One of the arguments from Republicans to support the BCRA’s steep cuts to Medicaid is that it is “bad insurance” – that having Medicaid somehow causes its beneficiaries to have WORSE health outcomes than those without insurance at all. Clearly, this is an extraordinary claim; how could having health insurance make one worse off? Is there “extraordinary evidence” to support the notion that Medicaid is harmful?
Health policy experts Austin Frakt and Aaron Carroll examine the available evidence. Moving beyond purely correlational studies (Medicaid patients are also quite poorer than average Americans, and so have many reasons to be unhealthy besides having Medicaid), it becomes clear that Medicaid does not, in fact, harm people.
“Findings from more recent studies looking at expansions in enrollment, in the 2000s and then under the Affordable Care Act in 2014, are consistent with older ones. One can argue that Medicaid can be improved upon, but the credible evidence to date is that Medicaid improves health. It is better than being uninsured.” Continue reading Health Policy Updates: July 8 2017→
The CBO report on the Senate’s ACA repeal bill – BCRA – came out on Monday. There are a lot of details, but you can read the general summary here. Since a picture is worth 1,000 words, I think their predictions can best be captured in a single picture – which Alvin Chan and Sarah Kliff at Vox.com have produced from the CBO’s numbers.
If repealing Obamacare was the goal, it looks like BCRA would achieve that. This bill, if it becomes law, would erase all of the insurance coverage gains made over the last 5 years, and effectively take us back to the pre-Obamacare era.
“The bill, drafted in secret, is likely to come to the Senate floor next week, and could come to a vote after 20 hours of debate…The premise of the bill, repeated almost daily in some form by its chief author, Mr. McConnell, is that ‘Obamacare is collapsing around us, and the American people are desperately searching for relief.'”
Sarah Kliff at Vox.com runs through the contents in a condensed explainer.
“In aggregate, these changes could be advantageous to younger and healthier enrollees who want skimpier (and cheaper) benefit packages. But they could be costly for older and sicker Obamacare enrollees who rely on the law’s current requirements, and would be asked to pay more for less generous coverage.”
Dylan Matthews summarized all of the (many) groups of people who will be worse off if this act becomes law:
“We don’t know for sure how many people will lose health coverage, but there are a number of reasons to think the number will be bigger than the 23 million the Congressional Budget Office estimated would lose insurance under the bill that passed the House in May. The Senate bill cuts Medicaid more slowly but more deeply, and unlike that bill, it lacks any incentive for individuals to stay insured. It repeals the individual mandate and replaces it with nothing.”
The more serious Republicans get about repealing Obamacare, the more insurance companies feel at risk in continuing to offer exchange plans. And the more insurance companies pull out of the exchanges, the worse Obamacare looks and the clearer the rationale for repeal. Are we in a spiral is actually leading towards the ACA’s repeal?
“Meanwhile, across the nation, health insurance plans are beginning to flee the Obamacare marketplace. They’ve cited the uncertainty around the health care law’s future, sown by congressional Republicans and the Trump administration. The number of counties with zero health plans signed up to sell 2018 coverage keeps growing. The possibility that Republicans will repeal Obamacare or drive it into collapse is an increasingly real one. That’s a reality where millions fewer have health insurance and lower-income Americans struggle to afford coverage.”
After a couple weeks away for travel, with a LOT that I’ve missed in the interim, here are some of the events and new ideas out over the last week.
First off, the Senate continues to deliberate on health care legislation, with varying degrees of confidence as to whether it will go anywhere. Conservative (though reality-based!) health policy wonks Lanhee Chen and James Capretta have continued to advocate for the incorporation of auto-enrollment into health care reform. This would present a way to “nudge” more healthy people into health insurance – a positive outcome – without the “big-government” personal mandates that Conservatives tend to bristle at.
“Even with the ACA’s penalties for going uninsured, large numbers of Americans are forgoing coverage and either paying additional tax penalties for doing so or applying for an exemption from the law’s individual mandate…If [the AHCA is] enacted, Congressional Budget Office forecasts there would be much lower take-up of insurance under the GOP’s plan than under the ACA…A well-designed automatic enrollment program can help boost enrollment into coverage whatever the design of the overall system.”