The Crazy Republican Party War Against Health Care

Yesterday CNN interviewed John Kasich, who was in Munich for a security conference. Among other things, they asked him about Paul Ryan's and the House Republicans' plans to take away health care from millions of Americans by "phasing out" the Medicaid expansion under the Affordable Care Act. You can listen to Kasich's response in the short video above. In short, he's appalled. "That is a very, very bad idea," he said, "because we cannot turn our back on the most vulnerable." But that's exactly what Ryan's plan, timidly and partially presented last Thursday, does, by forcing the already hard-pressed states to pay more of what the feds were paying towards the health costs. 31 states-- where most Americans live-- would be impacted by the GOP power play. Ryan's plan pits the extremist Republican House against more mainstream Republican senators and governors.

The plan was sent to Republican House members to take home to study it over the break-- and several of them, for a variety of reasons, promptly leaked it to the press. The far right is fuming because they oppose the tax credits that aren't offset in the budget and more mainstream Republicans are unhappy because it will leave poor people out in the cold. The new plan also repeals the mandate, which, according to the Congressional Budget Office, would almost immediately raise insurance premiums by around 20%, something most Republican congressmen don't want to see happen before the 2018 midterm elections, when increases like that would likely cost the GOP at least 35 seats-- and control of the House.

On Saturday, The Atlantic's Vann Newkirk took a stab at explaining what the House Republican leadership is doing. Remember the vast majority of Medicaid recipients are either disabled or low-income seniors, many with serious (i.e., expensive) health care needs. Those costs have been split between the states and the feds. Ryan (and Trump's new Secretary of Health, Tom Price) want to change that now, not just in regard to their Obamacare obsession but also as a as a way to destroy Medicaid entirely. "The plan," he wrote, "is short on specifics, including the mechanics of its implementation, and looks like a watered-down combination of some existing Republican repeal plans, including Ryan’s and Price’s. It would repeal Obamacare’s taxes and mandates, and replace the tax subsidies for purchasing insurance on the exchanges with tax credits and incentives for health-savings accounts. The details of those tax credits are not provided, save that they would be age-rated and refundable but not adjusted by income."

The proposal appears "likely to sharply reduce the number of people covered, since it rolls back funding for the Medicaid expansion, ends subsidies, and eliminates the mandate to purchase insurance. Their tax-credit policy would invert Obamacare’s progressive financing scheme. Under current law, subsidies increase as income decreases, but the Republican plan would flatten that tax advantage, thus no longer proportionally increasing affordability for low-income people. It would age-rate the credits, granting more affordable coverage to older people, who tend to be sicker than younger Americans, but would not control for costs among poorer individuals, who also tend to be sicker and more prone to disability than their middle- and upper-class counterparts."



And it establishes "a per capita cap on federal Medicaid funding for individuals based on state economic and health factors, as well as the category of beneficiary (whether they are aged, blind and disabled, children, or otherwise able adults). That reform erases the open-ended funding of Medicaid and essentially replaces it with a set annual allotment of federal funds to each state. The brief would allow states to receive that funding as a block grant, provided that they 'transition' people covered under the Obamacare Medicaid expansion to other programs. That block grant appears to come with rather significant relaxation on states’ requirements to meet eligibility standards and provide comprehensive services for Medicaid enrollees."

The per capita cap and block-granting scheme would certainly save the federal government money. The main appeal of universal spending caps is not only that they promote thrift among states, but that pegging them to economic factors, at the start of a prescribed “base year,” basically underfunds them in the future. But this scheme might also work against the ability of Medicaid to effectively cover people. A report from the Kaiser Family Foundation shows that such a policy could “lock in” funding to states based on their position in the base year, and would create long-term “winners” and “losers” in states. States would no longer be able to react in real time to crises like drug epidemics, disasters, or job crunches, and funding would not respond to demographic changes. In essence, people might be blocked from receiving care simply based on where they live. That this problem recreates the geographic incoherence of the current Obamacare Medicaid expansion-- where people covered under the expansion in some states will lose coverage if they move to non-expansion states-- is no small irony.

The logic behind block grants and per capita caps on federal funding is that they force states to be efficient with Medicaid dollars since they’re on the hook after that money is gone. But there are no guarantees that states wouldn’t simply create that “efficiency” by dropping people from coverage, diminishing the services covered, or reducing payments to providers. In fact, the House plan appears to encourage just that, as it only specifies coverage of mandatory services for disabled and elderly people in its requirements for block grants. The ensuing system, then, would no longer be a safety-net entitlement for all people who need care, but one where many of the riskiest patients with the most pressing issues might simply be forced to do without. That’s a strong departure from the underlying logic of the program, outlined when President Lyndon Johnson railed against “the injustice which denies the miracle of healing to the old and to the poor” when he signed the amendment to the Social Security Act, which gave the country Medicare and Medicaid in 1965.

DWT has heard that Lee Rogers, the progressive doctor who previously ran for Congress in Los Angeles, is being recruited by district supporters to run again in 2018. And we think thats good news because Dr. Rogers knows how to give Republicans a taste of their own bad medicine. Dr. Rogers offered the following diagnosis and prescription on Paul Ryan's plan:

"Republicans are fixated on their belief the healthcare is a privilege. But they use confusing language to hide this unpopular fact. They state that they want everyone to have 'access to healthcare.' We all know that having access to care is in not the same as having care. As Senator Bernie Sanders pointed out, you currently have access to one of Donald Trump's mansions, but without 5 million dollars, you can't afford it. I believe healthcare is a right. There is nothing more precious than your life. Medicaid expansion has helped low-income patients get the care they need and it has also been an economic stimulant for the states. We can't put greedy insurance companies and the pharmaceutical industry back in charge of healthcare."

Hopefully demonstrators at Ryan's house Wednesday will remind the rogue-Catholic of this