The secret GOP health bill
Senate Majority Leader Mitch McConnell is pushing for a vote next week on a bill to repeal and replace Obamacare despite having held no public hearings, obtained no feedback from budget analysts and taken no testimony from doctors, patients or hospitals. That’s a recipe for disaster. Senate Republicans have been inundated with complaints about the secret negotiations over the bill, which took as a starting point the House Republican leadership’s execrable American Health Care Act. So far, their negotiators have not been deterred by the accusations of recklessness (healthcare spending accounts for about a sixth of the massive U.S. economy), heedlessness (dozens of groups representing healthcare professionals say their input has been ignored) and hypocrisy (this is, after all, a group that complained for years about Democrats “rushing” the passage of the Affordable Care Act in 2010 after months of hearings and weeks of debate on the Senate floor).
Instead, the only thing holding the Republicans up has been the splits within their own caucus over a few key policy issues, such as how much of the cost of healthcare to shift onto the states and their taxpayers. There’s no point in involving Democrats — or the public — in shaping the bill, some Republicans say, because only Republicans will vote for it. Funny, but Republicans were involved in much of the wrangling over the bill that became the Affordable Care Act, even though Democrats saw early on that Republicans were determined to vote no.
This time around, the process has not only been maddeningly partisan, but it’s also been willfully blind to the real problems in the U.S. healthcare system, as well as the steps insurers and providers have been taking to address those problems. As a consequence, Senate Republicans are on the verge of moving the country backward, and significantly so, when it comes to reducing healthcare costs, improving quality and broadening availability.
McConnell said Tuesday that a “discussion draft” of the bill would be released this week, first to Republican senators, then to the public. Still, we already know that the bill won’t simply repeal Obamacare or magically restore the healthcare market to what it had been before — a market plagued by rapidly rising costs, double-digit increases in insurance premiums and a large and growing population of Americans without coverage. That’s largely because the legislative shortcut the Republicans are taking to prevent a lethal Democratic filibuster also prevents them from changing any provision of the Affordable Care Act that doesn’t directly affect the federal budget. But it’s also true because Republicans want to cut the taxes the ACA imposed — on high-income Americans and an assortment of health industry groups — while offering their own version of subsidies to help consumers pay for insurance.
In order to do that, they have to cut something else. And that would be Medicaid, the health insurance program for impoverished Americans. Like their House counterparts, Senate Republicans are reportedly seeking to end the federal government’s promise to cover at least half the cost of Medicaid enrollees’ healthcare expenses, shifting instead to block grants tied to population and state healthcare spending. It’s a huge change in policy that’s fraught with risk for the poor and state governments, especially ones like California’s that have already pushed through reforms to cut spending per enrollee. And rather than give the industry more incentive to improve the quality of care, it would simply give states an incentive to offer fewer services to fewer people — including optional services such as in-home care that actually save money over the long term.
The Senate GOP also appears wedded to the House’s approach to lowering insurance premiums for those not covered by a health plan at work. Rather than trying to lower the cost of care, the focus is on letting insurers offer less coverage and cheaper plans that attract only healthy customers. Doing so would reverse efforts within the industry to spread risks and control costs, which is exactly the opposite of what Republicans say they’re trying to accomplish. These sorts of fundamental flaws are exactly why this bill needs maximum public exposure and scrutiny, not the see-no-evil treatment it’s getting from the Senate GOP.