Republicans are Taking a Big Political Risk on Health Care, But they Continue to Push Ahead

 

 

 

18700041_1209034349226222_1915516221192932300_nGarance Franke-Ruta of Yahoo News pointed out that while the nation was transfixed Thursday by the ongoing battle between former FBI director James Comey and President Trump. It was not the day’s only political sparring in the nation’s capital and the Media is salivating over the slightest possibility of any issue that could result in President’s Trump’s impeachment.

Sen. Claire McCaskill, D-Mo., blasted Senate Finance Committee Chair Orrin Hatch, R-Utah, during a hearing on Capitol Hill at which Health and Human Services Secretary Tom Price testified.

“Will we have a hearing on the health care proposal?” McCaskill asked Hatch, concerned about Republican plans to fast track the Senate’s version of the Obamacare repeal bill without Democratic involvement or public hearings. “Will we?”

“I think we’ve already had one,” Hatch replied.

“No, I mean on the proposal that you are planning to bring to the Senate floor for a vote? Will there be a hearing?” she pressed him again.

Hatch conferred with an aide. “Well, I don’t know that there’s going to be another hearing,” he said, “but we’ve invited you to participate.”

At that response, McCaskill unloaded.

“When you say that you’re inviting us — and I heard you, Mr. Secretary, you said you’d love our support. For what? We don’t even know,” she replied. “We have no idea what’s being proposed. There’s a group of guys in a back room somewhere that are making these decisions. There were no hearings in the House. I mean, listen, this is hard to take.”

“You couldn’t have a more partisan exercise than what you’re engaged in right now. We’re not even going to have a hearing on a bill that impacts one-sixth of our economy. We’re not going to have an opportunity to offer a single amendment,” McCaskill continued. “It is all being done with an eye to try and get it by with 50 votes and the vice president.”

That wasn’t the case in 2010 for the Affordable Care Act, she said. “Even though the vote wound up being partisan, the amendment process wasn’t,” she said, noting that Republicans were able to offer amendments and contribute to a bill that they ultimately chose not to vote for. “I want that opportunity. Give me that opportunity. Give me an opportunity to work with you.”

McCaskill’s remarks come as Democratic activists are frantically trying to mobilize opposition to a Senate bill they have yet to see and the prospect that the upper chamber will follow the path of the House and vote to repeal Obamacare. A number of observers had predicted, in part based on statements from key GOP senators themselves, that the matter might not even come up for a vote this year, or else would be deliberated slowly.

But while public comments from senators signaled a lengthy process with little chance of success, behind the scenes the parliamentary machinery has been put in place by Senate Majority Leader Mitch McConnell to fast track the health care bill for a vote by the end of June.

A Quinnipiac poll in late May and early June found that only 17 percent of those surveyed approve of the House bill, while 68 percent disapproved of it.

Untitled.Quinipiac Poll

I believe, as you may have realized through my previous posts that, as Ricardo Alonso-Zaldivar of the Associated Press pointed out in his article, the Republicans are taking a big political risk on health care.

They’re trying to scale back major benefit programs being used by millions of people. And they’re trying to do it even though much of the public is leery of drastic changes, and there’s no support outside the GOP.

But it’s not stopping them. They now promise to deliver a Bill to repeal and replace the Affordable Care Act/Obamacare by September.

After seven years attacking former President Barack Obama’s health care law, Republicans are finally in control of the entire government and say they have to deliver now. Yet they’re not talking much about the trade-offs that come with sweeping changes, not to mention estimates that millions more people could be uninsured.

“I don’t think anything of this consequence has ever been passed in the entitlement arena,” said Jim Capretta, a health policy expert with American Enterprise Institute, a business-oriented think tank. “It’s a piece of legislation that would be highly consequential.”

Unprecedented “is a perfectly fair characterization,” said Lanhee Chen, who was policy adviser to former GOP presidential nominee Mitt Romney. Like Capretta, Chen agrees with the general direction congressional Republicans are taking, if not all the specifics.

Senate Republicans are winnowing down policy options in search of 51 votes to advance House-passed legislation this summer.

Some of the central issues in the GOP’s health care gamble:

THE HISTORIC SHIFT

Health care programs usually grow faster than other government services. Republicans want to break that decades long trend, although they’d leave Medicare largely untouched for now.

The talk is all about repealing the 2010 Affordable Care Act. But the GOP’s American Health Care Act would have lasting impact on Medicaid, the federal-state program covering about 70 million low-income and disabled people, including many elderly nursing home residents.

Republicans would phase out richer financing that the Obama-era law provides states that expand Medicaid to cover low-income adults. More significantly, the GOP would limit future federal spending for the broader program. Medicaid has been an open-ended entitlement, with the feds matching part of what every state spends, about 60 percent on average.

The House-passed GOP bill would cut $834 billion from projected federal Medicaid spending over a decade, leading to a reduction of about 17 percent in people covered by the program, according to the Congressional Budget Office.

“There is no capacity at the state level to pick up the slack if the federal government withdraws its commitment,” Sen. Ben Cardin, D-Md., said at a recent budget hearing. Some Republican governors also question the plan.

Health and Human Services Secretary Tom Price said Medicaid can be more efficiently managed by the states, and that open-ended federal financing doesn’t necessarily mean improved health for beneficiaries.

