HEALTH BILL BREAKS GOP PROMISES
CBO: Costs will go up and coverage down. Trump and his party pledged the opposite.
In Democratic circles, I hear many wondering how Republican senators could vote for a health care bill that, according to the non-partisan Congressional Budget Office, will cause an estimated 22 million people to lose coverage by 2026 and deals a severe blow to tens of millions of vulnerable people insured by Medicaid.
Prominent Republicans I interact with have a different lens. They are not primarily focused on covering more people. To the extent they have a focal point in health care, it’s more likely to be costs. They point to premium and deductible increases under the Affordable Care Act (ACA) in some markets and say this shows the need to repeal the law.
In many ways, this is a classic case of talking past one another — using the same area of legislation to achieve a different goal without understanding the other party’s thinking. It’s probably not the only time this has happened in Washington.
But the new CBO projections should drive home to many in the GOP-controlled Senate a message that millions of worried constituents haven’t been able to make them hear: This bill will dramatically increase premiums for millions of Americans and do nothing about medical costs. GOP IN TOUGH SPOT In the face of the extreme unpopularity of the Republican plan, without the ability to stand up to tell their constituents that costs are going down, this becomes a tough bill to support. And that’s for Republican reasons, not just Democratic ones.
Look at the work put out by the Center on Budget and Policy Priorities. Its researchers analyzed the impact of the Senate proposal on Americans at various ages and income levels in different states. What they found is that under the Senate plan, for most customers buying insurance in the ACA marketplace, deductibles would more than double for a plan with the same premium they are paying now.
If people chose to stay with their exact same insurance product, a 60-year-old making $42,000 a year would have to pay $5,000 more. These effects are even worse in high-cost, rural states such as Alaska, Arizona and West Virginia. At these levels, it’s no surprise the CBO estimates that millions will become uninsured — and not by choice. With lower subsidies and other cutbacks, they simply won’t be able to afford insurance.
This leaves GOP senators in an awkward place. Defending the loss of coverage in your state is difficult enough, particularly in hard-hit states such as Louisiana, Nevada and Alaska where the 2010 Medicaid expansion to people slightly above the poverty line has been such a boon. But knowing that costs will be higher is more troubling from their perspective. That and the fact that 4 million who get insurance at work are expected to lose it.
Democrats are absorbed with the radical changes to the Medicaid safety net. But it’s the increase in costs that creates an unpleasant political reality for GOP senators now. A UNIQUE PROBLEM The Republicans’ health care proposal has the support of only 17% of Americans and less than half of Republicans. People Americans trust — physicians and nurses, patient advocacy groups, children’s hospitals and religious leaders — vociferously oppose it. Were the law to pass and Americans felt its actual financial impact, it would be viewed even less favorably.
This political problem begets another, more unique one. Trump campaigned on keeping coverage and even at times on ex- panding it. And when he sees popular opinion going against him, he’s not going to be afraid to have congressional party leaders lie down on the highway so he can back up the bus over them a few times.
The president confirmed Sunday that after toasting the House bill in the Rose Garden, he did later call it “mean.” Senators know by now that if they vote for their bill, they would stand alone once their constituents feel its impact.
The Republican plan isn’t achieving what GOP leaders promised and hoped because of the rushed, closed process. Experts, open hearings, public input and time for debate make bills better, not worse. Senate leaders have pulled their bill for now; they should start over with a focus on controlling costs and improving coverage.
Those are actually the right goals for America. Both sides need to understand that they aren’t in conflict but tightly linked. And the CBO just told us that the Senate bill fails on both counts.
Andy Slavitt, a member of USA TODAY’s Board of Contributors, was acting administrator for the Centers for Medicare and Medicaid Services from 2015 to 2017.