This week we got a good look at the three health-care options going forward. Two seem to be out of the question, which leaves the third — namely, tweaking Obamacare.
Sen. Bernie Sanders (I-Vt.) did his usual smoke-and-mirrors routine, proposing universal health care — without explaining how we’d get from here to there and exactly how we’d pay for it. The libertarian Reason magazine did some digging and found that Sanders wasn’t always so glib about financing single-payer health care:
Back in 1987, a much younger Bernie Sanders apparently had that sense too. He warned that expanding Medicaid, the jointly run federal-state health care program for the poor and disabled, to everyone in the country would “bankrupt the nation.”
“If we expanded Medicaid [to] everybody. Give everybody a Medicaid card—we would be spending such an astronomical sum of money that, you know, we would bankrupt the nation.”
Republicans have requested that the Congressional Budget Office score the bill, but if the past is any indication, the health-care plan rolled out during the campaign was estimated to cost an additional $32 trillion over a decade. The Urban Institute explained: “In total, federal spending would increase by about $2.5 trillion (257.6 percent) in 2017. Federal expenditures would increase by about $32.0 trillion (232.7 percent) between 2017 and 2026. The increase in federal spending is so large because the federal government would absorb a substantial amount of current spending by state and local governments, employers, and households. In addition, federal spending would be needed for newly covered individuals, expanded benefits and the elimination of cost sharing for those insured under current law, and the new long-term support and services program.”
Back on planet Earth, Republicans are making one last stab at getting rid of the Affordable Care Act. The Post reports:
The proposal, crafted by Sens. Bill Cassidy (R-La.), Lindsey O. Graham (R-S.C.) and Dean Heller (R-Nev.), essentially turns control of the health-care markets over to the states. Rather than funding Medicaid and subsidies directly, that money would be put into a block grant that a state could use to develop any health-care system it wants. It also allows states to opt out of many ACA regulations. “If you like Obamacare, you can keep it,” Graham has said, using a common nickname for the health-care law. “If you want to replace it, you can.”
In reality, that may not be true. The Medicaid expansion and subsidy funding would be cut sharply compared to current spending, going to zero in a decade.
For those GOP senators and all Democratic senators who nixed other plans that slashed Medicaid, this should be rejected out of hand.
When all else fails, there is the reasonable, bipartisan approach backed by governors. Roll Call reported:
Governors are calling for multiyear funding for cost-sharing payments and for federal assistance to launch reinsurance programs as part of a bipartisan measure to stabilize the individual insurance market.
The conversation among governors and senators in a Sept. 7 hearing before the Senate Health, Education, Labor and Pensions Committee echoed what insurance commissioners told the same panel earlier in the week about how to bring stability to the individual insurance market before the fifth open enrollment period.
The committee’s leaders hope to advance a narrow, bipartisan package before insurance companies finalize contracts with the federal government for the 2018 coverage year on Sept. 27.
HELP Chairman Lamar Alexander suggested the contours of a package could include funding for the health care law’s cost-sharing reduction payments, which the state officials have pleaded for, and additional restructuring of the law through waivers or through allowing certain consumers to buy basic catastrophic coverage.
Supporters of this approach got a boost on Thursday when CBO reported on the current status of Obamacare — before any fixes are applied. CBO found that between 2018 and 2027, the number of insured Americans will grow from 242 million to 247 million, while the uninsured will grow from 30 million to 31 million. In other words, the percent of covered individuals is expected to remain constant. (This week, the Census Bureau reported that the uninsured rate was only 8.8 percent last year.) CBO directly contradicts the claim that Obamacare is in a death spiral: “The nongroup health insurance market to be stable in most areas of the country. Preliminary data for 2018 show that insurers will offer coverage in all or almost all areas. Although premiums have been increasing, most subsidized enrollees buying health insurance through the marketplaces are insulated from those increases because their out-of-pocket payments for premiums are based on a percentage of their income; the federal government pays the difference between that percentage and the premium for a benchmark plan.” Remarkably, only “one-half of one percent of people in the country” will live in areas with no individual group insurers. Interestingly, now that Obamacare is here to stay, CBO expects that “over time” more states will expand Medicaid.
CBO does find some problems — caused by the uncertainty this administration created. For example, on price, in 2018 “the average benchmark premium will be roughly 15 percent higher than it was in 2017, largely because of short-term market uncertainty—in particular, insurers’ uncertainty about whether federal funding for certain subsidies that are currently available will continue to be provided— and an increase in the percentage of the population living in areas with only one insurer in the marketplace.”
Likewise, in the individual market, lower numbers of enrollees are expected from 2018 to 2026 — some 7 million to 10 million people fewer than in March 2016. Why? In part, more employers are offering insurance, a good thing. However, the CBO finds that “data suggest that one reason for the difference is that more employers are offering coverage to their employees than CBO and JCT had anticipated. Also, [the CBO and the Joint Committee on Taxation] expect lower enrollment because of announced reductions in federal advertising, outreach, the enrollment period, and other enrollment efforts and, in 2018, because of higher premiums resulting from insurers’ uncertainty about federal funding of CSR payments; those factors were not incorporated into the March 2016 projections.” If that can be fixed — as Alexander’s bill aims to do — the number enrolled in the individual markets through the exchanges should go up.
In sum, the latest attempt to expand Medicaid seems unlikely to succeed. Sanders is peddling a pipe dream. That leaves Obamacare –with some improvements. Laughably, President Trump seems ready to grab that and then slap his “repeal and replace” label on it. Politico reports:
After months of hammering Republicans over their failure to repeal Obamacare, President Donald Trump huddled this week with moderate House Democrats and Republicans who were trying to sell him on a fix to the health care law.
Upon hearing it had bipartisan support, the president had one question: “Can I call it ‘repeal and replace’?”
“You can call it whatever you want, Mr. President,” a Democratic lawmaker told Trump, eliciting laughter throughout the room.
The president loved that response.
Almost as much as Democrats will. You see, Trump is more than willing to advance Obama’s domestic agenda (health care, Deferred Action for Childhood Arrivals) — so long as he gets credit. In this case, a repaired Obamacare may be the least bad option available.