Republican senators Ted Cruz and Mike Lee are pushing for an amendment to the Senate GOP’s Better Care Reconciliation Act (BCRA) that would substantially alter the current landscape of health-insurance regulation. They believe their amendment, which aims to give insurers much more freedom to offer any kind of product they want to customers, would go a long way toward restoring a free market to health care, and would result in lower premiums for millions of consumers.
The strong commitment of these senators to this particular amendment, and the insistence on its inclusion in the Senate bill by conservative groups, reveals a broad misunderstanding among conservatives of what is wrong with health care in the United States, and what is needed to build a market-driven system.
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The biggest problem with Obamacare is that it expanded health coverage through Medicaid, a program with notoriously poor access to doctors, because Medicaid pays doctors far less than private insurance. The Senate Republican health care bill aims to change that, by giving states the ability to offer an innovative new model to their poorest residents: direct primary care.
The fact that people enrolled in Medicaid have poor access to physicians is well-documented in the literature (see here and here and here). To take one example, kids with acute asthma attacks on Medicaid only had a 45 percent chance of securing a doctor’s appointment, compared to 100 percent of those with private insurance.
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For the better half of a decade, lawmakers in Washington have been experimenting with the nation’s healthcare policy in an attempt to bring coverage to all Americans, while controlling costs and sustaining quality. The Affordable Care Act was the climax of such attempts.
While the ACA did bring some positive ideas to the table—such as giving more Americans the ability to enjoy health insurance and protecting people with pre-existing conditions from predatory premiums—it fell short in many other aspects.
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Senate Republicans returning from a July 4 recess are so divided over a health-overhaul bill that they are also struggling to agree on what to do if they fail to pass their legislation.
Some conservative lawmakers say an implosion of the Republican legislation would give them a chance to return to their goal of fully repealing the Affordable Care Act, putting off until later a decision about what system to put in its place. Others, including Senate Majority Leader Mitch McConnell (R., Ky.), are considering the possibility of legislation to shore up the law’s marketplaces where individuals buy health coverage, action that would involve working with Democrats.
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Democrats loudly complain that people will lose health insurance if the Affordable Care Act is repealed. They never mention those who lose jobs because the ACA remains.
The ACA includes a penalty on employers that fail to provide “adequate” insurance for full-time workers. Thanks to the ACA, hiring the 50th full-time employee effectively costs another $70,000 a year on top of the normal salary and benefits.
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According to widespread media reports, Senate Republicans are considering an amendment to the proposed Better Care Reconciliation Act from Texas Senator Ted Cruz under which, if a health insurer offered at least one Obamacare-like plan with community rating, it could also offer a plan in which healthier people would pay lower rates than the sick. Although this proposal might please conservatives otherwise worried that the BCRA is but “Obamacare-lite” and although it might mollify some moderates — if you like your Obamacare you can kind of keep it — it creates an “income cliff.” People who need expensive medical care will be far worse off if they make more money. Some additional modifications to the Republican bill could reduce this problem, but they are likely to be some combination of ineffective or expensive.
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The last man to pull out of the Republican race against Donald Trump was John Kasich, the Ohio governor, a long-shot contender for the presidential nomination whose chances had long since faded. But he has returned to the role of thorn in Mr Trump’s side as Republicans in Washington struggle to reform Obamacare, leading a group of governors trashing their own party’s plan.
The intra-party revolt is rooted in Republican proposals to gut Medicaid, a programme for the poor that provides insurance to 69m Americans. Republicans have long seen it as an emblem of mismanaged welfare programmes that distend government and discourage people from working. But Mr Kasich is showing change is afoot.
He was one of 16 governors from Republican-led states that took an option to expand Medicaid offered by Obamacare, adding 700,000 Ohioans to the programme, despite the broad distaste for Barack Obama’s reforms in his party. In recent weeks he has stressed its vital role in treating people ravaged by opioids and other drugs, which killedan average of 11 Ohioans each day last year, and those suffering from schizophrenia, bipolar disorder and other mental illnesses.
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