Republican Senate Makes One More Go at Healthcare Reform

Senate Republicans are at it again, and this one may be their last chance to deliver on healthcare reform. And it is simply amazing to me how this has morphed into a bill that no one will like.

Even though an additional $70 billion has been provided to subsidize care over the next 10 years for the indigent, the bill still reduces subsidies and guts the broad Medicaid enhancements under the Affordable Care Act (ACA). The law changes the ratio of highest to lowest cost from 3 bands to 5 bands, which means while younger Americans may pay less, older Americans are going to get crushed with higher premium costs – especially those earning over 350% of the federal poverty level, which could be as low as $42,000 or so a year depending on state and household size.

The inclusion of Senator Ted Cruz’s Consumer “Freedom” amendment has drawn severe criticism from the insurance carriers, who rightly believe that those newly-allowed plans, which omit essential benefits, will split the market sharply between the sick and the healthy. And to rub salt in the wound the provisions of the Consumer Freedom amendment would not apply to plans sold to federal employees. No doubt the press will have a field day with this one…

Moderate Republicans say this bill will leave millions without coverage. Right-leaning Republicans want nothing short of full repeal and they are not happy with the significant tax provisions of the ACA that have been left in – the excess Medicare tax and the tax on investment earnings.

The GOP has to be cautious as they run the risk of major failure, even with majority control, on a core campaign promise. Senators Rand Paul and Susan Collins have stated that they are out – so there is no more margin for defection. And even if the bill makes it through the Senate, bringing the House in line won’t be easy.

In the event that Republicans decide to redirect, I have an idea; eliminate the employer mandate, eliminate the exchanges but strengthen Medicaid and add a meaningful tax on Americans who do not have coverage. Simple, and it may work. Both parties should talk – if they ask, I would be willing to moderate.

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Comments

  1. avatarJohn P. Greyson says

    While one can certainly disagree about the need for health insurance companies, I have yet to see anyone provide a comprehensible reason to indicate why we do. Your prior reference to checks and balances is a non-starter. I can’t recall anything in the U.S. Constitution that established the inclusion of insurance companies in any of the three branches of government. And if our government and its reps are ineffective in their role in this healthcare debacle, a large part is due to excessive influence by industry “liaisons” (a euphemism for lobbyists) who protect their interests and profits. In fact, the insurance companies have likewise been ineffective with their role in our dysfunctional healthcare system. Solutions are needed, but none have been offered, only variations on the same old, tired mantra and platitudes of trying to shift blame to the big, bad government, that single-payer is socialism, etc. Part of the solution is new leadership needed who are not part of the problem. Insurance companies are not necessary to fund a better healthcare system.
    Why do you need insurance for medical care that is expected, such as annual checkups, prescription drugs, and standard primary care? Insurance may work well when you’re insuring something you don’t expect to happen. Where else in life do you purchase insurance to cover expected expenses? You don’t insure oil changes or tires for your car. You insure it against accidents and loss. You don’t insure carpets, paint, and basic maintenance on your home. You insure it against major fire damage or accidental destruction. So why would insurance make any sense for basic healthcare? It doesn’t. And any exclusion of single payer in the healthcare reform debate is simply asinine. Anyone who rejects single payer, is hardly a suitable moderator.

    To maintain that the U.S. has the best system, or as exceptional is simply untrue. A new analysis published on Friday by the Washington-based Commonwealth Fund finds that the U.S. healthcare system currently ranks last among 11 other advanced countries in healthcare outcomes, access, equity, and efficiency. As opposed to nations that guarantee healthcare to all, the authors concluded that Americans’ ability to attain quality healthcare is almost entirely dependent on financial status. “Your level of income defines the healthcare you receive far more in the United States than in other wealthy nations,” the authors note.

    • avatarCraig Hasday says

      John,
      Thanks for your well-thought-out response. You overlook the fact that the overwhelming amount of healthcare is provided through Medicare and Medicaid, two government-run systems, and through self-insured employers. So the “insurance” companies are really claim adjudicators. Systemic change for 20% of the economy is monumental. There are trade-offs in every system and change will create winners and losers regardless of the path chosen. Our culture combined with the U.S. political process make this even more complex. In view of these factors, I believe that we will need to evolve and not erupt the system. There are no easy answers.
      – Craig

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