Today’s Managing Health Care Costs Number is 216
(Blue are Medicaid expansion states; Orange are nonexpansion states, cross-hatched states have some activity to expand Medicaid.
The Republicans have pledged to vote on the American Health Care Act tomorrow – and their majority leader has said that he has the 216 votes to pass the bill. I hope he’s wrong.
The Congressional Budget Office still has not scored the bill – and most give the bill little chance of passing the Senate. But moderate Republican congressmen should not rely on the upper chamber to prevent the harm that this bill could bring.
One of the provisions of the Republican bill would let states opt out of the Affordable Care Act’s essential benefits and protections for those with preexisting illnesses. Plenty of commentators have shown that would lead to more uninsured and less valuable insurance –the opposite of the lower deductibles that Trump promised on the campaign trail.
The ACA included plenty of provisions to allow states latitude to establish their own markets, including allowing state regulators to determine essential benefits and regulate their own marketplaces. The Supreme Court allowed states to opt out of the Medicaid expansion. The result has been an unmitigated disaster for health care access. There is every reason to believe that the AHCA’s new provisions to allow states to eliminate the core insurance requirements would also lead to worse health care and worse health care value for residents of states whose legislatures eliminate these protections.
Here are some of the ways that states have worsened the health of their populations and their economic prospects since the passage of the ACA. This is an incomplete list – the harm done by misguided state actions has endangered the health of millions.
· 19 states still have not expanded Medicaid. This has meant that over 4 million extra Americans remain uninsured.
· The State of Tennessee allowed farm bureaus to sell nonconforming health plans to healthy individuals – leading to the ACA Exchange marketplace population being less healthy than projected. As a result, 15 counties in Tennessee have no exchange insurers for 2018
· Arkansas is preparing to kick 60,000 low income people off Medicaid – which will save a pittance in the state budget. (The budget is $5.2 billion, and this move would save $66 million over 4 years- or 0.3%)
· Florida is seeking to get expanded disproportionate share payment dollars en lieu of Medicaid expansion, even though these will buy much less coverage for Floridians.
· Scott Walker is imposing drug testing on Medicaid recipients in Wisconsin, despite the fact that this is an utter waste of money.
Allowing states to undo the consumer protections and the protections for the sick in the Affordable Care Act is bound to go wrong. The House should reject this bill.
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