their personal costs, while only 21% thought it would decrease costs. Republicans have touted the ability of the plan to bring costs down, but it doesn't appear to be resonating with voters.
What resonates with Republicans in Congress will be the threat of losing their seats, and then more to primary challenges than to general election losses. The fate of the Better Care Reconciliation Act will depend not on how much pressure McConnell exerts, but on how much voters do.