Today's Managing Health Care Costs Number is 9 |
The Republicans hit the talk shows and the radio waves this weekend to defend the indefensible American Health Care Act (AHCA). There are lies everywhere - making the moniker "TrumpCare" totally appropriate. Here are five key recurrent lies:
Lie One: At least the AHCA will lower the cost of health care.
No such luck. There is nothing in the bill that would lower the cost of actually delivering health care; at least the ACA had alternative payment models and the CMS innovation center and pathway for approval of bioequivalent drugs. The CBO estimatesthat the premiums will actually increase by 15-20% by 2019. Premiums will be lower in 2026 not because costs have been averted, but because sick people will be priced out of the market.
No such luck. There is nothing in the bill that would lower the cost of actually delivering health care; at least the ACA had alternative payment models and the CMS innovation center and pathway for approval of bioequivalent drugs. The CBO estimatesthat the premiums will actually increase by 15-20% by 2019. Premiums will be lower in 2026 not because costs have been averted, but because sick people will be priced out of the market.
Lie Two: The AHCA will have no impact on employer-sponsored health insurance .
Au contraire. Employer mandate will be eliminated, and employers will be able to base their benefits on a benchmark plan that from a state that has opted out of essential benefits and doesn't require coverage of preexisting conditions or prohibit annual and lifetime maximums. Further, those covered by employer sponsored health insurance will be more reluctant to leave their jobs (whether to start a new business or retire early) since the individual market will be back to its dysfunctional pre-Obamacare state, where only healthy people qualify for insurance. Most employers will not want to go back to the pre-ACA policies - but the most vulnerable are those in low skill low wage industries where workers most need the protection they will likely lose.
Lie Three: No states will opt out of the ACA essential benefits and preexisting condition rules anyway.
Bullsh#t. Tom Reed, a New York representative, said this on NPR on Saturday. If no states would opt out, there'd be no reason to include this clause in the legislation. Look at the 19 states that have harmed their residents by not expanding Medicaid. States will be lobbied hard by various business interests to eliminate these requirements - and all it takes is a single state to opt out to mean that self-insured plans across the country can eliminate this required coverage.
Lie Four: We are not going to kick people off Medicaid!
Really? Then where is that $880 billion of savings coming from? Remember that the majority of Medicaid spending is on the elderly and dual-eligibles (those with disabilities) - and it's hard to kick grandma out of a nursing home. The impact on Medicaid for poor people is likely to be far worse. "Grandfathering" current Medicaid beneficiaries isn't so helpful when 1/3 cycle in and out of Medicaid eligibility each year. Don't forget - Medicaid covers about half of all births in the US!
Lie Five: High risk pools will protect those with preexisting illnesses
High risk pools are invariably subject to "death spiral" where they are so expensive that all but the sickest decide not to sign up - making them even more expensive in subsequent years. The only way to make high risk pools work is with massive public subsidies, and there is widespread agreement that the AHCA offers too little. Representative Fred Upton's $8 billion in additional funds (over 3 years) is not nearly enough.
Lie Six: No one dies because they don't have access to health care.
Raul Labrador (R, Idaho) was roundly booed when he asserted this at a town hall this weekend. Researchers suggest somewhere between 24,000 and 48,000 a year would die because of the "old" AHCA -before it was made worse by the new amendments
Lie Seven: The Senate will never pass this intemperate and ill-considered bill.
One thing we've learned in the past year is that we can't count on traditional political wisdom. The White House cares about wins, and promotes the AHCA as a distraction from other issues including Russia, environmental degradation, and corruption. Anyone who thinks the Senate could never pass such a destructive bill should reconsider- and remember that the eventual Senate bill will be compared to the AHCA, not to optimal health care policy that maximizes coverage and value purchased. The House moderates would never have voted for the AHCA. And then, after a few cosmetic billion in funding for high risk pools, they fell into line.
Lie Eight: The Obamacare exchanges are failing.
There are problems with the exchanges - and most of these are generated by decisions made by state regulators (which allowed sales of non-exchange products that skim off the healthy) or by Congress (which removed risk corridor funding) or the Trump Administration (which has signaled it won't enforce the individual mandate and is daring the insurers to abandon the market by failing to commit to cost sharing reduction payments required by law).
Lie Nine: This is all about health care policy.
Lie Nine: This is all about health care policy.
Not really. The AHCA is a tax cut of close to a trillion dollars that will almost all go to the most wealthy. Those with income of over $1m will on average gain a $50,000 tax cut; those The Republicans desperately want to deliver that tax cut - and will tolerate almost immeasurable damage to the health care system to do it.
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