Despite the surge in enrollment and spending—or perhaps because of it—Medi-Cal, California’s Medicaid program, has failed to fulfill its stated goal of improving health-care access for the indigent and disabled. A recent report from the Santa Clara County Civil Grand Jury highlighted the conundrum many of the state’s Medicaid enrollees face: “You’ve Got Medi-Cal, but Can You Get Medical Care?” By extending Medi-Cal to younger, healthier people—many of whom could be better served by the kind of bare-bones private insurance that ObamaCare outlawed—California has made it harder for those who most need low-cost care to get it.
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Republicans seem to be able to achieve near-unity on ending the individual mandate, allowing insurers to offer discounts for younger people, protecting taxpayers from having to subsidize abortion coverage, and giving states some freedom to relax regulations. They should work for legislation that achieves these goals and includes as much Medicaid reform as 50 senators are prepared to tolerate. Republicans should not claim that such legislation would repeal and replace Obamacare, since it would not, and should make it clear that additional legislation will be needed in the future.
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Senate Republicans killed their own health-care bill on Monday evening. This self-inflicted fiasco is one of the great political failures in recent U.S. history, and the damage will echo for years. This wasn’t the inevitable result of some tide of progressive history, but choices made by individuals to put their narrow political and ideological preferences ahead of practical legislative progress. The “ObamaCare Republicans” come from both the conservative and moderate wings, but all of these Senators campaigned for nearly a decade on repealing and replacing ObamaCare. Now they finally have a President willing to sign literally any bill that lands on his desk, but in the clutch they choked. The ObamaCare Republicans ran on fiscal discipline but they rejected the best chance for entitlement reform in a generation.
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The Trump administration and Republicans in Congress find themselves in a position there never wanted to be in: heading into the August recess having failed to repeal and replace the Affordable Care Act (ACA), and also without any significant legislative accomplishments since the November 2016 election.
Before charting a new course, the GOP needs to understand how they drove themselves into this political ditch.
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Medicaid has become one of the most hotly debated issues in health reform. Almost all agree that reform is badly needed. In Congress, it has become a numbers game about millions of people and billions of dollars. One side decries the poor health outcomes that will derive from people losing coverage; the other argues that Medicaid desperately needs reform, not only to serve today’s recipients but also to effect solvency for future generations. Many are being told that empowering the federal government further is the way forward; conversely states, both red and blue, feel they can better serve their citizens if they were given more flexibility in managing Medicaid. How Medicaid is reformed is critical to the future of health care reform because it will form the template for the design of Medicare and private insurance going forward.
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A decade after the nation’s top hospitals used all their advertising and lobbying clout to keep their tax-exempt status, pointing to their vast givebacks to their communities, they have seen their revenue soar while cutting back on the very givebacks they were touting, according to a POLITICO analysis.
Hospitals’ behavior in the years since the Affordable Care Act provided them with more than 20 million more paying customers offers a window into the debate over winners and losers surrounding this year’s efforts to replace the ACA. It also puts a sharper focus on the role played by the nation’s teaching hospitals – storied international institutions that have grown and flowered under the ACA, while sometimes neglecting the needy neighborhoods that surround them.
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The United States is facing another crisis in organizing its health care system. It is clear that the private exchanges concocted under the Obama administration are failing at a record rate for the simple reason that they violate all known sound principles of insurance. The planners who put these programs together unwisely thought that universal coverage would overcome the standard insurance problems of adverse selection and moral hazard.
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Rolling back ObamaCare’s Medicaid expansion has become the focal point of the health-care debate, and rightly so. Without fundamental change, Medicaid—expanded or not—will push state budgets to the brink even as it fails to help the most financially vulnerable Americans.
Consider Oklahoma, our home state. Despite intense lobbying by hospital corporations, the state Legislature stood strong and refused the Medicaid expansion. But the Medicaid rolls increased anyway, and at a dramatic cost to priorities like education, public safety and transportation.
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After all this time, it increasingly appears impossible to get 50 Republican senators to agree on legislation to replace Obamacare. Last night brought genuinely shocking news as two GOP senators, who up until now hadn’t appeared to be likely “no” votes, announced their opposition: Jerry Moran of Kansas and Mike Lee of Utah.
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Two more Senate Republicans have declared their opposition to the latest plan to overhaul the nation’s health-care system, potentially ending a months-long effort to make good on a GOP promise that has defined the party for nearly a decade and been a top priority for President Trump. Sens. Mike Lee (Utah) and Jerry Moran (Kan.) issued statements declaring that they would not vote for the revamped measure.
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