The Republicans’ health bill is an act of supreme hypocrisy and insensitivity to the experience of Americans. It will damage — not improve — the U.S. health system.
Obamacare was a failure because it passed with only Democratic votes — so charged Republicans. Yet all through 2009, Democrats tried to get Republicans to engage in discussions about health-care reform. Remember the “Gang of Six” or the “Gang of Eight” that Democratic Sen. Max Baucus ran to try to craft a bipartisan bill? Now, given their own opportunity for a bipartisan health-reform bill, Republicans passed a totally partisan bill and never even tried reaching out to Democrats to see if there could be consensus.
Democrats are giving the insurance companies bailouts — so charged Republican Sen. Marco Rubio. The Affordable Care Act contained risk corridors, a way to spread the risk across insurers when the exchanges just started and no one knew who would buy insurance. In 2014, Republicans voted to block funding for these risk corridors — a main reason that premiums on the exchanges went up so much in 2016 and 2017. Now, in their own bill, Republicans have included tens of billions of dollars for insurance companies. Bailout? No, Republicans relabeled this a “stability fund.”
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Republicans promised they would never allow insurance companies to discriminate against people with pre-existing conditions. Well, so much for that. House Speaker Paul Ryan’s bill allows states to grant companies the ability to charge exorbitant fees to people with pre-existing diseases. The Republican claim that no state will pass such bills is ridiculous. Why have the option then? More important, we know states have done much worse in the past. Remember Arizona denying bone-marrow transplants to patients with curable cancer on Medicaid? Who would have thought that could happen?
And those high-risk pools Republicans claim will protect people with pre-existing conditions? They don’t work. Even with Rep. Fred Upton’s amendment offering an extra $8 billion to the stability fund, the pools would be totally underfunded. Just do the math. Insuring patients with serious illnesses will cost about $10,000 each (a conservative estimate), so Upton’s money covers fewer than 200,000 Americans. Not even a modest fig leaf.
Other Republican axioms: Obamacare is collapsing; the exchanges are dying; premiums are skyrocketing; and a third of counties have only one insurer. Let’s put aside that the Congressional Budget Office and Standard & Poor’s concluded that the exchanges are stable. Let’s put aside that Anthem just announced it is doing well in the exchanges. If they wobble, it is the Republicans’ doing.
A few fixes would enhance the exchanges’ functioning: 1) Enforce the mandate so more healthy Americans buy in the exchanges; 2) guarantee funding for subsidies to consumers so insurance companies can lower premiums; 3) fund the risk corridors and reinsurance payments; and 4) increase targeted advertising so more people know about the subsidies and the requirement to get insurance.
The Republican bill will increase costs. Cutting essential benefits means people must pay for those uncovered services — whether that’s maternity care, mental-health care or dental care for children. With more uninsured people, hospitals will increase what they charge to cover the uncompensated care they give, driving up premiums. And there is no provision to reduce deductibles.
Most important, this bill has no serious cost-control ideas in it. No change in how doctors and hospitals are paid to improve quality and lower costs. No measures to reduce drug prices. No attempts to lower Medicare costs through site-neutral payments — that is, paying the same price regardless of where a procedure is performed — or to prevent hospitals from buying up physician practices to increase their bargaining power and raise their costs. Desiring to do something, Republicans have only shown hypocrisy and callousness. As polls suggest, they won’t have to wait long to see the repercussions of their actions — only till 2018.