Monday, 19 November, 2018


Senate bill would trade Medicaid for tax cuts

Patty Aguilar | 25 June, 2017, 22:39

All the "Obamacare is in a death spiral" talk is Republican wishful thinking, aided and abetted by active sabotage.

Since the Affordable Care Act was rammed through Congress in 2010, Republicans, including President Donald Trump, have been promising to replace the law with legislation that would halt or reverse skyrocketing health insurance premiums and deductibles. Politifact notably named that claim its "Lie of the Year" in 2013.

Republican Senate leader Mitch McConnell of Kentucky has pushed for a vote before the July 4th Independence Day holiday recess that begins at the end of this week. To explain, insurers can not outright deny coverage to someone with a preexisting condition, but if states remove mandatory coverage for certain conditions or coverage options, the exponential increase in costs or premiums makes coverage prohibitive.

The nonpartisan Congressional Budget Office will evaluate the proposal next week.

The new Senate health care bill (not to be confused with the AHCA) was finally unveiled this week by Republicans in the upper chamber.

However, Senate Republicans' bill would make deep cuts to Medicaid, rolling back Obamacare's Medicaid expansion and transforming federal Medicaid payments to the states into per capita reimbursements, the rates of rich would get smaller and smaller through 2025, or block grants.

On Friday, Conway touted $500 million in grants given to states from the Substance Abuse and Mental Health Services Administration under Health and Human Services Secretary Dr. Tom Price. If the risk pool is healthier, premiums would rise more slowly. By basing subsidies in part on geography and generally providing greater subsidies for people living in rural areas, the ACA and the Senate bill keep premiums as affordable in more expensive areas as they are in cheaper locations.

That could mean weeks to come of negotiations to craft a bill that would not only satisfy the hardline conservatives in the Freedom Caucus, but also moderate Senate Republicans who are already wavering on a Senate bill that is less conservative than the AHCA.

Trump said Senate Democratic leader Chuck Schumer criticized the GOP bill before knowing what was in it.

Under special rules McConnell is using that will block Democrats from using a filibuster to kill the bill, the legislation can not include provisions that make policy changes that don't primarily affect the budget.

The best conservative health policy analysis proceeds from the controversial but, I think, correct perspective that much health spending is wasted and that people do not value or benefit from insurance as much as liberal technocrats presume.

Another possibility would be to limit plan choices for people who've had coverage lapses, allowing only catastrophic coverage or plans that cover a lower share of medical costs.

The Senate bill takes immediate steps to stabilize insurance markets for the next two years.

"If they do to Medicaid what they're trying to do, it's not just a health care adverse outcome, we will be a different country, we'll be a different society, because we won't be taking care of people that most of us believe we should take care of", Casey told reporters in the Pennsylvania Capitol after he led a rally against the bill.

Many were puzzled to see that the Senate bill released Thursday contained no such provision.

The KFF poll notes that "proposed Medicaid changes were not initially a major point of discussion surrounding consideration of the House bill... which may partly explain why many respondents were unaware of its effect".

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