CBO Again Says No-Go on Senate Healthcare Bill, Deductibles Soar!

New Orleans   The nonprofit Congressional Budget Office had a more leisurely schedule in costing out the latest, zombie Republican Senate effort to replace Obamacare with something, almost anything more draconian. The numbers were the usual at one level: 22 million would lose coverage by 2026, 15 million of them immediately. Medicaid would be hammered with a 26% cut over the next decade. Like I said, the usual.

There were a couple of new twists though that caught my eye.

The CBO number also took a look at the impact of going all-Trump on a repeal now and punt down the field until some later date. 32 million Americans would lose coverage on that less than brilliant, but certainly spiteful, bitter pill strategy. That’s 10 million more than under the original Senate slice. Majority Leader Mitch McConnell is pressing for a vote on something, in fact just about anything, next week so that he can count the bodies and move on or move home. That’s going to be a hard bill to force feed.

The other factoid that caught my eye went to my long term grievance: no cap on deductibles.

Just to reprise my constant complaint. In bargaining union contracts for lower waged service employees, all of the companies had compliant plans under the Affordable Care Act, but they also included deductibles that ranged from $4000 to $6000 on top of the 9% monthly payments for coverage. The result for lower waged workers making less than $20,000 per year is that there was almost zero participation, but they were also excluded from any of the subsidies or cost-sharing of Obamacare, even though they could participate in the marketplace and pay full price, because they technically had coverage under their employers miserable plans. We found ourselves having to advocate nonparticipation and paying the fine.

The CBO noted that under Obamacare the average deductible for single person coverage was in fact $5000. Under the Republican Senate bill they estimated that the average deductible would soar to $13,000 per person on individual coverage. Remember that’s a deductible, meaning the individual would shell out $13,000 before getting any benefits from the so-called health insurance and after paying a monthly premium. Who is going to buy that pig in a poke? Eliminating the mandatory requirement means that’s an easy guess with the answer being: nobody!

Face the facts. At this level of deductible, this is nothing more than catastrophic care. Why would anyone sign up if they felt kind of healthy, and kind of lucky, unless they were suddenly feeling a little woozy, or a fortune teller told them to look out.

Meanwhile what we have, warts and all, is becoming more popular, up to 60% support, and the Trump Administration is debating outright sabotage, as distinguished from Congressional sabotage, I guess.

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Humpty Dumpty Health Care

Paris   Nothing like a couple of weeks on the road, three countries, a half-dozen or so cities, and the siren song of home, heat, and humidity all sounds better and better. Of course there’s no escaping the headlines or the occasional questions from random people from all walks of life about what thoughts we might have on Trump. As excited as people around the world were about Obama as president, they are mystified by Trump. They are not alone.

The Republican Senate’s efforts to not just repeal-and-replace Obamacare, but to cap entitlements for Medicaid and pretty much kick the teeth out of the poor, elderly, disabled, and others seems to have alienated a couple of senators, while others wanted a chance to run up and kick harder and go for the kill. The New York Times reported that Senator Portman from Ohio has been a huge problem behind-the-scenes for the Republican majority leader and his efforts to pull together the votes. Seems he was concerned about what might happen to 700,000 people in Ohio that had gained coverage under the Affordable Care Act. Wow! That’s a good question for a lot of politicians from a lot of states it would seem. Turns out that when you push Humpty Dumpty off the wall, it really is hard to put the pieces back again.

And, in fact as the votes collapsed on the latest Senate version, there was an even greater implosion on the latest Trump twitter tantrum urging just repeal and deal a couple of years down the road. Seems immediately three Republican women in the Senate from West Virginia, Maine, and Alaska said the equivalent of “what are you pulling my leg,” saying that it would be reckless and irresponsible to simply repeal and blow the Act up.

Many of the Republican governors with shorter terms and quicker elections who are forced to be closer to their constituents also got their back up on these draconian cuts and caps in Nevada, Ohio, and elsewhere. They have earned some thanks as well.

I wish there were a lesson learned on the order of “don’t mess with entitlements,” but we know better. Like a bad dream, they’ll be back with more mischief and other attempts, and one way or another, they will have to do something now, we might hope, to fix some of the pieces of Obamacare that are broken.

Will they reach out to Democrats? Do they really have a choice?

Maybe this will be a twist on the old story, that if you break it, you own it. In this case, the message to the Senate might be, if you can’t break it, then do your job, and fix it.

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