As details emerge from Senate Republicans’ backroom deliberations to
write a single bill repealing Obamacare, defunding Medicaid and
deregulating health insurance, it's clear that virtually no American
household—apart from the very rich—would be immune from fiscally painful
and medically harsh consequences if the GOP gets a bill to the
president’s desk.
For the past month, an 11
man committee appointed by Senate Majority Leader Mitch McConnell, R-KY, has been meeting
in secret
to fine-tune the House-passed Obamacare repeal legislation. They are
not starting anew, but are polishing a bill that will leave 15-20
million people without health care, prompt higher insurance and medical
costs for all but the youngest adults, freeze and shrink state-run
Medicaid (which now covers
45 percent of the children in rural America), and defund Planned Parenthood. This is according to
analyses by the Congressional Budget Office, Kaiser Family Foundation and others.
Even the pro-corporate
Washington Post editorial board has called out the GOP for its chaos-creating prescriptions,
writing that
they are “motivated to solve a problem that does not exist—saving a
health-care system supposedly on the path to inevitable collapse by
repealing and replacing Obamacare.” None of that seems to matter to
McConnell, who wants to pass the as-yet-unreleased bill before the
Senate’s July 4 recess. While defections from the GOP’s
far right or few
moderates
could thwart any Senate bill’s passage, the White House has made it
clear it wants McConnell to pass something the president can sign.
What’s
unfolding in Washington right now is appalling. Beyond the cowardly
political tactics, the GOP is literally playing with the lives and
livelihoods of hundreds of millions of Americans.
Everyone ages, and
many will get sick and develop chronic illness and disease. The
consequences can be devastating if the GOP shreds medical safety nets
for the poor and allows the insurance industry to charge more yet
deliver less health security in myriad ways.
What follows are 10 takeaways from the Senate’s Obamacare repeal process.
1. McConnell’s skullduggery is back.
As Andy Slavitt, the acting administrator of the Centers for Medicare
and Medicaid Services from 2015 to 2017, wrote in a Washington Post
column Saturday,
only 8 percent of the public supported passage of the House’s Obamacare
repeal bill (which also slashed Medicaid and included major tax cuts
for the rich). He could have told senators to fix Obamacare’s problems,
such as allowing small states to form insurance pools.
“Instead,
McConnell put a plan in place to pass something close to the House bill
using three simple tools: sabotage, speed and secrecy,” Slavitt wrote.
“He formed a committee to meet secretly, hold no hearings, create a
fast-track process and pressure Senate skeptics with backroom deals.”
Trump just wants it done, Politico.com
reported. “He’s definitely leaving it to Mitch to lead. But he very much wants it to happen,” Sen. Bob Corker, R-TN, told Politico.
2. Congressional chaos is having its desired effect—2018 premiums to rise.
The GOP is not just sending mixed signals about what they may do to
one-sixth of the U.S. economy. They are intentionally provoking insurers
to raise their prices for 2018 as a pretext to pass their legislation.
This was cited in a Washington Post
editorial,
“The GOP’s Obamacare Sabotage Continues,” in which the editorial board
was unusually clear-eyed. “‘Insurers have made clear the lack of
certainty is causing 2018 proposed premiums to rise significantly,’
House Ways and Means Committee Chairman Kevin Brady (R-Tex.)
said Thursday, arguing that Congress should step in.” That’s creating a problem to fit a solution.
3. Meanwhile Trump’s team is also embracing more chaos. The Trump team is doing everything it can not to enforce Obamacare, such as “lax enforcement of the
individual mandate
to purchase health insurance, inadequate efforts to enroll more people
in coverage and other gratuitous subversions of the finely tuned system
Obamacare sought to create,” the same Post
editorial said. As significant, the White House is refusing to commit to paying 2018 Obamacare subsidies for millions, according to
Vox.com,
which reported that Secretary of Health and Human Services Tom Price
wouldn’t even tell a U.S. Senate committee what the administration’s
plans were.
4. Against this backdrop, the Senate is 'making progress.' That’s
the word from a handful of center-right Republicans who have been shown
glimpses of what’s going on behind closed doors—as if reversing one or
two planks of the House bill is supposed to be a sign of moderation.
That is absurd. Moreover, what the Senate is said to be doing is
terrible.
For example, restoring Obamacare’s pre-existing condition
rule—which requires insurers to sell people policies—but without cost
controls or coverage requirements. Last month’s Congressional Budget
Office
analysis
of the House-passed bill said a wide swath of the public “would be
unable to purchase comprehensive coverage with premiums close to those
under current law and might not be able to purchase coverage at all.”
Moreover, many policies are likely to cover less once minimum coverage
standards are deregulated.
