Molly Reynolds, fellow in Governance Studies, considers what’s next for the AHCA in the Senate following the House narrowly passing the bill.
Tag Archives: ACA
I have a pre-existing condition. I do things “the right way”.
I have a pre-existing condition. I do things “the right way”.
When I was a medical student, I started to notice blood in the toilet. I was a medical student, so I panicked. I called my father, who at the time was still a practicing surgeon, and he told me it was likely hemorrhoids. Given the alternatives, I breathed a sigh of relief.
The blood didn’t go away, though. Soon, I started to have diarrhea, cramps, and the urge to go to the bathroom all the time. That summer, I worked at Children’s Hospital of Philadelphia on a research project, and I had to go to the bathroom so many times, I thought they were going to fire me. It got so bad, my Dad (who is a minimalist), finally sent me to the gastroenterologist. The short version of the story is they determined I had ulcerative colitis.
I’ve written about this before, so I’m not going to get into the details of the disease. The only reason I bring any of this up is so you understand that I was diagnosed when I was 22 years old and a full-time student.
None of it was my fault.
Today, I eat a well-balanced diet. My weight is good. I exercise 5 times or so a week. I don’t smoke or do drugs. I don’t drink more than socially. I do everything I’m supposed to do. I still have ulcerative colitis, and I will until I die, likely. I’m doing the things I need to do to keep my body healthy. I lead a good life.
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I try very hard to see the good in others. When I write, when I debate others, I do my best to assume that the intentions of those with whom I disagree are righteous. Even when we see the world differently, I make every effort not to think that others are “bad” or want to see people suffer. I’m not one who writes that people who want to reform the insurance system want “to kill people”. I don’t think that people who want to reform welfare “hate the poor”. I’m not perfect, so sometimes I screw up. When I do, I apologize.
Yesterday, a Congressman went on TV and said (emphasis mine):
“My understanding is that it will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool. That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now those are the people—who’ve done things the right way—that are seeing their costs skyrocketing.”
I cannot adequately describe how much this enraged me. This is one of those things that you hear people say “the other side believes”, but discount. I don’t want to believe that people think this. I don’t want to believe that people think that some others deserve to be sick. I don’t want to believe that people equate being ill with a moral failing.
I didn’t do anything to get ulcerative colitis. I did nothing wrong. I lead a good life. I didn’t fail.
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My brother, amazingly enough, has Crohn’s disease; the Carroll GI protoplasm ain’t the best. When I was a resident, and he was a law student, we would talk often about how we would both have to work for very large companies or organizations in order to get health care. It was a fact of life. We both knew that on the individual market, no insurance company would touch us. Ever. Because of our pre-existing conditions, we’d be screwed for the rest of our lives.
He didn’t do anything wrong either, by the way. He was diagnosed in high school, and he was a really good boy, too.
I could start quoting statistics here, but what’s the point? A huge number of Americans have pre-existing conditions. They couldn’t get insurance on the individual market before the ACA because it was in insurance companies’ best interest not to issue them policies. It made good business sense. That didn’t mean it was right.
There is certainly a case to be made that people have some responsibility for their health. But the lines aren’t clear at all. It’s easy to point at smokers and say they’re doing something harmful and are raising costs for all of us. That’s why we can charge smokers more under the ACA. After that… it gets dicey.
Do you start regulating what people eat? What they drink? If you eat dessert, and I don’t, why should I have to pay for your healthcare? Should we charge people more if they drive cars (number one killer of children!)? I like to ski. That has risks. So does rock climbing. Or playing contact sports. Should we make them stop, or charge them more? What about people who scuba dive?
Should we start penalizing people who have different organs in their body than we do?
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I expect that this Congressman will soon be issuing a statement saying he was “taken out of context”. Something along the lines of “he misspoke”. But maybe not. Maybe he does believe what he said, that people who did things the right way are the ones who are healthy. If that’s the case, then I have just one question for him.
What did the baby born prematurely, the one with congenital heart disease, or the toddler with sickle cell disease, or the child with autism, or the little girl with leukemia, or the boy with asthma, or the adolescent with juvenile arthritis, or the young woman with lupus, or the young man with testicular cancer, or the new mother with breast cancer, or the new father with inflammatory bowel disease, or the woman with familial heart disease, or the man with early onset Parkinson’s disease, or the retiring woman with Alzheimer’s disease, or the elderly man with lymphoma – what did they do wrong?
Did they lead bad lives?
I guess I had two questions. Take your time answering. I’ll wait.
The AHCA and the ACA in two charts
The House passed the American Health Care Act (AHCA) this afternoon. It’s still a considerable way from becoming law, but if it does it will repeal the Affordable Care Act (ACA). Here are two charts that explain why this happened.
