Uh…Dig In? by Pat Conrad MD

Speaker Paul Ryan and the GOP fulfilled the script this past week when they threw the white pigeon that is the American Health Care Act up in front of a crowd of shotguns. The liberals are screaming about how this will hurt the poor, the elderly, the young, the reproductive, the trans-, the immigrants, the…and so on. The conservatives are hollering that this is “Obamacare Lite,” not a grand departure from a collapsing idea, but a fiscally irresponsible mess with a new, if thin coat of paint.

Pick your side, you’ve got an easy target. I’m trying to do something damn near impossible for an ideologue like me, which is to be dispassionately pragmatic: will the thing work?

  • The AHCA gets rid of the hated (and often ignored) individual mandate, but allows insurers to charge an extra 30% (of the monthly premium) surcharge to those who had a lapse in coverage.
  • The AHCA gets rid of the budget-busting subsidies for lower income purchasers, and replaces them with budget-busting tax credits based on age and income.
  • ObamaCare allowed insurers to charge older customers up to three times the premium of younger customers, based on age. The replacement bill would allow Big Insurance to charge the middle-agers up to FIVE times the rate for the college crowd.
  • The replacement bill would double how much we could contribute to tax-free health savings accounts, up to $6,550 per individual or $13,110 per family.
  • The additional taxes on investment income, on more wealthy individuals, and on tanning parlors are done away with.
  • Insurers will still be banned from denying coverage on the basis of preexisting conditions.
  • Dependents can still stay on mom and dad’s plan until they reach 26.
  • Insurers are still required to offer ten essential benefits (Are those the same as under ObamaCare? I skimmed the 123 pages of the bill and couldn’t find that part, but hey, I skimmed.)
  • An additional 11 million were moved onto Medicaid rolls under ObamaCare; the AHCA will deal try to cap costs for the 70 million on Medicaid by sending states a fixed amount per enrollee, the “per-capita cap.” (There is a provision in the language – no kidding – of the bill “Letting States Disenroll High Dollar Lottery Winners,” which probably covered a lot of people…sigh.)
  • There are a lot of nooks and crannies in this thing, and you will still need a lawyer and an accountant to read over your shoulder to understand it. Small businesses and HSA’s seem to be treated better – I think. I didn’t see any provision blatantly call to kick someone to the curb, but maybe it’s there. From what I can tell both liberals and conservatives are unhappy, which does not necessarily define a success.

What I didn’t see was the oft-proclaimed Republican intention of allowing the sale of health insurance across state lines. What I didn’t see was anything involving malpractice reform, or dealing with defensive medicine. If I missed it, Dear Reader, please correct me.

Let us stipulate in a non-partisan fashion, that ObamaCare is collapsing rapidly, that it has been a huge sop to Big Insurance, who gleefully screwed the paying customers. Access if anything, worsened. ObamaCare was a huge, additional expense to the taxpayer. That is the record.

Presently I see no curb to Big Insurance, which will wave its beggin’ bowl at the capital and poor mouth, even as premiums increase for everyone possible. The inability to deny coverage, keeping millenials on their parents’ plan, mandated essential benefits, and permission to charge the older more will all provide reason – or at least excuse – for the insurance companies to dig in on the site of their inflated premiums. The spin is still whirling the CBO estimates around, but it’s hard to see how this replacement will cost the taxpayers less in the next few years. I don’t see how this replacement bill will lower costs, or increase access. The GOP says this is just the first step. That’s the same GOP that voted repeatedly for outright repeal for the six years until they actually had the power to do just what they claimed they wished.

97200cookie-checkUh…Dig In? by Pat Conrad MD