Healthcare Plan is a Killer

Little Rock   How many of us have heard from our mothers that “if we can’t say something good, then don’t say anything at all.” I wish that were the case with the Ryan and some Republicans’ healthcare bill. So far, I’m failing to find any silver lining, other than it’s not a total repeal where we have nothing, but that’s too thin a reed to grab.

There are still no Congressional Budget Office tabulations on the cost of this proposal or the number of people likely to lose healthcare. Some Republicans are even wary and unhappy about being forced to vote on this thing without even that meager level of information. Reporting by the New York Times finds Standard & Poor’s in a report has estimated that 2 to 4 million people would drop out of the individual insurance market, largely people in their 50s and 60s who are too young to qualify for Medicare because of higher costs. Why? One feature of the new proposal is that it would allow insurance companies to increase the gap for older Americans from three times the young to five times the young causing premiums to soar to unaffordable levels.

Several researchers listed the predictable outcomes of transferring these decisions to the states by citing not theories, but the facts on the ground based on what states had done where they have had discretion in the past and get caught with budget shortfalls similar to the ones faced in the 2008 Great Recession. They talked about the blood on Arizona governor Brewer’s hands when that state stopped paying for transplants and allowed people to die. They talked about how states had dealt with billions of dollars from the smoking settlements with tobacco companies and the meager percentage of the funds that had gone to cessation programs as opposed to budget shortfalls, capital expenditures, and a bit of whatever.

Unbelievably there are some Republican Senators who still bridle at any plan at all. More troubling have been some arguments that some are starting to make that we might be better with nothing at all, though that strains credibility as well.

You know it’s bad when we aren’t even getting into the weeds on things like the impact on women. The ban on Planned Parenthood funding just seems like a bizarre, mean spirited outlier which must just drip with questionable legality. Past the first mention, the fact that people would be barred from buying insurance with governmental support that paid for abortions also seems like a flashpoint that hasn’t gotten much attention. Props though to Planned Parenthood for having pushed away the offers for not only continued funding at half-a-billion bucks but an increase, if they were just willing to make a deal and stop doing abortions anywhere, regardless of the fact that no federal money funds any part of their abortion service anyway. Comforting to know that a least one major national nonprofit is unwilling to abandon its mission for money. That must have been something of a shock to the Trumpsters, though the so-called offer was likely something of a wink-and-nod, and never serious anyway.

Or how about mental health services? Will they continue to be supported? Believe me our partners in Alaska with the Mental Health Consumers Action Network (MCAN) are having emergency meetings and deep discussions about this.

The list is endless. The pain tremendous. The death count will be astronomical.

Here’s my point in a nutshell: all of this is bad, and we still don’t know the half of it.

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Affordable Care is Simply Not Affordable

HealthCareGovSiteNew Orleans    The more studies that are done, the more time that passes, the more it seems impossible to get around the core issue embedded in the compromises of the Affordable Care Act: it’s just not affordable for lower income families.

The government’s projections for the current signup period are frankly modest at about nine million signups, rather than the twenty million projected several years ago for this period. Given the number of states that continue to boycott the expansion of Medicaid, which is where a lot of the gap for the uninsured continues, the budget offices are finding the predicted costs of Obamacare are about 20% lower than originally expected.

Furthermore, the mandate is not pushing enough people into insurance who don’t have it, particularly among lower waged workers. Studies are finding that at about $40,000 the maximum participation is achieved. Lower income families are simply paying the penalty, because it’s cheaper than the insurance bite.

Reports from employers are very depressing, though not surprising. Having represented big health care employers with sorry health plans for decades and seen the abysmal participation figures, we were hardly shocked, but still reading figures for huge food service companies with tens of thousands of employees and their reports of only 500 workers out of 25,000 actually signing up for employer insurance is ridiculous. The workers are blocked from access to ACA marketplace subsidies and cost sharing because they have opted out of corporate insurance, but they have opted out because the costs are too high and the benefits are too crummy with essentially catastrophic coverage and deductibles as high as $6000. Who can afford any of that on $10 or $15 per hour?

Increasingly, it seems clear we have a little bit of something for health insurance, but it’s only a bit better than nothing, and under the private company and corporate-centered regime, it’s too pricey and too paltry. We need real national health insurance, but that means a more significant governmental investment, and that is a bridge way past the level of political consensus.

It is also way past the level of public support, which fuels the continued opposition to Obamacare. When even the primary beneficiaries of the program among low-and-moderate income families are still priced out of the market, who is left to show the program the love it needs and deserves?

Half-stepping clearly has only gotten us halfway to where we need to be. We shouldn’t be surprised, but that doesn’t make it any easier to live with the disappointment or the continued perilous state of national health protection in the United States for low-and-moderate income families.

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