Health care ‘ac­cess’ is not the same as ‘cov­er­age’

Imperial Valley Press - - OPINION - CLARENCE PAGE

Watch­ing top Repub­li­cans ex­plain their pro­posed Af­ford­able Care Act re­place­ment can make you won­der who hi­jacked the English lan­guage.

For ex­am­ple, if you’re like me, you might have been shocked by the news that 24 mil­lion fewer Amer­i­cans will have health in­surance by 2026 if the Repub­li­can-pro­posed al­ter­na­tive passes, ac­cord­ing to the non­par­ti­san Con­gres­sional Bud­get Of­fice — in­clud­ing 14 mil­lion fewer peo­ple in the next year alone.

But that’s OK, say Repub­li­can con­gres­sional lead­ers. House Speaker Paul Ryan, a Wis­con­sin Repub­li­can, al­ready had de­clared such gloomy out­looks to be a “bo­gus” met­ric. It’s not “cov­er­age” that counts, he said; it’s “ac­cess.”

“What mat­ters is that we’re the low­er­ing costs of health care and giv­ing peo­ple ac­cess to af­ford­able health care plans,” Ryan said in a news con­fer­ence. Ryan, a self-de­scribed “pol­icy wonk,” was ex­cited.

He loves the mere sound of words like “free­dom,” “choice” and “ac­cess” even when the re­al­ity of “ac­cess” amounts to hav­ing the free­dom to be of­fered de­cent health in­surance but also be­ing too poor to buy it.

And he’s not alone. “In­surance is not re­ally the end goal here,” Of­fice of Bud­get and Man­age­ment Di­rec­tor Mick Mul­vaney later told NBC. “We’re choos­ing in­stead to look at what we think is more im­por­tant to or­di­nary peo­ple: Can they af­ford to go to the doc­tor?”

OK, call me old-fash­ioned but I thought be­ing able to af­ford to go to the doc­tor is why we have in­surance.

But, no, said White House Chief Eco­nomic Ad­viser Gary Cohn to host Chris Wal­lace on Fox News Sun­day about the prospect of mil­lions los­ing their health in­surance: “it’s not just about cov­er­age it’s about ac­cess to care. It’s about ac­cess to be able to see your doc­tors.”

So where did I get the idea that the goal was cov­er­age? Maybe Pres­i­dent Don­ald Trump had some­thing to do with that when he promised a Repub­li­can plan that would pro­vide “in­surance for ev­ery­body.”

But he also said in a White House meet­ing with House Repub­li­cans after the Grand Old Party’s pro­posed leg­is­la­tion was un­veiled, that it “will lower costs, ex­pand choices, increase com­pe­ti­tion and en­sure health care ac­cess for all Amer­i­cans.”

There’s that word “ac­cess” again. By now, I sup­pose, we should know from ex­pe­ri­ence that only the pres­i­dent’s most re­cent ver­sion of the truth should be be­lieved, if that.

What gives? Is promis­ing “ac­cess” a nice-sound­ing squishy dou­ble­s­peak way to say, “We’re not giv­ing you any more money to help you buy in­surance?”

That’s the big­gest rea­son why the CBO and other an­a­lysts ex­pect to see mil­lions lose cov­er­age un­der the Repub­li­can plan. Yet Speaker Ryan and other GOP lead­ers are more ex­cited by the $337 bil­lion that the CBO says the fed­eral gov­ern­ment will save over the next decade by shift­ing most of the ACA’s health care bur­den back to the states and to in­di­vid­u­als.

The Repub­li­can plan would re­move man­dates that re­quire every­one to buy in­surance, which en­ables the ACA to bar in­surance com­pa­nies from deny­ing cov­er­age be­cause of pre­ex­ist­ing con­di­tions. It would re­place sub­si­dies with tax cred­its to help low-in­come peo­ple buy in­surance and ex­pand health sav­ings ac­counts so more peo­ple could save more of their own money to pay for their own health care.

But mar­ket-driven in­cen­tives work best for peo­ple who can af­ford them. I like HSAs, for ex­am­ple, but house­holds that are liv­ing pay­check-to-pay­check of­ten find they sim­ply can’t af­ford to salt away much sav­ings. One health crisis can eat up your health sav­ings overnight. And there goes your “ac­cess.”

All of which makes it all the more poignant — or sad, as Pres­i­dent Trump might tweet — that the big­gest losers in what’s be­ing called “Trump-care” prob­a­bly would be the core sup­port­ers of Pres­i­dent Trump’s elec­tion cam­paign.

The same lower-in­come, older vot­ers who voted for him in ru­ral red-state America stand to lose more in fed­eral in­surance sub­si­dies than any other de­mo­graphic, ac­cord­ing to an anal­y­sis of coun­try vot­ing and tax credit data by Noam Levey of the Los An­ge­les Times.

That’s the po­lit­i­cal base that Trump in his in­au­gu­ral ad­dress lauded as the for­got­ten men and women to whom he had given a po­lit­i­cal voice. Now the bur­den is on Trump to show whether “ac­cess” to health in­surance is as good as the real thing. Email Clarence Page at cpage@chicagotri­

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