How GOP plans to repeal Health Care will blight millions of Lives

By Simon Haeder | (The Conversation) | – –

At the end of July, the nation held its collective breath as Senate Majority Leader Mitch McConnell (R-Ky.) looked poised to achieve his most formidable parliamentary accomplishment: the repeal and replacement of the Affordable Care Act.

But Republican hopes were dashed by one of their own, Sen. John McCain (R-Ariz.), who cast the deciding vote that appeared to decisively derail the multi-year effort.

McCain called to return to “regular order,” to work through committees, to bring in and listen to experts, to be open and transparent, and perhaps most importantly, to at least listen to both parties.

And indeed, Senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) went to work, bringing together demands from Republicans like more flexibility for states to waive certain provisions of the ACA, and demands from Democrats to provide cost-sharing subsidies, for example, to stabilize health care markets. The bipartisanship appeared to be spreading as Orrin Hatch (R-Utah) and Ron Wyden (D-Ore.) appeared to have reached an agreement on the future of the Children’s Health Insurance Program.

Now Republican hopes of repealing the ACA have been rekindled with the Graham-Cassidy-Heller-Johnson Amendment led by Senators Lindsey Graham (R-S.C.) and Bill Cassidy (R-La).

Like all health care legislation, the bill is complex, but the broad outlines of it are rather clear: It would undo much of the reforms implemented through the ACA and then go a step further.

What’s in the bill?

Senate Republicans are rushed once more as they want to achieve health care reform by September 30, the deadline to pass the bill through the reconciliation process which requires only a simple majority. Indeed, due to their haste, the Congressional Budget Office will not be able to provide any estimates of the bill’s effects on the deficit, health insurance coverage or premiums.

Graham-Cassidy seeks to undo many of the reforms initiated by the ACA. For one, by 2020 it would eliminate the ACA’s Medicaid expansion, which has provided coverage for 12 million Americans for states that chose to expand their program. However, it would prevent new states from expanding their program by 2017. It would also eliminate the insurance marketplace subsidies to assist individuals purchase coverage and with out-of-pocket costs.

To soften states’ financial losses, Graham-Cassidy partially replaces funding for both components with a temporary block grant to states that would run out in 2026. Yet even with the block grant, states would see their funding reduced by a combined US$239 billion over six years, according to an analysis by the left-leaning Center on Budget and Policy Priorities.

Graham-Cassidy also significant alters the regulatory reforms implemented via the ACA. The much-maligned individual and employer mandates would be repealed retroactively. The individual mandate requires that all people of a certain income buy insurance or face a penalty. The employer mandate requires that all employers of a certain size provide insurance to their employees.

While individuals still could not be turned down based on their health status, states could also obtain waivers to weaken or wholly eliminate preexisting condition protections. For example, the Center for American Progress has estimated that individuals could face insurer premium surcharges of $140,000 for metastatic cancer, $17,000 for being pregnant and $26,000 for rheumatoid arthritis.

Similarly, states would be able to waive the ACA’s Essential Health Benefit provisions that required insurers to cover cost for expenditures like ambulance transport, prescription drugs and inpatient services. This would affect all individuals in the respective states because lifetime and annual limits apply only to the Essential Health Benefits. States could also waive the requirement to cover preventive services like immunizations and well-child visits.

Yet like most of the previous efforts to repeal the ACA over the past several months, Graham-Cassidy goes well beyond addressing changes brought about by the ACA. Most severely, the bill moves to dramatically slash and transform the Medicaid program. It would do so by establishing severe per capita caps: that is, it would provide a set amount of money for each enrolled individual compared to an open-ended federal match. These caps, which would affect children, seniors and individuals with disabilities, would also begin in 2020. They would be adjusted by inflation, but not the much larger medical inflation. They would thus result in further reductions over time. The resulting cuts would amount to $175 billion by 2026.

It would also allow states to establish work requirements for the program, defund Planned Parenthood and further expand Health Savings Accounts, among other things.

However, unlike most of its predecessors, Graham-Cassidy provides political protections for its supporters because the full extent and severity of its cuts would not fully emerge until 2027, at least two elections away for most senators. The Center on Budget and Policy Priorities has estimated that the effect in 2027 alone, the cliff year, would amount to $300 billion. California alone would lose $58 billion, while the state of West Virginia would lose $2 billion. The Center on Budget and Policy Priorities also expects that more than 32 million Americans would lose their insurance.

