the bill would allow people to use tax-favored health savings accounts to pay insurance premiums. This effectively creates a big new tax shelter that mostly helps people with high incomes
.. So this is still a bill that takes from the poor to give to the rich; it just does so with extra stealth.
.. So how does he address the two big problems with the original bill —
- savage cuts to Medicaid and
- soaring premiums for older, less affluent workers?
He doesn’t.
.. The most important change in the bill, however, is the way it would effectively gut protection for people with pre-existing medical conditions.
.. the new Senate bill gives in to demands by Ted Cruz that insurers be allowed to offer skimpy plans that cover very little, with very high deductibles that would make them useless to most people.
.. The main answer, I’d argue, is that what would happen if this bill passes — a big decline in the number of Americans with health insurance, a sharp reduction in the quality of coverage for those who keep it — is what Republicans have wanted all along.
.. the Republican elite considered and still considers people on Medicaid, in particular, “takers” who are effectively stealing from the deserving rich.
And the conservative view has always been that Americans have health insurance that is too good, that they should pay more in deductibles and co-pays, giving them “skin in the game,” and thus an incentive to control costs.
.. So what we’re seeing here is supposed to be the last act in a long con, the moment when the fraudsters cash in, and their victims discover how completely they’ve been fooled. The only question is whether they’ll really get away with it. We’ll find out very soon.
Democrats to Use Senate Rules to Challenge Health Care Bill
Democrats are preparing to challenge these provisions, among others:
Planned Parenthood: The Senate Republican bill would cut off federal Medicaid funds for Planned Parenthood for one year.
Age ratios: The Senate bill would let insurers charge older consumers five times as much as young adults. Under the Affordable Care Act, they can charge no more than three times as much. Democrats say the purpose of the change is purely regulatory, not budgetary
Waiting period: People who went without insurance for approximately two months in the prior year would be required to wait six months before they could start coverage under the Senate bill. Democrats say the purpose is not to save money, but to regulate insurance and to encourage people to obtain coverage without imposing an “individual mandate.”
.. Democrats are also expected to challenge a provision of Mr. McConnell’s bill that would allow states to impose work requirements on some Medicaid beneficiaries.. And they are prepared to challenge a proposal by Senator Ted Cruz, Republican of Texas, that would allow insurers to sell stripped-down insurance, free of most federal regulations, if they also offered at least one plan that complied with insurance standards like those in the Affordable Care Act. Health plans could, for example, omit coverage of maternity care or mental health care.
Are the GOP’s Proposed Medicaid Reforms Mean?
Trump has repeatedly praised Canada’s health-care system, which has a very similar structure to Medicaid, as offering a model for the United States to emulate. However, the reforms proposed in both the House and the Senate bills would in fact bring Medicaid even closer to the structure of Canada’s health-care system — only with a far more generous level of funding.
.. Canada’s federal funding system was established in 1957, with the national government providing one dollar for every dollar that provinces spent on hospital and physician services. By the 1970s this arrangement was widely recognized to be causing costs to soar, and the Liberal prime minister Pierre Trudeau reformed this “Canada Health Transfer” so that provinces would receive a fixed annual allocation from the national government.
.. The U.S. Medicaid matching payment to states ($344 billion, or $1,071 per American, in 2015) already well exceeds the Canadian block grant to provinces (US$26 billion, or US$716 per Canadian) — even though the Canada Health Transfer is supposed to cover Canadians of all ages and income levels, whereas Medicaid is dedicated to 21 percent of the U.S. population with low incomes.
.. U.S. federal taxpayers spend an additional $646 billion on Medicare, and $122 billion on other health entitlements such as CHIP or VA — yielding total federal health-care entitlement spending of $3,461 per capita.
.. Canada is not getting more value for money; it is just getting fewer services. Canada’s federal payment doesn’t cover prescription drugs; only hospital and physician services are paid for. Canada also saves money by rationing operating-room time and the ability of physicians to order costly services.
.. Nor does Canada pay significantly less for its physicians than the United States; it just limits access to the expensive ones. In 2010, family physicians earned incomes (net of practice expenses) averaging $159,000 in the United States and US$156,000 in Ontario, while cardiologists averaged $325,000 in the United States and US$283,000 in Ontario. According to the World Bank, the United States has 2.45 and Canada 2.07 physicians per 1,000 inhabitants, while the United States has 0.55 specialist surgeons per 1,000 and Canada 0.35.
.. Waiting lists save lots of money because some patients get better by themselves, others give up seeking care, and a substantial number die before receiving treatment.
.. the allocation of federal payments by open-ended matching has caused funds to be distributed according to how much states can themselves afford to put in. As a result, the states that need help the least received the most assistance. In 2015, Connecticut collected $12,240 in federal Medicaid funds per resident under the poverty line, whereas Alabama received only $4,070.
To keep funds from being captured by the richest states (which generally use them to expand eligibility to wealthier individuals who mostly already had private coverage), it therefore makes sense to cap the increase in funding that each state is able to claim from the federal government every year.
.. The Canada Health Transfer currently increases the funds received by each province at a standard rate of 3.0 percent every year. By comparison, the House GOP’s proposed reform would limit the annual increase in federal payments claimed by each state to a statistic that has increased around 7.0 percent for spending on the aged and disabled and 4.9 percent for that on able-bodied adults and children
President largely sidesteps the bully pulpit in pushing health-care bill
With the Republican push to revamp the Affordable Care Act stalled again, even some allies of President Trump question whether he has effectively used the bully pulpit afforded by his office and are increasingly frustrated by distractions of his own making.
.. The lackluster sales job, combined with recent controversial tweets and public statements targeting the media, has diminished the focus on the president’s leading legislative priority at a key juncture in the Senate, allies and analysts say.
“It’s a mystery,” said Barry Bennett, a Republican operative who advised Trump’s campaign last year and remains close to the White House. “I don’t know what they’re doing.”
.. Trump’s public efforts to dismantle the health-care law, however, contrast sharply with President Barack Obama’s efforts to build support in advance of its 2010 passage. Obama gave a joint address to Congress on health care. He fielded questions at town hall meetings around the country. And he even bantered on live television with hostile lawmakers at a Republican retreat.
.. Not only has Trump been unsuccessful at swinging public opinion toward the legislation, but also “he hasn’t really tried that much,”
.. It’s not hard to imagine other things Trump could be doing to try to boost support for the GOP plan among the public and, by extension, on Capitol Hill, Bennett said.
Trump could make much better use of Twitter, urging his 33 million followers to call their senators and ask them to back the GOP bill, Bennett said... Trump could have visited several states last week, holding events that highlight the sharp rise in premiums under Obamacare.. “You use the model that works for you,” Spicer said, noting that Trump has advanced a health-care bill further in the process at this point in his term than Obama. The ACA did not pass until the second year of Obama’s first term.“We’ve been more efficient,” Spicer said.