Weekly newspaper of Three Rivers, California, and Sequoia-Kings Canyon National Parks

Better Care Act is a tax-cut wolf in sheep’s-reform clothing

John Elliott

Last Thursday (June 22), the highly anticipated and secretive Senate health care bill — “Better Care Reconciliation Act” — was unveiled by Senate Republicans amid reactions ranging from “finally” to a huge chorus of “oh no, here we go again.” Here we go again because the margin for passage is so razor thin that if three Republicans vote against the measure even a tie-breaker vote cast by Vice President Mike Pence won’t be enough to guarantee passage. Senate Majority Leader Mitch McConnell (R-Kentucky) has labeled the document a “discussion draft.” Apparently, there will be more time for discussion because McConnell announced on Tuesday, June 27, he now wants to bring the measure to a vote after the July 4th recess. Larry Levitt, a health policy expert at Kaiser Family Foundation, said on Twitter shortly after the bill was made public that in its broad framework, the Senate bill looks a lot like the House bill: “Big tax cuts, big cut in federal health spending, big increase in the uninsured.” In effect, the Senate bill would repeal major parts of the Affordable Care Act (ACA), also known as Obamacare. It rolls back the ACA’s Medicaid expansion, calling for deep cuts compared to the current law. It also proposes eliminating many ACA taxes, and employer penalties associated with employer and individual mandates would be repealed retroactively, dating to the start of 2016. Like the House bill, the Senate version allows young adults up to the age of 26 to stay on their parents’ plans. And like the House bill, the Senate proposal also allows insurance companies to charge older Americans five times more than younger people — under the ACA, that ratio is 3 to 1. Expect pushback here because this provision will hit the 50-to-64 age group hard precisely at the time when many are dealing with catastrophic medical issues. Some lawmakers like Sen. Rand Paul (R-Kentucky), an ophthalmologist, have already publicly stated that the Senate’s version will wreak havoc on the insurance market place. Healthy people will presumably once again go without insurance, and with all those millions joining the ranks of the uninsured, that will drive costs up for everyone else. Paul said recently on the Today Show: “...And without the individual mandate, that sort of adverse selection, the death spiral, the elevated premiums, all of that’s going on gets worse under this bill.” The ACA tried to address the problem by requiring all Americans to have health insurance or pay a penalty. But the “individual mandate” is one of the least popular provisions, and McConnell and his colleagues are determined to get rid of it. On the Senate floor the day the latest bill was released, McConnell said: “We agreed on the need to free Americans from Obamacare’s mandate so Americans are no longer forced to buy insurance they don’t need or can’t afford.” If the bill passes, it will be like pulling the plug on the healthcare pool we are all struggling in to keep our heads above water. This will leave a nasty bathtub ring but pales in comparison to the fallout from the proposed draconian cuts to Medicaid. Medicaid crisis: The Medicaid expansion, and that includes huge payments to MediCal in California, would begin to be phased out by the federal government in 2020 if the Better Care Act is enacted. The extra funds states had been receiving will be reduced over three years. California Governor Jerry Brown said Tuesday that if the Senate bill is passed these cuts will have a devastating effect on California. Monday’s nonpartisan Congressional Budget Office (CBO) report said 22 million more people than now will be uninsured by 2026; 13 million more by 2018. The CBO also said low-income Americans in their 50s and early 60s would be disproportionately likely to lose their health insurance coverage under the Senate bill. The loss of coverage will hit underserved areas like Tulare County the hardest. It will be like turning the clock back to pre-2010, and will cause a ripple effect throughout the entire system. In Tulare County, if you have an acute health issue, whether you summon an ambulance or not, you will probably end up waiting in the emergency room at Kaweah Delta Medical Center. Every seat nearly every hour of the day is taken waiting for admittance, and the majority of these patients have no insurance coverage. Having a premium policy with a reasonable deductible doesn’t move you up in the emergency-room line. Critical-care patients get some evaluation but to be admitted to the hospital, chances are you will be waiting a minimum of several hours. The hospital cannot refuse to treat the uninsured so how will they be reimbursed for services? They have no choice but to cut a deal with insurance companies to pay more for those who have policies to help pay for the cost of the uninsured. Insurance companies will raise premiums to the insured while cutting benefits to maximize profits. The so-called “death spiral” will be more pronounced in rural and underserved areas that depend on Medicaid and, in California’s case, MediCal. Many of the hospitals and critical-care clinics in areas with a high proportion of residents living below the poverty line will have no choice but to close. There would be more stable markets in the more populated, urban areas because there would be a higher number of insured to share the costs. Some of these people buying private policies would see lower premiums in many cases but the policies will cover less and out-of-pocket costs will be higher. “Despite being eligible for premium tax credits, few low income people would purchase any plan,” the CBO said. It came as no surprise that at least four Republican Senators broke ranks and voiced opposition to the plan after realizing what the devastating cuts to Medicaid would do to their states. Majority Leader McConnell is certainly aware of the implications of the bill in his home state of Kentucky and to all individuals. Sen. McConnell had polio as a child. Ironically, he would not be in such a position of power today had his parents not had financial assistance due to his health-care needs in 1944 when he was just two years old. Back then, polio was an epidemic that often paralyzed or was deadly to those affected. McConnell received treatment at a hospital in Warm Springs, Ga., which was funded by the National Foundation for Infantile Paralysis, a charity started by President Franklin Roosevelt (also a victim of polio) to treat people with polio. McConnell, who has publicly stated that the disease nearly bankrupted his parents, was given a second chance by receiving assistance from the nonprofit predecessor to the March of Dimes, and he recovered from the disease. McConnell’s state of Kentucky was a leader in signing up the uninsured under the ACA. By all indices, health care to the rural poor in that state has made some of the biggest gains anywhere under the ACA. So in its essence, the Senate bill is not about health care, it’s all about the money. Why not fix what’s not working with the ACA and move health care forward instead of going back to a time when insurance companies called the shots? We can all count our blessings for Medicare — it’s a single-payer plan that’s been amended and improved on several occasions since it was first created in 1965. You think there is outrage over health care now, just wait until lawmakers mess with Medicare.