What the British government is doing to a baby and his family is almost unbelievable. The government has determined that Alfie Evans, afflicted as he is by a rare neurodegenerative disorder, has so poor a quality of life that no efforts should be made to keep him alive.
He was taken off ventilation, but continued, surprising the doctors, to breathe. He has also been deprived of water and food. His parents want to take him to Italy, where a hospital is willing to treat him. The British government says no, and has police stationed to keep the boy from being rescued.
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Big news on the health-care policy front: Democrats appear to be converging on an actual agenda if they win in 2020.
Senator Elizabeth Warren introduced new legislation on Wednesday that policy guru Charles Gaba calls “ACA 2.0.” The Huffington Post’s Daniel Marans has details here.
This is, as Gaba describes it, more than just patching up Obamacare to make up for the damage done by Congress, states and design flaws in the original bill. It’s an upgraded version of the Affordable Care Act. At the same time, it’s nowhere close to the various single-payer or “Medicare for all” proposals that liberals have been spending a lot of time talking about over the last two years.
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“The Trump administration’s action today is cruel,” said Democratic Congressman Frank Pallone Jr. of New Jersey. The new policy is “the latest salvo of the Trump administration’s war on health care,” according to a health-care advocacy group. “The pain is the point” of the policy, wrote columnist and economist Paul Krugman.
They were attacking the Trump administration’s decision last week to allow states to impose work requirements on Medicaid beneficiaries. But far from being a “cruel” action designed to inflict “pain” on the vulnerable, the administration’s decision is completely reasonable.
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Republicans have famously failed to pass health-care legislation this year. But future attempts at reforming Obamacare will have an advantage over previous ones. The most politically powerful argument against Republican health-care legislation has been that it would “take insurance away” from many millions of people. That argument was based on the CBO’s findings, and most of it was based on the end of the individual mandate.
If Republicans end the mandate in the tax bill, any estimates of the effects of future legislation on coverage will be about 13 million lower. The tax bill doesn’t just advance a major conservative objective on health policy. It prepares the ground for replacing other parts of Obamacare as well.
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Conservatives are supposed to get two wins in the Alexander-Murray bill. The first is the creation of “copper” plans within the Obamacare exchanges. Moderate Democrats have championed this idea as a way for consumers to buy plans with lower premiums and higher deductibles than others available on the exchange. But because the plans would still be subject to Obamacare’s regulations, they would still be a far cry from the low-cost catastrophic plans that conservatives would like to see. The deal also gives states a little more flexibility — but constrains that flexibility in a way that makes it valueless. States would have to show that any policy changes they make would lead to a comparable number of people having the same kind of comprehensive coverage that Obamacare seeks to foster. But that’s not the kind of coverage conservatives want to make the focus of public policy.
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A major problem with the Affordable Care Act is the way it was passed: on a party-line vote, without support from a single Republican. This made the law vulnerable and created uncertainty about its future among market participants. The unsuccessful GOP repeal-and-replace efforts have been just as divisive. For a policy change of this magnitude to be lasting and stable, it should have at least some bipartisan support.
Universal coverage should be pursued in a way that is affordable, both to households and to the government, and that helps lower the trajectory of health-care costs overall. It should lead to higher-quality medical care, to make being insured attractive to households, and should encourage innovation, productivity and technological progress in the health-care sector. It should encourage young and healthy people to be covered in order to balance the risk pool facing insurers, making it attractive for insurers to offer insurance. It should ensure that even the hard-to-cover are insured.
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Republican efforts to pass health-care legislation are in jeopardy again, in part because of controversy over its potential impact on Medicaid. But the Republican reforms are more moderate, and more worthwhile, than they are getting credit for.
The CBO is exaggerating the effects of the Republican legislation on Medicaid enrollment, it’s worth putting Medicaid on a firmer footing, and any additional resources for health insurance for low earners should be directed toward enabling them to buy private coverage rather than pumped into Medicaid. On Medicaid, in short, the Republicans are on the right track.
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The new Senate bill 1) Reduces the number of people eligible for subsidies, reduces the values of the premium subsidies, and lowers the cap on total subsidy expenditure; 2) Eliminates the individual and employer mandates; 3) Restricts coverage for abortion; 3) Ends the cost-sharing reductions — but not before paying insurers back for the money they’ve already laid out; 4) Gives states a great deal more flexibility in the waiver program; 5) Gets rid of a lot of Obamacare taxes; 6) Provides market stabilization funds; 7) Winds down the Medicaid expansion funding, but not as fast as the House bill; and 8) Converts Medicaid to a per-capita allotment rather than an open-ended entitlement.
Healthcare.gov enrollment came in well below what was anticipated last month. After running very slightly ahead of last year’s numbers in December, January brought the news that about 400,000 fewer people had enrolled on the federal exchanges than did so in 2016. Those are scary numbers, not so much for the absolute size of the decline—it’s roughly 4%—but because any backwards movement is very bad news for the exchanges. Trump was only president for a few days’ worth of open enrollment. Could he really have somehow caused 400,000 people to forgo health insurance?
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The Republicans are thinking of leaving Obamacare’s regulations in place because they fear that a bill altering them would die in a filibuster. They are sure they can use a procedure for avoiding filibusters if they target only the law’s tax and spending provisions.
This course could cause the insurance exchanges, already in trouble, to collapse entirely. That’s because the Republican bill would scrap the individual mandate while keeping Obamacare’s requirement that insurers treat sick and healthy people alike.
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