The first chart is from Henry Aaron of the Brookings Institution (previously discussed here). For each decile of the US income distribution, it projects the income gains and losses from the ACA, where the cash value of the health insurance benefit is treated as income. The positive bars on the left are income gains by the people in the lowest 20% of the US distribution. They are balanced by losses in the upper 80% of the income distribution.
The horizontal axis on the Urban Institute graph represents income ranges, not income deciles. The four bars that are positive on the right represent people making $50,000 or more (the upper 37% of the US income distribution). The bar on the far right, with the huge positive income transfer, represents people earning $200,000 or more (the top 0.33% of the income distribution). Notice also that the vertical axis of the Brookings chart represents percentage changes in income, whereas the axis in the Urban Institute chart represents changes in dollars. If you converted the Urban Institute chart to percents, the magnitude of the bars on the left (low) side would grow and those on right (high) side would shrink. The Institute projects that the average person earning $200,000 or more will get a 1% increase in income. They project that the average person earning less than $10,000 will experience a 33% net loss of income. Think about that for a moment.
Here is why the AHCA is moving forward. The ACA used tax funds to pay for the healthcare of people in the bottom 20% of the income distribution. High earning people pay most of the taxes, so the ACA transferred money from them down to people in the bottom deciles of the US economic hierarchy. The AHCA cuts taxes in the ACA and reduces the amount that the government will spend on the health care of the poor. The net effect of the AHCA is a massive loss for the poor and a benefit for the very top of the economic scale.
I would love to be able to say that these bills represent clashing views about the best way to deliver health care. Unfortunately, I am unable to find a conservative health policy expert who thinks the AHCA is optimal. There may not be one who thinks it’s even good. The AHCA did not pass based on its merits as a health policy solution. The AHCA passed because Republicans wanted these transfer effects.
Healthcare Triage News: Narrow Insurance Networks Limit Access, Especially for Kids
Healthcare Triage News: Narrow Insurance Networks Limit Access, Especially for Kids
Narrow health insurance networks cover fewer doctors, and can be especially narrow when it comes to specialists. And, it turns out, this limited access to specialists disproportionately affects children. This is Healthcare Triage News:
Scripps CEO Chris Van Gorder on AHCA vote: Healthcare is personal, not political
The House of Representatives on Thursday passed the American Health Care Act of 2017 by a 217-213 vote with all Democrats opposing.
Chris Van Gorder, president and CEO of San Diego-based Scripps Health, shared his reaction to the vote with Becker’s Hospital Review via email.
“Healthcare legislation approved by only one party will not last the test of time,” he wrote. Mr. Van Gorder believes the bill’s passage maintains the uncertainty around the future of healthcare and how it is going to be funded, while also creating fear and confusion among patients and healthcare providers.
“[T]his is just one more example of our elected officials refusing to compromise and work together for the good of the country,” he said. “Healthcare should not be political — it’s personal. It’s about life and death.”
Mr. Van Gorder urged elected officials to drop bipartisan arguments and work together to design a healthcare plan that increases coverage and access, improves quality and outcomes, and lowers costs.
“Good and sustainable legislation should come out of debate, compromise and the involvement of the experts — in this case, healthcare professionals,” he said. “We healthcare leaders stand ready to help.”
What Are Pre-Existing Conditions and What Would the GOP Bill Do?
Important background for understanding what happened today in the House:
America has the only healthcare system in the world designed to avoid sick people. Private for-profit health insurers do whatever they can to insure groups of healthy people, because that’s where the profits are. They also make every effort to avoid sick people, because that’s where the costs are.
The Affordable Care Act puts healthy and sick people into the same insurance pool. But under the Republican bill that just passed the House, healthy people will no longer be subsidizing sick people.
Healthy people will be in their own insurance pool. Sick people will be grouped with other sick people in their own high-risk pool – which will result in such high premiums, co-payments, and deductibles that many if not most won’t be able to afford the cost.
Republicans say their bill creates a pool of money that will pay insurance companies to cover the higher costs of insuring sick people. Rubbish. Insurers will take the money and still charge sick people much higher premiums. Or avoid sick people altogether.
The only real alternative here is a single-payer system, such as Medicare for all, which would put all Americans into the same giant insurance pool. Not only would this be fairer, but it would also be far more efficient, because money wouldn’t be spent marketing and advertising to attract healthy people and avoid sick people.
Republicans’ plan to protect sick people has a long history of not protecting sick people
Republicans technically have a plan for covering sick people: setting up a system that could do so, but, if history is any guide, wouldn’t.
