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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When National Healthcare is Not Mean, but Vindictive, Not Policy, but Politics

New Orleans  Healthcare is a huge part of the overall US economy and, arguably, of critical importance to every American. Regardless of the cliché, it is in fact a question of life and death. Yet we are watching a horror show spectacle of a White House that is clueless about anything but whether or not it can claim a “win,” and a Congress that is cunning and calculating without any field of vision that can see past 2018 and the midterm elections.

Meanwhile the public is treated to media coverage that, rather than focusing on the complexity of the bill and its evisceration of any semblance of public policy, treats the whole affair as if this were an extra innings baseball game and the only real issue was whether or not Majority Leader Mitch McConnell can get enough votes to pass the Senate version before the totally arbitrary deadline of July 4th. Well, perhaps not totally arbitrary, since McConnell is worried that when his caucus goes home for the recess their constituents will kick their asses so badly his whole secret legislative architecture will collapse.

Remember Kellyanne Conway, so discredited as a Trump aide that we’ve been spared her doublespeak recently. Well, she was back on this bill with the outrageous claim that no one can support, that, oh, no, there are no cuts to Medicaid in the Senate bill, which everyone knows is wrong. Good try, Kellyanne, now go hide out again, because this time there weren’t even any headlines following such an outrageous claim.

How about we look at how the Senate went from mean to downright vindictive? Their bill restored funding for what is known as “disproportionate share” money to hospitals. Pay attention in class now, friends, this is important. In places like Louisiana where I live we know a bit about “disproportionate share” payments because in their heyday they figured so prominently in statewide political scandals. Ever popular, former multi-term Governor Edwin Edwards did court and prison time on the issue of having unduly helped some friends get such money to build hospitals in poorly served and lower income areas of the state. Indeed, disproportionate share payments were designed to subsidize health care costs in lower income and ill-served areas originally in order to assure communities that these institutions could survive, because a “disproportionate share” of their patient base was poor. Obama’s Affordable Care Act flipped the script here. By assuring that everyone would have to get insurance and providing subsidies for lower income families and Medicaid expansion, disproportionate share payments would be phased out to pay for Obamacare. In fact now is the time when $43 billion would be reduced between 2018 and 2025.

What did the Senate do in their bill? They buckled to the lobbyists and restored these disproportionate share payments, but, now get this, only to states that had not expanded Medicaid coverage. This allows them to punish those states and their people by cutting the subsidies to Medicaid in their bill and rewarding the scofflaws by restoring the disproportionate share payments.

Now it’s politics that inflicts real pain and terrible consequences. Need a vote in Alaska or Maine, then sweeten the pot on opioid money even though states throughout the country are reeling under such a crisis. Take away support for mental health coverage, but throw some dollars out here and there to get a vote. Cutback money for the elderly poor on Medicaid, but kick the can down the road past 2018 so that you can keep the votes with a wink and a nod until the oldsters figure out the con.

None of this is good policy, and, frankly, I’ll be darned if I even understand how it is good politics, when all of these repeal bills are wildly unpopular in every poll of the American people. The public wants to live, not die, at the hands of government. Why isn’t that news everyone understands?

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