Health · Politics

Republicans about to score big win by dismantling health care access

Bob CollinsBob Collins May 4, 2017
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Apparently, the House will have to vote on its revamped health care bill before we can find out what’s in it.

The Associated Press, in its story on the MPR News site today, calls the re-emergence of the legislation “startling.”

Is it? Anyone who watched rich owners get public funding for sports stadiums and arenas in Minnesota and elsewhere may not be surprised. Politics is the art of wearing down the people. Keep asking for something wildly unpopular, and eventually people will tire of putting up enough objections to it.

A month ago, the idea that women’s health wouldn’t be covered or people with pre-existing conditions would have difficulty finding affordable coverage, sank the Republican measure, which was so flawed that it did the unthinkable: It made Obamacare more popular.

President Trump left the measure for dead and promised to turn his attention instead to “tax reform,” but then he realized the plan to provide massive tax breaks to the most wealthy Americans, was funded partially by the money not spent on providing health care access to people who are decidedly not.

So the hard-liners in the House went to work and made the measure even more hard line, while exempting Congress from its provisions, and now it’s likely to pass thanks to a single Republican vote, which may well be Minnesota Republican congressman Erik Paulsen, who was quoted on MinnPost on Tuesday as not having digested the full bill yet.

Paulsen is a likely “yes” vote because (a) when’s the last time Paulsen bucked his party and (b) he spoke on the House floor in support of the previous version of the bill just before House leadership stabbed him in the back by pulling the bill. Paulsen is a good party soldier who continues to confirm that last November’s Star Tribune editorial endorsing him was a work of utter fiction.

“Seventeen percent of the people supported this legislation last time,” Sen. Al Franken, DFL-Minn., told MPR’s Cathy Wurzer this morning. “And this is worse. Seventeen percent is the same number of people who claim to have seen a ghost.”

With time, the details of the bill will come out. But time is working against the Republican measure, which is why it’s up for a vote today. Details matter, but details can sink legislation if people find out what’s in it.

How’s that for good governing?

The bill, according to ABC News, has many of the elements that made it unpopular before. A 30-percent price hike for people who let insurance lapse, significantly increased premiums over the next decade for older people, the option of providing no coverage for pregnancy and mental health services, and a limit on Medicaid payments to states, which most certainly will result in low-income people losing access to health care.

These are all protections which congressional Democrats were too scared to defend in the last campaign.

The New York Times says the bill would allow insurers to charge older customers five times as much as younger ones. But states could waive that rule and establish an even higher ratio.

But wait, there’s more.

Today, the Wall St. Journal — certainly no liberal rag — reports that a “little-noted provision” in the bill could affect people who have the luxury of not caring about today’s events because they’ve got employer-provided health insurance.

They could lose a cap on out-of-pocket expenses for medical coverage, the paper says.

It’s part of a last-minute amendment that included giving states the right to remove all the coverage people objected to removing when the bill was up for a vote weeks ago.

Large employers could choose coverage rules from any state in its provided insurance, even states that don’t require coverage or out-of-pocket limits, even if you work in a state that does, the Journal says.

Under the House bill, large employers could choose the benefit requirements from any state—including those that are allowed to lower their benchmarks under a waiver, health analysts said. By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation.

The measure would give employers added flexibility to take steps that could lower costs by limiting more-expensive coverage areas. And it would lessen the federal regulation of insurers, a goal of GOP lawmakers who believe the ACA is an example of government overreach.

The impact on employer plans expands the scope of the health bill to affect, potentially, everyone not insured by Medicare or small-business plans, since the bill also includes cuts to Medicaid and changes to the individual market. Employer health plans are the single largest source of health insurance in the country, with about 159 million Americans receiving coverage through their jobs

The good news, if there is any good news for working stiffs, is that we at least know about the provision, thanks to the Journal. The bad news is not everyone reads the Journal and knows what’s in the legislation.

A lobbyist for big business told the paper that “even if self-insured health plans are no longer banned from imposing annual or lifetime limits, they’re unlikely to attempt to squeeze the toothpaste back into the tube.”

Which doesn’t explain why Republican lawmakers want so badly to provide the option for something unlikely to happen.

How many people would lose coverage under the plan? In the last debate, the answer to that question helped sink the bill. So today’s vote will occur before the Congressional Budget Office can release its analysis.

“This is not a hard bill to grasp; this is not like Obamacare which was 2,400 pages long. This is not hard to understand,” Congressman Tom Cole, R-OK, told NPR’s Steve Inskeep this morning.

Fair enough, so why are some Republican congressmen avoiding defending the measure by saying they haven’t finished reading the bill yet?

It’s difficult to hold the nation’s attention. The gleaming new sports stadiums are a testament to that. And, soon, so will be the sick and uninsured.

Politicians are really good at this game.