The Republican Healthcare Scam Keeps Getting Worse

The struggle by the House Republicans to repeal and replace the Affordable Care Act (ACA) has been a scam to cut one trillion dollars from health care programs. The GOP bill will not lower premiums or deductibles or improve access to affordable healthcare. It will also cut Medicaid by $800 billion.

By effectively ending the Medicaid expansion and converting Medicaid to a per capita cap, the previous version would have cut federal Medicaid spending by $880 billion over the next ten years and reduced Medicaid enrollment by 14 million people in 2026, the Congressional Budget Office (CBO) estimated. The updated version makes additional changes to Medicaid that are even more damaging overall, including giving states the options to: convert their Medicaid programs into block grants; impose onerous work requirements on adult beneficiaries who are not elderly, disabled, or pregnant; and freeze enrollment in the ACA’s Medicaid expansion starting in 2020. These provisions would likely add to the millions of people who would have Medicaid coverage under the ACA but would become uninsured under this legislation. They also would cut needed care still more deeply for many who keep their Medicaid coverage.

Many of those Medicaid recipients have preexisting conditions. Covering preexisting conditions has been the biggest hang up for the House. The far right wing Freedom Caucus don’t want to require insurance companies to cover them or much else for that matter. While the moderate GOP members, many of whom are in Democratic leaning or purple districts, having faced some very angry constituents want something to protect those people. The problem is all the amendments attempting to create and fund high risk pools just make it worse. The latest proposal is the biggest scam yet that, unfortunately, just may get the votes to pass. Greg Sargent at the Washington Post‘s Plum Line explains the latest amendment.

The new amendment, which is being championed by Rep. Fred Upton (R-Mich.) — who made a huge splash by opposing the bill yesterday — would essentially add $8 billion of funding over five years in addition to the so-called high-risk pools, which are supposed to function as a safety net for people with preexisting conditions who lose coverage as a result of the GOP bill. The Republican plan would gut protections for people with preexisting ailments, because it would allow states to waive the prohibition on insurers from jacking up premiums for them — a prohibition that’s called “community rating” — which could lead to soaring costs and many of them getting priced out of the market entirely.

This is a major reason that so many moderates oppose the GOP bill. Even though the bill also requires states that waive those protections to set up some sort of mechanism for people with preexisting conditions — such as high-risk pools — history has shown that they are traditionally underfunded, hit sick people with massive premiums (since only sick people are in the risk pools), and, as a result, leave many uncovered.

Thus the new $8 billion amendment. The Associated Press reports that this $8 billion would be allotted to helping some of those people cover some of those costs so that fewer go without coverage. But as the AP notes, the sum is a paltry addition relative to what is currently in the bill, and that sum is already being derided as woefully inadequate — so it’s hard to see how this $8 billion changes much:

Upton said the proposal would provide $8 billion over five years to help some people with pre-existing medical conditions pay costly insurance premiums … There’s already around $130 billion in the legislation for such assistance, which critics call a fraction of what would be needed for adequate coverage.

That’s a move from $130 billion to $138 billion, and there are tens of millions of people in the United States who suffer from preexisting conditions. I asked Larry Levitt, a senior vice president at the nonpartisan Kaiser Family Foundation, what impact this additional $8 billion would have. He emailed:

If you waive the community rating requirement in the ACA, insurers will charge people with pre-existing conditions astronomical premiums to make sure they’re priced out of the market entirely. $8 billion sounds like a lot of money. But, spread over five years and the potentially millions of people with pre-existing conditions in the individual market with a gap in insurance who would face very high premiums, it won’t go very far.

If a large number of states seek waivers from community rating, this money could maybe help a few hundred thousand people, while millions of people with pre-existing conditions are buying insurance in the individual insurance market or uninsured.

Levitt pointed out that the money could go a lot farther if few states seek these waivers. But the plain fact of the matter is that many red-state lawmakers are very likely to seek them, since they’d presumably either want to relax the Affordable Care Act’s regulations or come under tremendous pressure to do so. In this scenario, then, this additional money would help only a fraction of those with preexisting conditions who could be harmed by the GOP bill.

And let’s not forget the crucial larger context here. Though the discussion is heavily focused on preexisting conditions, the GOP bill would also cut $800 billion in spending on Medicaid, which could leave 14 million fewer people covered (pdf) by that program, even as it delivers an enormous tax cut to the rich. So, even with this amendment — which itself would probably do little to mitigate the harm to people with preexisting conditions — the bill is still a massively regressive rollback of the ACA’s historic expansion of coverage. Many GOP moderates who opposed the first and most recent version of the bill cited this, too, as a crucial reason for opposing it. So it’s hard to see why this amendment should make a difference, in moral and substantive terms.

Of course, many of these moderates are probably looking for some way to get to Yes, and some may grab on to any kind of “change” to pretend that the bill’s cruel and regressive dimensions have somehow been mitigated. But if so, this could still constitute an enormous political risk. According to the New York Times’ whip count, a large number of House Republicans who currently oppose the GOP bill or are undecided are either moderates, or come from districts won by Hillary Clinton, or both. It’s very hard to see how this $8 billion addition will somehow insulate them from attacks, since the bill still guts protections for people with preexisting conditions and rolls back health coverage for millions and millions of poor people.

The bottom line is that funding to help cover people who fall into high risk pools will fall short by $200 billion over ten years leaving many of them without coverage or access to care.

None of these bills address the real problem: health insurers and pharmaceutical companies that charge consumers whatever they want. There are no regulations limiting how much they can raise premiums, deductibles or the cost of life saving medications.

Jimmy Kimmel is right, “No parent should ever have to decide if they can afford to save their child’s life,” he said. “It just shouldn’t happen. Not here.”

But it still does, even with Obamacare, there are still millions with no insurance, and that is fixable. Republicans and some Democrats (Hello Diane Feinstein) don’t want to do it and if Trump and the GOP have their way, it will get worse.