A step backward … and not addressing the real issues

In my reading, Graham-Cassidy, just like all its predecessors, does little to fix the problems of the American health care system.

Our system is generally of low quality. Medical errors kill more than 250,000 Americans each year, making it the third leading cause of death. Prescription errors alone are responsible for more than 7,000 deaths. Virtually the entire developed world, and many less-developed countries, are ahead of us with regard to infant mortality. The list goes on.

Despite these obvious shortcomings, our health care system is also, by far, the most expensive system in the world. We spend more than 17 percent of our GDP, or well over $9,000 per person, on health care. This compares to 10 percent and $3,700 for Japan, 11 percent and $4,900 for Germany, and 9 percent and $3,300 for the United Kingdom.

And yet, even after the coverage expansions of the Affordable Care Act, and after spending more money from the public’s purses than all but two countries, our uninsurance rates just inched below 10 percent, and more than 28 million Americans are without insurance.

Indeed, we do not even cover all children in this country, although the rate of insurance from children reached a historic high of 95 percent.

With low quality, high costs and lack of universal coverage, much needs to be improved about the American health care system. Unfortunately, Graham-Cassidy as currently written does nothing to improve quality, and it does nothing to reduce the underlying drivers of excessive costs. Indeed, it reverses the significant progress achieved under the ACA in offering coverage to all Americans.

The ConversationLarge-scale changes to the American health care system cannot and should not be quickly patched together without input from the Congressional Budget Office, policy experts, the public and the other party. Many lives and one-sixth of our economy hang in the balance. The American public deserves better.

Simon Haeder, Assistant Professor of Political Science, West Virginia University

This article was originally published on The Conversation. Read the original article.

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Related video added by Juan Cole:

Senator Brian Schatz: Latest GOP Obamacare Repeal Bill Is Worst Yet | All In | MSNBC

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6 Responses

  1. California has 21 2/3 the population of West Virginia but loses 29 times as much money. I wonder if that’s part of a pattern of partisan punishment.

  2. How can something so simple — it costs x dollars for a doctor in a hospital to treat a patient, therefore x dollars are needed to treat him/her — elude GOPers? Limiting the amount paid by the government will not change that part of the equation and can only result in a shortfall. So either the government pays for people who can’t afford insurance and the US joins the rest of the civilized world, or else it does not and this government shows it doesn’t care about a majority of its own citizens. What a sad day it will be if GC comes to pass.

    • Healthcare is really about “pay now or pay more later.”

      We KNOW, in great detail, exactly how much of each type of healthcare will be needed over the next year in the USA. We do not know exactly what human will need, what healthcare, but overall we have a very exact picture.

      This AMOUNT of healthcare is fairly stable over time because the drastic lifestyle changes that would be needed to lower the usage by a small amount is not something we humans are capable of doing for sustained periods of time (I keep quitting soda every few months only to start back up – I KNOW it is bad for me, but I still relapse like all humans).

      What we are arguing about is how to manage the COST of this NEEDED healthcare and who pays.

      Costs = Currently the USA makes no effort to control costs because of the “free market” myth. As a result of extreme greed in all parts of the healthcare deliver system, costs keep going up and NOTHING that has been proposed does anything to limit the costs. BTW – “Free market” is totally useless for controlling costs as has been documented a zillion times. Costs MUST be controlled by a government decree.

      Who pays = Most of the humans in the USA do not have the wealth to pay for healthcare directly, so various “insurance” schemes have been put in place. BUT the wealthy that can afford to pay for healthcare directly do not want to participate out of pure “i got mine, screw you” attitude.

      In an ideal system, healthcare deliver costs would set by the government and the total cost of healthcare would be spread across society on an ability to pay basis where the wealthy would pay their “unfair” share.

      Right now the USA pays almost DOUBLE what the next most expensive nation on earth pays with no better results.

      That is, the USA could CUT its cost almost in HALF just by taking all the best features of the the healthcare systems of other countries and throwing out the USA system.

      BUT because of the USA culture and basic greed, the USA will continue to have a healthcare crisis for quit a while.

  3. Dear Juan,

    Thanks for reporting on this . . . That said I thought my experience from five different health care systems might provide some food for thought. Please see my ranking below.