Welcome to “high-risk pools,” the government-subsidized groups for people who — in the world where insurance companies can go back to their pre-Obamacare practice of discriminating against those with preexisting conditions — can’t get covered on their own. In theory, the pools can be a good way to make sure money is going to the people who need it the most. But in practice, they don’t tend to give out enough money in the first place. Which is why the GOP’s plan to repeal Obamacare’s protections for the sick and replace them with high-risk pools might literally be a life-or-death gamble for a lot of people.
Now, the first thing to know about high-risk pools is that they aren’t magic. They don’t make it any cheaper to cover sick people. That costs what it costs regardless of whether we pay for it with a combination of higher premiums and higher taxes (like Obamacare does), or with higher taxes alone (like high-risk pools would). And yes, it’s something that “we” have to pay for, since the most serious illnesses cost far more than anyone could pay on their own. Indeed, the sickest 5 percent of people make up 50 percent of health-care spending. Although there’s a big caveat here. The idea that high-risk pools won’t save any money is based on the assumption that, as President Trump put it, we won’t have people “dying in the streets.” In other words, that we’ll adequately fund the high-risk pools.
We haven’t in the past. Before Obamacare, you see, a lot of states had their own high-risk pools that were supposed to do what Republicans say they will today: cover sick people separately so that healthy people aren’t burdened with higher premiums. The only problem was they forgot to do that first part. State governments didn’t put anywhere near enough money into their high-risk pools, with the predictable result that these only slightly subsidized costs were still too expensive for a lot of people with preexisting conditions. And even then, they often faced lifetime limits on their coverage. Not to mention the fact that there were long waiting periods before you could join — not something, say, a cancer patient could afford.
Here’s why that matters now. Republicans don’t actually want to set up their own high-risk pool. They want the states to do that themselves — with $138 billion coming from Washington over the next 10 years. But there are three problems with this. First, this almost certainly isn’t enough money. Even conservatives like James Capretta and Tom Miller think that high-risk pools would need around $150 billion to $200 billion to work over the next decade. Emily Geeof the left-leaning Center for American Progress, meanwhile, thinks it’s more like $330 billion. Second, this money isn’t even required to go to high-risk pools. States could also use it to offset costs for healthy people in the individual market — which is what the nonpartisan Congressional Budget Office expects they’ll do. And third, this funding isn’t flexible. It’s a one-time grant that states won’t have an easy time supplementing since they have to balance their budgets every year. The result would be a much more precarious than the system we have now where sick people can’t be charged more and any subsidy they get automatically goes up with their premiums to try to keep them from being priced out of the market.
How Every Member Voted on the House Health Care Bill
The House narrowly passed a health care bill on Thursday that would repeal and replace major parts of the Affordable Care Act. Every Democrat voted no, joining 20 Republicans.
The Next Step for the GOP Health Care Bill: A Skeptical Senate
As House Republicans on Thursday shoved their health care bill across the finish line, stuffing it with amendments and extra dollars to secure a hard-won majority, the lawmakers who will inherit the legislation delivered their own message from across the Capitol:
That’s cute.
On the Senate side, where several Republicans have long been deeply skeptical of the House effort, the bill is expected to undergo sweeping changes that might leave it unrecognizable — perhaps stripping away some of the provisions that helped earn the support of hard-right House members and ultimately secure its passage.
The Republicans’ narrow 52-member majority in the Senate leaves little room for defections, and several Republican senators have worried aloud about the House measure. Their concerns include insurance costs for poorer, older Americans and funding issues in states with high populations of hard-to-insure people.
Senate GOP rejects House Obamacare bill
http://www.politico.com/story/2017/05/04/house-health-care-bill-senate-doa-238000?cmpid=sf
After all the energy the House just expended on ramming through its Obamacare repeal, the Senate is about to start over.
“We’re writing a Senate bill and not passing the House bill,” said Sen. Lamar Alexander (R-Tenn). “We’ll take whatever good ideas we find there that meet our goals.”
They need to end up with a bill that can win over 50 of the 52 GOP senators in the narrowly divided chamber. And even if they accomplish that, their bill could be unpalatable to House conservatives. The House bill squeaked through on a 217-213 vote.
The two chambers have not coordinated much in recent weeks as the House — with an assist from the White House — frantically worked to kick the health care bill to the other side of the Capitol. Senate Republicans say they’ll take the time they need to understand the House bill’s ramifications. And they will insist on a score from the Congressional Budget Office before voting, unlike the House.
“Like y’all, I’m still waiting to see if it’s a boy or a girl,” said Sen. Lindsey Graham (R-S.C.). “Any bill that has been posted less than 24 hours, going to be debated three or four hours, not scored? Needs to be viewed with suspicion.”
HENRY KOTULA 