Will the Repub­li­can health­care bill make us more free?

Only in the sense of hav­ing noth­ing left to lose. It’s merely a ve­hi­cle for cut­ting Oba­macare taxes, es­pe­cially on the wealthy.

Los Angeles Times - - OP-ED - Ni­cholas Ba­gley is a pro­fes­sor of law at the Univer­sity of Michi­gan.

The cen­tral theme of the Repub­li­can cam­paign to re­peal the Af­ford­able Care Act has been free­dom: free­dom from Oba­macare’s oner­ous reg­u­la­tions, free­dom from over­priced in­sur­ance and, most of all, free­dom from the tyran­ni­cal in­di­vid­ual man­date.

The Se­nate has now re­leased its long-awaited al­ter­na­tive to Obama-era health re­form. Although the Bet­ter Care Rec­on­cil­i­a­tion Act is be­lea­guered, there’s still a de­cent chance that the Se­nate will pass it. If it does, the bill is likely to be­come law.

So it’s rea­son­able to ask: How does the Se­nate bill stack up when it comes to free­dom?

Start with the in­di­vid­ual man­date, which the bill would re­peal im­me­di­ately. In its place, the bill would im­pose a six-month lock­out pe­riod on any­one with a gap in cov­er­age. If you get can­cer and you’re unin­sured, you’re free to sign up for cov­er­age — but you’ll have to wait six months be­fore it pays for your che­mother­apy.

Both the lock­out pe­riod and the in­di­vid­ual man­date are meant to dis­cour­age healthy peo­ple from wait­ing un­til they get sick to buy in­sur­ance. With the man­date, you pay a fi­nan­cial penalty for go­ing unin­sured. With the lock­out pe­riod, you also pay a fi­nan­cial penalty, al­beit one of uncer­tain scope: the full costs of any med­i­cal care you might need for six months.

They’re both sim­i­larly co­er­cive. If you thought that the man­date was a big in­cur­sion on per­sonal lib­erty, the lock­out pe­riod should be at least as ob­jec­tion­able.

What about Oba­macare’s reg­u­la­tions?

Be­cause Repub­li­cans have only 52 votes in the Se­nate, they can’t break a Demo­cratic fil­i­buster. They are there­fore us­ing a process known as “rec­on­cil­i­a­tion” that al­lows bud­get-re­lated leg­is­la­tion to be passed by a bare ma­jor­ity.

But a rec­on­cil­i­a­tion bill can in­clude pro­vi­sions that only di­rectly af­fect fed­eral rev­enue or fed­eral spend­ing, which means all those pesky Oba­macare rules — in­clud­ing the ban on dis­crim­i­nat­ing against peo­ple with pre­ex­ist­ing con­di­tions, the caps on out-of-pocket spend­ing and the re­quire­ment to cover the es­sen­tial health ben­e­fits — will re­main in­tact.

If you care about free­dom, maybe that’s a good thing: Maybe the sick and healthy, rich and poor alike should be equally free to buy health in­sur­ance. But if you think reg­u­la­tions are free­dom-killing, you shouldn’t be happy about the Se­nate bill.

Surely, then, the bill at least lib­er­ates peo­ple from over­priced in­sur­ance? Quite to the con­trary. Med­i­caid is the cheap­est cov­er­age around: For the dis­abled, poor and el­derly who qual­ify, it’s es­sen­tially free. Yet the bill sav­agely cuts Med­i­caid. The Con­gres­sional Bud­get Of­fice es­ti­mates that the cuts would lead 8 mil­lion peo­ple to lose Med­i­caid cov­er­age by 2020, and 15 mil­lion by 2026.

These newly unin­sured peo­ple could try to buy health plans on the ex­changes. In con­trast to Oba­macare, the Se­nate bill al­lows peo­ple be­low the poverty level to use fed­eral sub­si­dies to buy pri­vate in­sur­ance. But the sub­si­dies cover only pre­mi­ums, not out-of-pocket spend­ing. And the pre­mium sub­si­dies will cover only the costs of health plans with very high de­ductibles — about $6,000 for an in­di­vid­ual.

Poor peo­ple there­fore would have the free­dom to buy in­sur­ance with a de­ductible they can­not af­ford. As Pres­i­dent Trump said about Oba­macare, “The de­ductibles are so high that you re­ally don’t have in­sur­ance, if you think about it.” CBO has thought about it, and it thinks that the Se­nate bill makes mat­ters worse: “Few low-in­come peo­ple would pur­chase any plan.”

And while it’s true that the Se­nate bill even­tu­ally would re­duce pre­mi­ums for a typ­i­cal ex­change plan by about 20%, that’s only be­cause the plans on of­fer would cover less than they do un­der Oba­macare.

In ad­di­tion, the Se­nate bill cuts fi­nan­cial sup­port for pre­mium pay­ments. To­day, a 64year-old earn­ing $26,500 per year has to pay just $1,700 to buy a stan­dard ex­change plan. Un­der the Se­nate bill, the same 64-yearold would have to pay $6,500 in pre­mi­ums alone. And he’d still face a $6,000 de­ductible be­fore his cov­er­age kicked in. Lots of peo­ple will shed cov­er­age rather than pay so much for health in­sur­ance.

All told, the CBO es­ti­mates that the Se­nate bill would push 22 mil­lion peo­ple off their health plans by 2026. Jan­ice Jo­plin once sang, “Free­dom’s just an­other word for noth­ing left to lose.” That should be the slo­gan for Repub­li­can re­form.

Be­cause the truth is the bill has noth­ing to do with free­dom. It’s a ve­hi­cle for cut­ting Oba­macare taxes, es­pe­cially on the wealthy. Over the next decade, in­di­vid­u­als who earn more than $200,000 and fam­i­lies that earn more than $250,000 will get a tax cut worth $230 bil­lion. The bill also re­peals taxes on health in­sur­ers, drug com­pa­nies and med­i­cal de­vice man­u­fac­tur­ers; in to­tal, the tax cuts amount to more than $750 bil­lion over 10 years.

The need to pay for the tax cuts ex­plains why the bill’s cov­er­age num­bers are so dis­mal. The more you re­duce fed­eral sup­port for health in­sur­ance, the more peo­ple will lose cov­er­age. It’s re­ally very sim­ple. Oba­macare taxed the rich to pay for in­sur­ance for the poor; the Se­nate bill ze­roes out those taxes and thus elim­i­nates the cov­er­age gains.

Now that the Se­nate has shown its cards, it’s be­come ap­par­ent just how empty the Repub­li­can rhetoric was all along. Trump­care may lib­er­ate wealthy peo­ple’s money from the tax­man, but that’s about the only free­dom it de­liv­ers.

Los An­ge­les Times

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.