    #1 France

    We bought a vacation home in France. The system here helped us solve some medical issues that the US system failed to resolve. Read on for more.

    France has a single payer system that covers everyone. What doctors and hospitals charge is regulated so even if you have insurance it’s not bad. Laboratories are not owned by physicians or hospitals so little corruption here. The patients own their medical and lab records. No fighting with providers to get what you need. Drugs are reasonably priced and pharmacy chains are outlawed so as to preserve competition and service.

    We are uninsured in France so the below is our actual costs out of pocket.

    Our GP charges $35 for 30 minutes of consultation. He is quite thorough and very professional. He is in medicine not to get rich but to help people and have a rewarding career. He doesn’t have to worry about $400 K in student loans.

    Here is an experience from an endoscopy and a colonoscopy. Here is how costs break down:

    Consultation with anesthesiologist: $80
    Cardiological examination and ECG: $80
    Endoscopy/colonoscopy: $120
    Hospital bill pending: estimated at $400
    Total: $680.00

    Administrative procedures are much more efficient than USA.

    France spends approximately 40% less on medical care than USA but with better outcomes.

    #2 Canada

    They have a single payer system that covers all Canadians. Getting appointments with physicians or specialists was easy.

    #3 UK

    Government owned and managed system. You get health care but difficult to see a GP and hard to see specialists.

    #4 Sweden

    The system is mostly government owned and highly deficient. Medical care appears to be breaking down. Some single payer experiments with good results. If Republicans needed a poster boy for socialized medicine Sweden fits the bill.

    #5 US

    Dead last for the poor. A lot of folks in our little town are pursued by hospital debt collectors. Some loose their cars or homes. Meanwhile the hospital constantly begs for money from the ‘community’ all the while 60% of their revenue is derived from the federal government – Medicare, etc.

    If you have $$ and connections you can get excellent surgical care. I know from our own experience. We are both on Medicare which costs us $925.40 per month. Supplemental insurance is $478.13 per month. Drugs are still quite expensive and various other non-covered items add to the bill.

    We have found most US doctors disinterested in doing anything to help us. All they want to do is to generate revenue and issue prescriptions.

    The administrative procedures are cumbersome due to the many insurance plans, but in our experience generally not very competent.

    We have always provided medical insurance for our employees. It’s gotten more and more expensive by the year. Things got a little bit better with ACA. We handled payment by simply increasing compensation and all elected to purchase their own policies. When I realized that ACA was going to be destroyed we managed to find a great group plan so our employees are safe for now.

    At the end of the day the United States has an inhumane medical system. If R gets its way there will be even more destroyed families. I’m a businessman but R will never again get my vote.

    Thanks for having the energy to read my rants.

  4. This is merely another racist attempt to rid our country of those most vulnerable and needing care at government expense.

    A concentration camp need not have walls to be a killing ground.

  5. Canada has an act of Parliament which dictates what provinces must cover as part of their provincial medical plans. Each province must cover what the federal act dictates. The federal act says you cover everything except plastic surgery. Doctors may not charge the patient. Hospitals and labs are covered by the system.

    Up until recently only one province, British Columbia charged premiums for medical coverage and that was $150 per month for a couple if you made in excess of $40K a year. Now that the government of B.C. has changed those premiums will drop by 50%. Ontario implemented a premium but its based on income. The rest of the provinces don’t charge a premium but its part of the tax system.

    The medical plans do not cover plastic surgery except as it relates to illness and injuries. It covers scaring from accidents but not a face lift.

    Each province negotiates the fee structure in their province with the Doctor’s association. All doctors must belong to the association in their province. Its also the group who licenses doctors for the province.

    Our system may not be perfect, but whether you have a bad cold or need a heart/kidney transplant, its all “free” Yes we have waiting lists, but emergencies get seen immediately. If you don’t pay your premiums in a province which charges them you still are provided medical treatment. Its not a matter between patients and the doctor or hospital. Its between the Revenue dep.t of the province and the person.

    What I have never understood is that a country as wealthy as the U.S.A. can’t at least cover the children of the country. It truly is beyond me why a nation, its president, politicians would want children to die and/or suffer. What is it with Americans that makes that an O.K. thing to do. What is even more mystifying is why people who profess to be Christian think it is O.K. for a child to die due to a lack of medical care.

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