THE GOALS AND OBJECTIVES

In addition to reducing federal health spending, Republicans want to lower premiums for those who buy their own health insurance, an estimated 20 million people. About half receive subsidies under the Obama law, but the rest pay full freight and many have seen steep premium increases stemming from changes under that law.

“Across America, premiums are skyrocketing, insurers are fleeing, and the American people are paying much more for much worse coverage,” President Donald Trump said recently in Cincinnati.

Republicans would try to lower premiums by loosening some of the law’s requirements, including standard benefits and a guarantee that those in poor health won’t be charged more. People would be required to maintain “continuous coverage” to avoid penalties.

The CBO estimates that the GOP approach would lead to lower premiums than under current law, but the trade-offs could be significant.

Insurance, on average, would pay for a smaller share of health care costs, meaning that deductibles and copayments are likely to be higher. In some states, certain policies may not cover services such as substance abuse treatment. Over time, people with health problems might be priced out of the market.

THE PROMISES, AND MORE PROMISES

Trump’s promise to repeal Obama’s health overhaul was a fixture of his campaign. But he also said he was a different kind of Republican, who would not cut Social Security, Medicare, or Medicaid.

Later in the campaign, Trump announced support for a Medicaid block grant, a way of limiting federal spending on the program. But candidate Trump didn’t elaborate on details, and repeatedly promised voters “great” health care.

The president again made that promise last week: “The Republicans are working very, very hard on getting a great health care plan,” Trump said.

But health care policy is all about trade-offs, and Republicans have largely avoided talking about downsides. Democrats are ready to pounce.

“There are critical, life-changing decisions being made about Americans’ health care right now in the United States Senate that should have people on high alert,” Sen. Ron Wyden, D-Ore., said in this weekend’s Democratic radio address. “This legislation is going to put the health of millions of Americans at risk.”

I love this analogy- THE LONE RANGER RIDES AGAIN

Republicans never ceased complaining that Obama passed his law without a single GOP vote. Now, their bill has failed to garner any Democratic support. Not surprisingly, polls show that Democrats and independents disapprove of the legislation by wide margins.

“They’re sending legislation through the Congress that is only supported by one party … and somehow thinking it’s going to have a different outcome,” said economist Gail Wilensky, a Republican. “It’s like, really, why would you think that?”

Consider why the GOP is pushing ahead. The cost of medical care — even for those who have health insurance — is keeping some families from seeking treatment, CNBC writes.

About 25% of adults in a recent poll said that they or a family member have avoided seeking medical attention because of the cost, according to a survey of 1,002 adults that Bankrate, a personal finance website, conducted in May.

“People across the board, regardless of the coverage they have, seemed to have a high level of health-care insecurity,” said Robin Saks Frankel, credit card analyst at Bankrate. “They are concerned about the quality of coverage and the costs associated.”

Here’s how even insured individuals can end up facing steep bills:

High-deductible plans

More than three in 10 of the survey participants said that their main source of coverage was through work. About 36% said they were covered through a government program such as Medicare or Medicaid, and 12% said they bought their own private insurance.

Having coverage doesn’t guarantee that you’ll be able to afford care when you need it, though.

For instance, research from the Employee Benefit Research Instituteshows those workers using a high-deductible health plan saw the doctor less frequently. This was particularly the case for low-income employees, who saw the doctor less often for preventive care and reduced their use of flu vaccines, according to EBRI.

Trade-off on savings

High-deductible plans tout lower monthly premiums, as compared to traditional insurance. In 2016 the average annual premium for employer-sponsored health insurance was $6,800 for single coverage in a preferred provider organization (PPO), according to data from the Kaiser Family Foundation.

However, the average annual premium for a high-deductible health plan available at work was $5,762, Kaiser found. There’s a trade-off for the lower cost of coverage: You are responsible for saving the amount of money you need to meet a higher deductible.

Under a high-deductible plan, employees can use a tax-advantaged health savings account (HSA) to cover qualified medical costs. These plans must have an annual deductible of at least $1,300 for self-only coverage or $2,600 for families, according to the Internal Revenue Service.

Out-of-pocket expenses each year may not exceed $6,550 for individuals or $13,100 for families.

“Don’t automatically choose the cheapest plan and hope you won’t need it,” said Bankrate’s Frankel. “You might choose not to go to the doctor because you don’t want to pay the out-of-pocket cost.”

High-deductible plans and HSAs have been central in the health-care debate.

House Speaker Paul Ryan and fellow Republicans have sought to increase the amount individuals can contribute to their health savings accounts.

For 2017, HSA holders with self-only coverage can contribute up to $3,400 annually, while those with family coverage can save up to $6,750. Assets in these accounts continue to climb and may surpass $53 billion by 2018, according to Devenir, an HSA consulting firm in Minneapolis.

The cost of medical care — even for those who have health insurance — is keeping some families from seeking treatment. About 25 percent of adults in a recent poll said that they or a family member have avoided seeking medical attention because of the cost, according to a survey of 1,002 adults that Bankrate, a personal finance website, conducted in May. So, something has to improve the health care system, but as I have mentioned- why not keep the good parts of Obamacare and fix the parts that will result in its demise or failure? And further, why not work with the Democrats assistance/involvement? And finally, what will we finally have to deal with as our health care system if not the Affordable Care Act?

Lets continue this conversation and yes you are all invited to comment and contribute suggestions.

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