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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Welcome to the No-Insurance Emergency Rooms as Long as They Last

New Orleans  The Congressional Budget Office has released its score on the cost and impact of the Senate Republicans version of healthcare coverage. The bottom lines have gotten wide publicity. 22 million will lose insurance by 2026, 15 million almost immediately. 15 million lower income people will lose Medicaid coverage. It wasn’t big news that this will be an income transfer from the poor to the rich, because we had already known that was coming in all the Republican bills.

Elderly people hoping to live long enough to qualify for Medicare will have to run the gauntlet, unless they are wealthy. The New York Times gave two examples from the CBO report that were appalling.

for a typical 64-year-old with an annual income of $26500, the net premium in 2026 for a midlevel silver plan – after subsidies – would average $6500, compared with $1,700 under the Affordable Care Act. And the insurance would cover less of the consumer’s medical costs. Likewise, the report said, for a 64-year-old with an annual income of $56,800, the premium in 2026 would average $20,500 a year, or three times the amount expected under the Affordable Care Act.

Yes, you understand the math. In the first example that’s a quarter of the person’s income and in the second it’s more than one-third, 36% to be exact.

The Senate added an amendment at the request of the insurance industry recently that anyone not on insurance more than 60 days would have to wait 6-months to get coverage and pay 30% more on their premiums. The industry recognized that as bad as this bill is, no one is going to get coverage until they are sick, so they wanted to try and put some boulders in the road.

And, of course they are right. With no mandate and no penalties for not having insurance most people will not get insurance for the plain and simple reason that they won’t individually be able to afford it unless their employer is providing it for them. Young people on insurance will be rare. For the rest of the population, health insurance will be the American version of Russian roulette. How long can you wait before getting insurance? People will be arbitraging their family fiances against their lives.

What if you are diagnosed with cancer or something and have to wait 6-months for treatment? In the short term survival for you and tens of millions of others will mean throwing yourself on the mercy of the hospital emergency room, as long as the law doesn’t allow them to refuse service, and until so many of these hospitals go bankrupt from providing care without government support or private insurance payments.

There’s a reason why hospitals, doctors, nurses, and everyone connected to providing health care services have opposed these bills. It’s not because many will lose their jobs as healthcare facilities go under, which they certainly will. They aren’t politicians. They’ll see the people dying at their door, too late to save, and too poor for the insurance, yet too rich for any assistance. Who wants to live through that?

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