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.