Editorial: Trumpcare II — An inevitable race to the bottom for nation’s healthcare

Anyone who has read anything about the Republicans latest plan to repeal Obamacare understands that at its core the plan cuts government spending on health care between 2020 and 2026, when the funding allotted in the current proposal would cease — and, we suppose, a new bill would need to be passed to supplement spending by the states, or a whole new system (Bernie’s Medicare-for-all should be popular by then) will be put into place.
The current GOP proposal, called the Cassidy-Graham bill, is expected to force 23 million Americans to drop their current health care coverage, expose those with existing conditions to much higher insurance rates, send prices soaring for senior citizens, and, over time, make it far more expensive for lower- and middle-class Americans to afford health care insurance.
In the long-term, it’s a proposal certain to fail because it doesn’t attempt to address the nation’s health care issues — rather, it seeks only to fill a campaign promise, satisfy its conservative base, and then (after Democrats dig the country out of another Republican-caused crisis) blame Democrats for the taxes raised to save the country, promise tax cuts to foolhardy, and preach the ills of big government to those with two-year attention spans.
As a political charade, it is a frustrating cycle.
Specifically, the strategy under the Cassidy-Graham bill is to shift the responsibility of health care costs to states and away from the federal government. To do this, the federal government would make huge block grants to the individual states (starting in 2020) based on a complex per capita formula. States would also be given wide flexibility on how to administer the block grants — including defining their own terms (with some parameters) of coverage. Some states, for example, might choose to cover maternity costs or hospitalization, while other states might not. And, of course, organizations like Planned Parenthood would likely lose government funding in conservative states, while more liberal states will keep such spending as long as they could.
But while greater state control may appeal to some conservatives, lower- and middle-class Americans (conservatives included) will likely be on the losing side of the deal. Worse, what could happen is a race to the bottom nationwide in terms of health care coverage. Here’s why:
• The block grants states would be given are based on a per capita amount; but increases in those amounts will be set by preordained-amounts, not by how many people are enrolled in the program. Those amounts are not expected to equal annual increases in health care spending. Thus, it will behoove a state to be most restrictive on its health care benefits if it hopes to avoid paying an increasing amount of state funding to cover health care expenses.
• The proposal pits state against state, but in the worst possible way. States that do the right thing and offer health care benefits to take care of low-income and help subsidize premiums for the middleclass (as Vermont, Oregon, New York and others have done), as well as provide generous benefits to citizens needing the most care — those with pre-existing conditions, those needing mental health services, or even those needing maternity care — will face an ever-declining amount of federal aid, thus driving up state taxes if they are to continue offering those benefits.
On the other hand, states which decide to be the stingiest with their health care dollars — essentially turning their backs on those Americans most in need — could actually benefit from those block grants (but at a higher personal cost to citizens.) One fear is that poorer Americans, or those with the greatest medical needs, would migrate to states with more generous (liberal) health care policies. Unable to absorb those added expenses, however, those states might also have to pare back coverage — creating a downward spiral of health care across the country.
• The outcome of such a downward spiral is that more and more Americans would postpone doctor visits until conditions warranted emergency hospital care. That, in turn, creates higher health care costs because care would be needed at the most critical level.
Such a longer-term scenario is bad enough, but in the short-term the Republican proposal — which is another version of TrumpCare — would continue to destabilize insurance markets for the next two years; would cause health care premiums to jump around 20 percent this year, and would instill a great amount of uncertainly and inconsistency in the nation’s health care policy.
Most Americans agree that is exactly the opposite of what the nation needs. In fact, polls show that a solid majority of Americans now prefer to keep Obamacare and work to improve it, rather than repeal and replace.
How it is possible Republicans could support such an ill-conceived proposal? Politics.
Having lied for the past six years about the ills of Obamacare, they feel compelled to pass something. But even Republicans are wary of how many Americans would be priced out of the health insurance market, what burdens such a plan might eventually place on state budgets, how it might undermine the financial health of the nation’s hospitals, and how it might impact the general health of all Americans. Already, Americans rank in the bottom tier of affluent western countries in terms of public health, while we spend among the most as a nation on medical expenses. It won’t be a pretty outcome if the Republican plan sends expenses higher, while creating a virtual health care epidemic in the U.S.
But few of these complex scenarios have been asked, let alone studied — nor have Republicans provided time for such discussion. The bill, which controls about one-sixth of the U.S. economy, was proposed two weeks ago and Republicans are rushing it to a vote before Sept. 30 — all to force it through a Republican majority without needing a single Democratic vote. If it can’t be done by then, future votes to repeal Obamacare will need 60 votes in the Senate to pass, and Republicans know they won’t be able to repeal it if they have to seek bipartisan support.
That not only doesn’t serve the public good, it doesn’t even try. It’s pure politics — and the ugliest sort, at that.
Angelo Lynn

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