Health Policy Updates: July 23 2017

Wow, another incredibly hectic week. Health policy has never been so frenzied…even though we ought to be getting used to it by now.

To sum up the horse-trading, by Monday night enough Senate Republicans had come out against the Better Care Reconciliation Act that it became clear the bill would never pass. Senate Leader Mitch McConnell, followed by Donald Trump, quickly reverted to the old “repeal and delay” strategy of voting to repeal the ACA in two years time, giving a prolonged interval to work on replacement. This strategy already failed back in February. Again, enough Senate Republicans came out against “repeal and delay” by Tuesday that this, too, seemed unlikely.

“But it became quickly apparent that GOP leaders, who were caught off guard by defections of their members Monday night, lacked the votes to abolish parts of the 2010 law outright. Three centrist Republican senators — Susan Collins (Maine), Shelley Moore Capito (W.Va.) and Lisa Murkowski (Alaska) — all said they would oppose any vote to proceed with an immediate repeal of the law.”

(the repeal and delay strategy, by the way, would result in 32 million Americans losing insurance, according to the CBO report that came out Wednesday).

Despite what looks like a lack of sufficient vote and the continually-damning CBO scores, GOP leadership continues to plan for a vote next week.

One of the big concerns with the GOP vision of expanding health insurance to more people is that the “more affordable” insurance they propose is also…worse insurance. To use the industry jargon, we are talking about insurance plans with lower “actuarial value” – which translates as “health insurance that covers less of your health care.” Therefore, while people may technically have health insurance, they still will not be shielded from high medical costs, leading to the description of these plans as “junk insurance.”

“Proponents of the bill argue that it would allow people to buy insurance they could not otherwise afford…Plans with much lower premiums are certain to be attractive to many people. But Elizabeth Imholz, a health policy expert for Consumers Union, warned, ‘The reality for consumers is that they can be stuck with huge, unexpected out-of-pocket costs.'”

This is why you will never hear an sensible health care idea coming from the President. He honestly believes that health insurance costs $12 a year. When someone’s understanding of the system, and its problems, is off by two orders of magnitude, then they are not going to be able to offer an intelligible solution.

How does the Medicaid program function? Who does it cover, and what services does it provide them? JAMA recently ran a factsheet on Medicaid, summarizing the basic facts about our nations largest health insurance payer.

“A fundamental question in the current debate is whether Medicaid provides value to its beneficiaries. Despite some political rhetoric to the contrary, a growing body of evidence indicates that the Medicaid program significantly improves access to care and well-being, with some studies also showing a reduction in mortality after expansion. The Medicaid program remains quite popular, both among beneficiaries and the general public.”


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