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Category Archives: Healthcare
Barring something unexpected, as discussed in Doc Jess’s post, the major action for the rest of this Congress on health care is likely to be at the administrative level with Tom Price doing his best to undermine the Affordable Care Act. However, there have been some unanticipated holes that have developed over the past seven years that do need to be fixed. As such, if Democrats regain control of the House and Senate in 2019 what issues should they be looking to address.
At the top of my list is the Medicaid expansion hole. Back in 2012, the Supreme Court ruled that states did not have to participate in the Medicaid expansion. The Affordable Care Act assumed that every state was going to participate in the expansion and only provided for subsidies for those who did not qualify for Medicaid. When a significant number of states opted to not expand Medicaid coverage, this created a group who earned to much to sign up for Medicaid, but too little to get subsidies to purchase insurance. The obvious fix is to expand the subsidies to cover this gap group.
The second issue concerns the exchanges. Again, the Affordable Care Act assumed that most (if not all) states would opt to set up exchanges just on principles of state autonomy. (Why would Republicans who complain about the feds taking over the insurance market let the feds take over the insurance market in their states?) It turned out that Republicans in the state wanted the symbolism of resisting more than actual local control. This problem offers a chance to offer the Republicans a two-edged sword. The Republicans complain that one of the problems with health insurance is that companies are unable to offer policies that cross state lines. (Placing the blame on regulations is not accurate, and the biggest restraint on such policies is the need of insurance companies to have deals with the local hospitals.) So I would offer up for discussion an exemption for policies offered on the federal exchange. If a state does not have its own exchange, policies on the federal exchange will be exempt from state regulations and will only be subject to federal regulations. If a state wants to regulate those policies, it can take over the exchange. If not, a state will not be permitted to sues state regulations to obstruct the federal exchange. My hunch says that the states will not opt to set up their own exchanges and that the exemption of insurance companies from state regulations will not increase the number of policies that cross state lines.
We had our day of glee over the abject failure of the GOP. And let’s recap: they had SEVEN YEARS to come up with a replacement and chose not to. It’s critical to understand why they didn’t, because it affects what we do moving forward. The Republicans never developed a replacement because they don’t want government to have any part of healthcare (or social services of any sort). Their goal is to dismantle not just the ACA, but Medicaid, Medicare and then Social Security. As a side dish – public education, environmental protection, etc. That’s their goal. And when your goal is death, you’re never looking to develop a treatment plan.
The AHCA bill was a tax bill, plain and simple. Its thrust was to create a trillion dollars in savings so that Ryan and crew could enact the tax cut bill they want: without the savings, it will be harder to decrease monies paid by individuals making over a million a year. They’ll likely make some progress, however, on corporate tax dismantling. More on that below.
It went down in flames for several reasons: yes, the protests certainly gave cover to Republican in moderate districts, especially those that Hillary Clinton carried last year. Don’t underestimate that, and DON’T STOP!!! But the overarching reasons are all on the Republican side: they have to do with the Freedom Caucus which stood en bloc in the face of direct threats from the White House. They couldn’t care less what their party thinks of them, they’re not afraid of Trump and Bannon, they don’t even care that much about their constituents. They are ideologues with no understanding of how government functions, only how to stop it. Their goal is NO government, and they’re too stupid to understand that “NO government” is synonymous with “Failed State” and “Anarchy”. In our planning, we need to consider the best ways to leverage them. Remember, this was never going to pass the Senate, and we suspected that when the first draft was published in early March. (See paragraph six in this link.)