5. The young will pay less, but everyone else won’t. The only people who stand to benefit, the New York Times
reported,
are those least likely to get sick. “The budget office [CBO] did note
that the House bill would potentially lead to lower prices, especially
for younger and healthier people,” it said. “But the budget office also
warned that markets in states that allowed insurers to charge higher
premiums for people with pre-existing conditions—whether high blood
pressure, a one-time visit to a specialist or cancer.” This is what
deregulation of the insurance industry will bring. The industry will go
back to creating more barriers between patients and doctors.
6. Many policies will only be used for hospitalization.
Other analyses include scenarios where people will see deductibles rise
to levels where they will pay for most care until a serious emergency
requiring hospital care arises. As the Times
wrote,
that can amount to a major fiscal burden.
“Millions of people could
also wind up with little choice but to buy cheap plans that provided
minimal coverage in states that opted out of requiring insurers to cover
maternity care, mental health and addiction treatment or rehabilitation
services, among other services required under the Affordable Care Act.
Consumers who could not afford high premiums would wind up with enormous
out-of-pocket medical expenses.”
7. Medicaid is going to be frozen, justified by big lies. Another detail that’s leaked out of the Senate drafting sessions is that it’s not a question
whether
Medicaid will see $800 billion in reduced spending and 14 million fewer
recipients during the next decade, as the House bill laid out. Rather
it is a question of how fast the Medicaid rollback will be. The Hill
reports there’s been debate whether it will be three years or seven years. Vox.com also
reports
that the Senate wants to institute an approach that could lead to
sharper funding cuts than the House: more frequent revisions to Medicaid
reimbursement rates.
The White House and GOP talking points on this are a series of lies. HHS Secretary Price
told
a Senate committee, “We are trying to decrease the number of
uninsured,” after the CBO estimated that 23 million people would lose
insurance. Trump has said he will not touch Medicare—even though
Medicaid pays for nursing home care in that program. And Republicans
keep saying this is not spending cuts, but slower spending increases.
“What the defenders of this claim—ranging from
Karl Rove to
Sally Pipes—have insisted is that this is a cut to the growth rate, not cuts to the existing program,”
wrote
health policy blogger Emma Sandoe. “The reality is that states will
have to reduce the number of services they provide or reduce the types
of people that can enroll as inflation and increased costs in medical
services rise.”
8. This is a war on government and on the poor. What the GOP is trying to do is not just go after Obamacare, but dismantle safety nets dating back to the 1960s. As Sandoe
noted,
“The GOP has campaigned for decades on the idea that the social welfare
state is bloated and that the oversized growth of the welfare state
needs to be trimmed. The GOP should embrace the idea of calling
per-capita caps and block grants cuts. From a policy perspective, the
goal of the per-capita caps and block grants is to reduce the size and
scope of the program.”
9. Republicans are pursuing this despite vast opposition.
Recent polls show safety nets are incredibly popular while the GOP’s
American Health Care Act is not. On Medicaid alone, a Kaiser Family
Foundation
poll by Democrats and Republicans opposed cutting its expansion and changing its financing structure. “
Many other polls
show that the majority of voters have favorable views of Medicaid,
coming close to the level of support for Medicare,” Sandoe wrote.
“Telling is that a Quinnipiac poll found that Republicans oppose cuts to
Medicaid. This is one possible reason that the latest [GOP] messaging
appears to be focused on reframing the cuts as minimal. Meanwhile, the
AHCA has polled from
17–
21 percent by Quinnipiac and only
8 percent think that the Senate should pass these reforms without changes.”
10. If this passes, a colossal downward spiral will ensue.
The impact of the AHCA, if passed, is not just going to be fiscal—in
terms of increased out-of-pocket costs for those with insurance
policies. As the Times
reported,
people age 50 and older, and “millions of middle- and working-class
Americans” will once again be trapped in their jobs because they will be
unable to pay for coverage. “The Affordable Care Act has enabled many
of those workers to get transitional coverage that provides a bridge to
the next phase of their lives—a stopgap to get health insurance if they
leave a job, are laid off, start a business or retire early.”
For
those too poor to buy insurance, Medicaid will contract and likely be
forced to focus on emergency and crisis care, rather than prevention.
Rationing care will likely ensue, unless states step in with raising
revenues to offset federal cutbacks. Safety nets are likely to roll
backwards, landing somewhere between where they are now and where they
were before Obamacare’s reforms took effect.
McConnell’s Fast Track
As Axios.com
reported,
McConnell is hoping to finalize the Senate’s legislation this week,
because the Congressional Budget Office will need two weeks to “score”
it—the Washington term for assessing its financial and programmatic
impacts—if it is to come up for a Senate floor vote before the July 4
break. While it's possible that McConnell could present a bill without
that analysis, it is likely that more details will emerge in coming
days.
At that point, Republicans will surely feel the full wrath
of voters who aren’t going to have anything positive to say if their
health care is trashed, or if the GOP tries to blame Obama and the
Democrats for market chaos they have worsened, not diminished.
