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Hullabaloo


Thursday, July 06, 2017

 

Trumpcare for kids

by Tom Sullivan


Source: Georgetown University

If policymakers are not focusing on quick fixes, they are fixating on the the wrong problems. Politico this morning examines how the focus on lowering insurance premiums misses the still-growing overall cost of health care: prescription drugs, hospital stays, deductibles, co-pays, etc. Even if Republicans were to somehow rein in premiums, the overall costs are going to pop out somewhere else, like putting your thumb on a blob of mercury from a broken thermometer.

Growing premiums made a tight, sound-bite issue to run on last fall:

“Too many in the GOP confuse adjustments in how insurance premiums are regulated with bringing competitive pressures to bear on the costs of medical services,” the American Enterprise Institute’s James Capretta wrote in a recent commentary for Real Clear Health. “They say they want lower premiums for consumers, but their supposed solution would simply shift premium payments from one set of consumers to another.”
Republicans claim their plans for replacing Obamacare will cut the federal government's health care expenditures — $800 billion less on Medicaid over a decade. But that will only shift the burden elsewhere.
Many Republicans predict that limiting federal payments to states would force Medicaid to be more efficient. Democrats says the GOP bill would basically thrust those costs onto the states and onto Medicaid beneficiaries themselves, who are too poor, by definition, to get their care — often including nursing homes — without government assistance.

The CBO gave a mixed assessment of what would happen to premiums under the GOP proposals. They’d rise before they’d fall — and they wouldn’t fall for everyone. Older and sicker people could well end up paying more, and government subsidies would be smaller, meaning that even if the sticker price of insurance comes down, many people at the lower end of the income scale wouldn’t be able to afford it.
The Kaiser Family Foundation believes it is the overall cost of health care the public feels more than premiums.

The Los Angeles Times considers what $800 billion less spent on Medicaid will mean to children in rural areas such as Fayette County, West Virginia where voters overwhelmingly supported Donald Trump. Five percent of children nationwide are without health coverage today, down from 14 percent two decades ago. Cutting Medicaid puts them at renewed risk:
“There is just no way to cut Medicaid on the scale that they are talking about and avoid hitting kids,” said Dr. Traci Acklin, who grew up in Fayette County and now runs the only pediatrician’s practice in Montgomery, out of the first floor of a community hospital founded a century ago to care for sick miners.

“Without the health insurance, kids aren’t going to get the immunizations and the checkups. There are going to be more lost days of school. More trips to the emergency room.... It would be food or healthcare for a lot of these families.”
Medicaid expenditures for children yield improved health, reading scores, and reduced dropout rates as well as higher future earnings according to research cited by the Times:
Overall, the Senate GOP legislation would slash more than a third of federal Medicaid funds over the next 20 years and nearly double the ranks of the uninsured by 2026, according to recent analyses by the nonpartisan Congressional Budget Office.

Budget analysts and many state governors, including some Republicans, predict such a retrenchment will have a devastating impact, including on children, as some 45 million low-income children rely on Medicaid and CHIP nationally.
The vast majority of counties where those children on Medicaid or CHIP reside — 622 of the 780 counties — have populations under 50,000, the report continues. "Most of the counties are overwhelmingly white, with the exception of predominantly African American counties in the Mississippi Delta and heavily Latino counties in New Mexico and along the Rio Grande Valley in Texas." In Arkansas, Mississippi and New Mexico, a majority of children in three-quarters of the counties count on two or more taxpayer-supported plans.

If the current Republican plan(s) for Obamacare reform pass, more is at stake for adults as well, writes Anna Maria Barry-Jester at FiveThirtyEight:
There’s little doubt that reducing the program’s federal funding by $772 billion over the next 10 years would alter who Medicaid covers and what services enrollees can receive. Medicaid covers more people than any other entitlement program in the country, so any changes would affect a lot of people. The program is responsible for 62 percent of nursing home residents in the U.S. and covers nearly half of all births. It also insures people who are in particularly dire need of health care: children with complicated, chronic conditions and people with HIV, for example. And that costs a lot of money. Medicaid is one of the federal government’s largest expenses, after Social Security, defense and Medicare. It’s the second-largest expense to states, after education.
What a shame the richest country in the world can no longer afford Americans. It will shed blood to defend them, but it won't spend money to heal them.

Well. The holiday is over. Time to get back (myself included) to making sure our electeds don't get an extended one.

Update: NC Senators faxed.