This is the third and final post in this series, though I’m sure it will not be the last relating to health care.
By January 20th of 2017 the federal government was controlled by Republicans, most of whom had been promising to kill the ACA for seven years. The Showman-in-Chief now residing on Pennsylvania Avenue had campaigned on it and the Speaker of the House Paul Ryan loudly proclaimed that the party had to keep its promise to the base and immediately repeal and replace the failing health care plan. Of course, Ryan’s entire career has been focused on reducing taxes and balancing budgets and he knows that he can’t tackle either until health care is resolved.
By the beginning of March, Ryan had hastily thrown together what was to be the death knell of expensive and freedom-stealing Obamacare, although February polls showed that 54% of all Americans approved of the ACA, and even 42% of surveyed Republicans indicated they just wanted the plan fixed, not completely dismantled (Pew Research Feb 2017). When specifics of the Ryan plan were made public, only 17% of all voters polled approved of it (Quinnipiac University Poll). The bill failed to pass.
The Speaker calmly announced that Republicans would just have to try it another time, while immediately meeting with competing opponents within the party, promising changes and amendments to the bill, some conflicting and almost all guaranteed to anger the public. Meanwhile, POTUS wined, dined and threatened conservative lawmakers before taking to Twitter with bold promises, many of which were in direct contradiction to what was being documented in the revision. Finally, on May 4, 2017, all of the cajoling was complete and it was rumored that even a couple of Republican representatives had read the bill. A vote was called and the bill passed, 217 to 213, along with the assurance that any imperfections would be smoothed out by the Senate before final approval (H.R. 1628).
So what will the America Heath Care Act do? The high points are:
- Eliminate the individual mandate to have insurance and the employer mandate to provide insurance.
- Eliminate any cost sharing (patient out-of-pocket) subsidies and modify the subsidies for premiums from income based to an age-based flat credit and add a credit phase-out at higher income levels.
- Eliminate the incentives for small businesses to provide coverage along with ALL of the taxes imposed by the ACA, including the penalties for not having or providing coverage, the increased payroll tax and investment income tax on high earners, the added tax to pharmaceutical companies and insurance companies and the increased medical device sales tax.
- Continue to define a child up to the age of 26 as a dependent child and prohibit the declination of coverage to someone with a pre-existing condition. However, states can request a waiver to use experience rating instead of community rating, terms you may remember from my first post in this series. Insurance companies in states who receive the waiver couldn’t deny coverage to folk with pre-existing conditions or old people, but could increase premiums for those individuals and redefine what essential benefits are. Not to worry, says Speaker Ryan. The act also provides up to $138 Billion (over 10 years, possibly divided by 50 states and the District of Columbia), to help any waiver victims pay for extra premiums and/or out-of-pocket expenses, though the funds come with lots of caveats and time-frame limitations.
- Keep essential coverage definitions, but again, allow states to request waivers to redefine “essential”.
- Mandate that Insurance companies MUST impose a one-year late enrollment penalty of 30% for folk who let their coverage from any insurance source lapse for more than 62 consecutive days. Meaning if you lose your job (and consequently either your employer-provided policy and no way to pay for cobra or no way to pay for your private policy premiums), you have to come-up with an additional 30% just to get back in the game. I was unable to determine the impacts on a Medicaid recipient who loses eligibility for 62 days.
- Defund Planned Parenthood for one year, even though ALL of the previous rules preventing funding, subsidies or tax credits related to any insurance policy providing non-Hyde Amendment abortions (abortions not needed to save the mother or not related to pregnancies resulting from rape or incest), stay in place, so this was apparently just a spiteful jab at liberals without concern for the low-income victims of reduced family planning services.
- Ends the Medicaid Expansion program and then changes funding from matching to block grants and creates caps. The Congressional Budget Office (CBO) indicates that move will cut Medicaid spending by $880 billion, but which Paul Ryan insist will help more low-income citizens.
While there can be many interpretations of this bill, mine is that conservatives believe health care is only for those who can afford it. If that is correct, then why don’t they just admit it so that the country has a baseline for the discussion. If the majority of Americans believe that basic health is a commodity available only to those with the ability to pay for it instead of a right, then let’s stop wasting time and resources trying to develop a government solution.
Those with means can continue to have their ills and their pains treated while those without can just do without, or try to convince one of our religious institutions (Christian, of course), to assist. However, since churches currently enjoy tax-free status, some individuals might interpret such aid to the sick as a government subsidy. A subsidy not up to interpretation would be the pre-tax treatment of employer-provided policies, so that policy would need to be rescinded immediately. An expense that will have to come from the public coffers, however, is that for the collection and disposal of the bodies. Not even a health care system for the affluent can adequately compensate for the diseases caused by heaps of decaying flesh.
It’s curious that even the staunchest, voucher-loving conservative doesn’t suggest that only the children of employed parents should be educated. They understand, if even from the most selfish vantage point, that an educated population is necessary for society to function properly. If for no other reason, we should all want an educated populace so that they can become good workers, hopefully supporting themselves, thus limiting their reliance on public assistance and allowing them to contribute to our Social Security system (retired Republicans still cash those checks, don’t they?). Why can’t we agree that the health of our citizens and the protection of their financial well-being are equally important?
The following 26 industrialized countries have Universal Health Care (UHC), with various combinations of funding sources, available services and government versus private delivery systems:
New Zealand Norway
Before you enlist the “if your neighbor jumped off a cliff, would you?” argument, please note that most of the countries above are routinely rated by their inhabitants as great places to live and I don’t believe any of them currently comprise a large portion of the waiting list to immigrate to this country.
UHC does not mean that every conceivable treatment or service is offered. Yes Sarah Palin, there would be Death Panels. They have existed for years, but they haven’t been run by bureaucratic committees, they’ve been headed by the CEOs and CFOs of insurance companies. Why not let elected (or at least appointed), folk develop those answers, without a stock-split or dividend pay-out as the goal?
UHC is also not limited in scope to just providing insurance. It has to include participation in service delivery, medical technology and pricing (yes, Big Pharma, that includes negotiation for drug prices). The free market has and will continue to create great things, particularly in the areas of “wants”. But we should not leave the he operation of systems providing what we define as “needs” to lords of profit.
The ACA is far from perfect, but solutions will take both liberal and conservative efforts. If we can all agree, even for self-serving purposes, that a healthy country is a successful country, then we can start working together to make it a reality. We are a nation full of bright folk and we have the experiences and ideas of at least 26 other countries to build upon. I believe it is only our attitudes that are holding us back.