The GOP’s act of hypocrisy and cal­lous­ness

The Washington Post Sunday - - SUNDAY OPINION - BY EZEKIEL EMANUEL The writer is chair of the Depart­ment of Med­i­cal Ethics and Health Pol­icy at the Univer­sity of Penn­syl­va­nia.

The Repub­li­cans’ health bill is an act of supreme hypocrisy and in­sen­si­tiv­ity to the ex­pe­ri­ence of Amer­i­cans. It will dam­age — not im­prove — the U.S. health sys­tem. Oba­macare was a fail­ure be­cause it passed with only Demo­cratic votes — so charged Repub­li­cans. All through 2009, Democrats tried to get Repub­li­cans to en­gage in dis­cus­sions about health-care re­form. Re­mem­ber the “Gang of Six” or the “Gang of Eight” that Sen. Max Bau­cus (D-Mont.) ran to try to craft a bi­par­ti­san bill? After Sen. Olympia Snowe (RMaine) voted for the bill in com­mit­tee, she re­versed her­self un­der ex­treme Repub­li­can pres­sure. Now, given their own op­por­tu­nity for a bi­par­ti­san health re­form bill, Repub­li­cans passed a to­tally par­ti­san bill, and they never even tried reach­ing out to Democrats to see if there could be con­sen­sus.

Democrats are giv­ing in­sur­ance com­pa­nies bailouts — so charged Sen. Marco Ru­bio (R-Fla.). The Af­ford­able Care Act con­tained risk cor­ri­dors, which were a way to spread the risk across in­sur­ers when the ex­changes just started and no one knew who would buy in­sur­ance. In 2014, Repub­li­cans voted to block fund­ing for th­ese risk cor­ri­dors — a main rea­son that pre­mi­ums on the ex­changes went up so much in 2016 and 2017. Now, in their own bill, Repub­li­cans have in­cluded tens of bil­lions of dol­lars for in­sur­ance com­pa­nies. A bailout? No, Repub­li­cans re­la­beled this a “sta­bil­ity fund.”

Repub­li­cans promised they would never al­low in­sur­ance com­pa­nies to dis­crim­i­nate against peo­ple with pre­ex­ist­ing con­di­tions. Well, so much for that. House Speaker Paul D. Ryan’s (R-Wis.) bill al­lows states to grant com­pa­nies the abil­ity to charge ex­or­bi­tant fees to peo­ple with pre­ex­ist­ing dis­eases. The Repub­li­can claim that no state will pass such bills is ridicu­lous. Why have the op­tion then? More im­por­tant, we know states have done much worse in the past. Re­mem­ber Ari­zona deny­ing bone-mar­row trans­plants to pa­tients with cur­able can­cer on Med­i­caid? Who would have thought that could happen?

And those high-risk pools Repub­li­cans claim will pro­tect peo­ple with pre­ex­ist­ing con­di­tions? They don’t work. Even with Rep. Fred Up­ton’s (R-Mich.) amend­ment of­fer­ing an ex­tra $8 bil­lion to the sta­bil­ity fund, the pools would be to­tally un­der­funded. Just do the math. In­sur­ing pa­tients with se­ri­ous ill­nesses will cost about $10,000 each (a con­ser­va­tive es­ti­mate), so Up­ton’s money cov­ers fewer than 200,000 Amer­i­cans. Not even a mod­est fig leaf.

Other Repub­li­can ax­ioms: Oba­macare is col­laps­ing; the ex­changes are dy­ing; pre­mi­ums are sky­rock­et­ing; and a third of coun­ties have only one in­surer. Let’s put aside that the Con­gres­sional Bud­get Of­fice and Stan­dard & Poor’s con­cluded that the ex­changes are sta­ble. Let’s put aside that An­them just an­nounced it is do­ing well in the ex­changes. If they wob­ble, it is the Repub­li­cans’ do­ing.

A few fixes would en­hance the ex­changes’ func­tion­ing: 1) En­force the man­date so more healthy Amer­i­cans buy in the ex­changes; 2) guar­an­tee fund­ing for sub­si­dies to con­sumers so in­sur­ance com­pa­nies can lower pre­mi­ums; 3) fund the risk cor­ri­dors and rein­sur­ance pay­ments; and 4) in­crease tar­geted ad­ver­tis­ing so more peo­ple know about the sub­si­dies and the re­quire­ment to get in­sur­ance.

Repub­li­cans passed ex­actly one fix: The sta­bil­ity fund does pro­vide some rein­sur­ance help. But that’s the only thing their bill does to help fix the sys­tem. Repub­li­cans are un­der­min­ing and not en­forc­ing the man­date. Repub­li­cans de­cided not to ap­pro­pri­ate money for sub­si­dies. And Repub­li­cans have se­verely lim­ited ad­ver­tis­ing.

This bill will make things worse. It will not im­prove the num­ber of in­sured; es­ti­mates show that the bill will force tens of mil­lions of Amer­i­cans to lose cov­er­age.

This bill will in­crease costs. Cut­ting es­sen­tial ben­e­fits means peo­ple must pay for those un­cov­ered ser­vices — whether that’s ma­ter­nity care, men­tal-health care or den­tal care for chil­dren. With more unin­sured peo­ple, hos­pi­tals will in­crease what they charge to cover the un­com­pen­sated care they give, driv­ing up pre­mi­ums. And there is no pro­vi­sion to re­duce de­ductibles.

Most im­por­tant, this bill has no se­ri­ous cost con­trol ideas in it. No change in how doc­tors and hos­pi­tals are paid to im­prove qual­ity and lower costs. No mea­sures to re­duce drug prices. No at­tempts to lower Medi­care costs through site-neu­tral pay­ments — that is, pay­ing the same price re­gard­less of where a pro­ce­dure is per­formed — or to pre­vent hos­pi­tals from buy­ing up physi­cian prac­tices to in­crease their bar­gain­ing power and raise their costs.

Repub­li­cans prom­ise cost con­trol later, in fu­ture leg­is­la­tion. But any ad­di­tional health-care leg­is­la­tion will re­quire sup­port from Democrats in the Se­nate. After this hy­per-par­ti­san bill, there is no chance a sin­gle Demo­crat will col­lab­o­rate be­fore the next elec­tion.

De­sir­ing to do some­thing, Repub­li­cans have only shown hypocrisy and cal­lous­ness. As polls sug­gest, they won’t have to wait long to see the reper­cus­sions of their ac­tions — only un­til 2018.

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