We Waited Eight Years For This?

March 11, 2017

For eight years the GOP tracked President [Barack] Obama like a timber wolf stalks its prey, looking for that one unguarded moment to pounce and... devour the president’s signature health care achievement so that it could be regurgitated in a form that satisfied the rapacious appetite of Republican conservative orthodoxy.


To the conservative right, Obamacare was an abhorrent assault on every free market principle they hold dear. Throughout both of Obama’s terms, the GOP bellowed loudly that the Affordable Care Act (ACA) had grotesquely distorted the health insurance market.


Similarly, they railed against the law's taxes on insurance companies, manufacturers of medical devices, and the top 1 percent of earners in this country - all necessary to pay for health care subsidies for the poor.


Not foolish enough to attack the ACA's prohibition on those appalling policies that allowed insurance companies to routinely deny health care coverage to persons with pre-existing medical conditions, the GOP nontheless bitterly complained about the individual mandate – the underlying mechanism used to fund the cost of providing care to persons with complex health problems by forcing young, healthy Americans to buy into and thus balance the insurance risk pools.

But what most stoked the anger of conservatives was, to their mind, the law’s reckless expansion of Medicaid to cover childless adults with incomes that reached just $16,400. Ignoring the wrenching effects of poverty for persons who live on incomes at or below this level, the conservative elite labeled this policy as an aggressive overreach by liberals which dramatically upset the historic balance in the federal-state partnership for Medicaid.


After taking eight years to develop, House Speaker Paul Ryan -- a thoughtful policy wonk -- stood before the country this week to unveil the GOP’s proposal to “repeal and replace Obamacare.” What he rolled out was a brazen attack on the individual insurance market, an outrageous gift to wealthy Americans at the expense of the poor, and a massive shift of responsibility for health care costs from the federal government to the states.


Under the GOP proposal, Obamacare's popular income-based subsidies which help low- and middle-income Americans to purchase health insurance would be wiped out, replaced with tax credits that increase with age, not income, and are measurably smaller than the subsidies provided for poor and middle income non-elderly adults under the ACA. This was done because the proposal allows insurance companies to charge much higher premiums to the elderly than is permissible under Obamacare. However, this also means, for example, that older millionaires -- even billionaires -- will get more federal assistance to purchase health insurance than a single parent young mother living in our economically depressed inner cities or, those living in desperate poverty in rural America where insurance cost are higher.


The GOP plan also rewards with generous tax exemptions, persons who stow away dollars in Health Savings Accounts (HSA) which can later be used to purchase health insurance -- a popular strategy of the rich. HSAs are effective vehicles for lowering marginal tax rates so they are of virtually no value to persons whose tax rates are already suppressed by low earnings and who certainly do not make enough money to stash cash away in HSAs.


However, the most pernicious changes in the GOP plan were reserved for poor people on Medicaid. In a historic break from the 52 year-old sacred Medicaid entitlement -- a longstanding promise by the federal government to pay a share of  the health care expenses for all persons who are entitled to receive Medicaid coverage -- this plan caps funding to the states and if these limits are exceeded, the offending states will be hit with penalties.


Refusing to end the politcal flagellation of the states with just the unforgiving funding caps, the proposal hits with severe funding cuts, those states that expanded their programs to provide coverage to more than 10 million childless adults. These cuts will come in the form of reduced federal funding for any Medicaid expansion beneficiary who leaves the program for at least two months and subsequently returns. Combined, these two policy changes will undoubtedly cause most of the 32 states that expanded their Medicaid programs under Obamacare to roll back this coverage while also implementing benefit reductions so as not to exceed the imposed spending caps.


In the District [of Columbia] we determined that if the GOP bill becomes law and the city does not alter its Medicaid program, the five-year cost of these changes would be as much as $3.6 billion. In larger states that expanded their Medicaid programs, this number will likely be in the double digit billions - gag inducing amounts for state's that attempt to swallow these costs. So this is clearly unsustainable and will, without question, cause states to ultimately impose deep cuts to their respective Medicaid programs, leaving millions without health care.


Thus, not only does this plan threaten to separate 10 to 15 million people from their current coverage, it wickedly creates a caste system in health care, punishing the unemployed and working poor and squeezing middle America while concomitantly gifting the richest members of our society with tax cuts in the form of tax credits and exemptions.


If passed into law, this GOP plan will most assuredly widen the chasm in health disparities between the rich and poor, leave many on the precipice of bankruptcy due to unpaid medical bills, put an enormous strain on rural and inner city hospitals – likely causing a significant number to close their doors -- and frankly, force us to watch as many people who suffer with treatable illnesses die prematurely due to lack of access to affordable health care.


In a shrewd move, the GOP is trying to garner support for this plan before asking the Congressional Budget Office (CBO) to score its cost. When the CBO finally turns its analytical radar on this plan, they will surely project the cost to be staggering because the bill offers copious tax credits, and exemptions without any offsetting revenue enhancements.

Hopefully, a nonpartisian assessment of the plan's cost will kill this proposal before it gains momentum, passes into law, and begins killing Americans.


What a horrible and embarrassing proposal.






















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