Health Care II — a Re-run

Terry H. Schwadron

I hope members of the Republican leadership in the House are quietly cringing as White House-induced pressure builds to pass a health care bill, as quickly as possible.

The reason they are having trouble, of course, is because the bill is a bad idea — an opinion shared even among their own members. Still, the issue looms.

What may have worsened it were remarks by the President himself over the weekend, which appeared to contradict the outlines of a deal struck with the so-called Freedom Caucus, the most conservative House Republicans. The President told CBS on film that the bill he will guarantee a clause in it to preserve protections for pre-existing health conditions; the compromise supported by the Freedom Caucus allows states to back out by allowing much higher prices for those who are sick or aging.

Of course, we don’t know, because there is no bill. Nevertheless, White House folks are saying they now have the votes; the House has yet to schedule a vote, and the Senate is ready to kill it in any case.

Forget about dealing with Democrats, this is still about finding enough support among different flavors of Republicans-who-know-best to pass anything. As they cater to the most conservative legislators, they lose the “moderate” Republicans.

The leadership should be cringing quietly because public truth-telling is being eliminated in favor of various worshipful statements about the President, his sort-of agenda, and the sanctity of government-cutting actions. Fortunately for them, the new version of the health bill exempts members of Congress and their staffs from losing their own benefits.

Even with no written bill, people seem fully engaged about what the new version will do that the first, which was withdrawn before it could be voted down, did not. The answer is: The provisions are much the same, but worse. They are seemingly a bit better for insurance companies and for states that don’t think much of providing health care, and not so good for you and me.

A bevy of patient advocacy groups, for example, yesterday denounced the rewrite as inadequate.

Let’s just return to the basics. The good news about Obamacare was to extend availability of health insurance policies by at least 20 million; it protects such things as insurance availability for those with a pre-existing medical condition, adult children remaining on family policies through age 26, and, to make it work, subsidized markets in hard-to-insure areas. The bad news, generally, is that prices for policies continue to rise, that there is a mandate on individuals to buy insurance or pay a penalty, and that deductions and pharmaceutical drugs cost too much.

The basic Republican approach is to eliminate the mandate, threaten to withdraw the subsidies, want the popular stuff, but drop any way to help people pay for it. The result, naturally, is widely perceived to be less insurance — or eventually free market policies that cover less. Republican mantras say that is actually good, because it preserves freedom of choice and will spur competition. Anyone else says that is nuts because it isn’t about health, it is about cutting “taxes” for younger, more wealthy people who don’t want to pay into insurance that affects us all.

So, the new approach, drawn to win votes among the most conservative House members, apparently is to give states the chance to drop the insistence on insurers covering pre-existing conditions (and other benefits) and to cut back the programs in other ways that help keep insurers in the game, like cutting the time for enrollment.

Columnist Mike Hiltzik at the Los Angeles Times, who follows this closely, says the new approach sounds as if it were written by insurance companies to guarantee profits. In a recent column, he charted moves by United Healthcare, which has said it is withdrawing from some areas and has lobbied about what should be in the bill. “This would include ‘restoring short-term and limited coverage policies,’ which were essentially outlawed by the ACA because so many of them proved to be overpriced junk insurance that left owners stranded when genuine medical needs cropped up,” he said. United also wants to strengthen employer-based policies, a lucrative area for the company.

States could ask for waivers of such benefits in the name of reducing price and by setting up a high-risk pool for poorer citizens. But the language is not written, and the effect will become a competitive dive to the bottom of coverage. Clearly less coverage always means less health care. That happens now with Medicaid, in which states set their own levels of patient eligibility. Some states cover more people and circumstances than others. Overall, it is difficult to argue that this makes for better public health.

None of this affects drug prices. It is hard to see how doctors, nurses, hospitals or we patients would benefit. Those who would benefit are never ill.

I agree with Hiltzik:

“Here’s a suggestion: If UnitedHealth wants to play in the lucrative sandbox of Medicaid, it should be required also to participate in the ACA exchanges. It might not make as lavish a profit as it did this quarter, but by all indications it would still be in the black . . . Its participation would help stabilize the exchanges so they actually could become profitable for all participating firms.”

Bottom line for me: House Republicans want to cut mandates and health policy prices, and forever bury anything associated with Barack Obama. Senate Republicans are waiting to crush whatever the House does. The President doesn’t really care what the effects are, so long as something passes that looks like achievement. At public forums all over the country, people made clear that the House Republicans are barking up the wrong tree. But they persist.

The discussion is about taxes, not about health. Top officials are not clear about what is in the bill. What seems to matter most is passing something that rejects anything associated with Obama. It would be nice if something were actually written.

It’s a shame. Someone should be embarrassed.




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