From last night’s very long live blog of my first read through of Cassidy-Collins, there are two comments I really want to highlight:
Admittedly, my view on this is strictly selfish, but it does have some larger utility.
“Does this kill me?” is pretty much how I judge any Potemkin Village “replacement”. If the answer is “no” then at least they acknowledge that leaving the ACA largely intact is the only viable way going forward. If the answer is “yes”, then a whole lot of other Medicaid and individual-insurance folks are going to die with me, and it means they still only care about ‘repeal’ with ‘replace’ being nothing more then a fig leaf to hide the mass graves.
For those who don’t know his story, Archteryx has a chronic condition which requires regular nursing and surgical care. He moved from a non-Medicaid expansion state to a Medicaid expansion state as soon as he could in order to guarantee his access to care. Under the 2009 status quo, the national health policy for him is “Be quiet and die quickly in the corner”. Cassidy-Collins won’t kill him.
Secondly, from Barbara on picking fights:
Here is a lesson I learned over the many years I have been working on health care regulation: things that are tweaks or forward looking can be changed and improved. Things that dismantle or gut the structure of a program will be, for all intents and purposes, permanent. They certainly won’t be revisited for at least 15 years. The two cardinal examples of this during my career were prescription drug and long term care coverage for Medicare beneficiaries (passed in 1988 and repealed in a mindless fury a year later, with drug coverage not re-examined until 2003 and long term care still not covered); and health care reform (killed in 1994, not revisited until 2009). Based on that simple analysis here is my reaction to what I have seen so far:
Hills to die on: Medicaid block grants
Hills to keep fighting on: high deductibles that mostly leave the rest of the ACA structure in place.
Let’s keep these two evaluation lenses in mind when we look at what comes out of this Congress and whether or not Democrats decide to engage on policy.
Baud
Oh, wow. It’s the rare double, in-between STOMP.
guachi
I’d be satisfied with a health care plan that leaves red states with 2/3 or 1/2 of the money that full ACA states get. Other details to be worked out later, but no way would I support red states getting large chunks of money to just to give huge tax cuts.
rikyrah
Thanks for this.
Ben Vernia
Thanks so much for the analysis – which is sadly missing in the rest of the media. Thanks, too, to thoughtful commenters like those you highlight.
Jay S
I have a hard time believing that this legislation is going anywhere in the Senate let alone the House. I be happy to be wrong.
Sab
Thanks for this.It gives me something not panicked sounding to say to my Republican senator who is or is pretending to be a moderate.
MomSense
I’m so furious at Collins whose phone lines have been going straight to voicemail.
She said that her bill will return power to the states. Has she no compassion for the people in her state who are already suffering because LePage refused to expand Medicaid? That assmouth will do everything he can to deny poor Mainers access to health care.
She may just as well have said let them eat cake. I’m livid.
waysel
Have pre-existing and 26 y/o children been gutted already, or is that just in the pipeline?
cmorenc
@Jay S:
The bigger meaning is that so long as there is a group of three or more GOP senators willing to bottleneck any further repeal movement unless there is a plausibly realistic replacement plan (and not merely a Potemkin Village fraudulent front of one) – “repeal” is blocked by impassible shoals, however much the boat commander blusteringly wishes to try to plow on through it. The downside is that Collins has a long history of talking like a moderate and then voting like a wingnut when it really matters. And so does Lindsey Graham and a couple of other GOP senators who have expressed serious doubts about repeal without a coherent, realistic replacement plan.
Jay S
@cmorenc: Exactly why I don’t see this going anywhere. History doesn’t make these people much more than blusterers.
I don’t trust this group to hold the line, let alone sell a competing plan.
Starfish
Did you see this? Are these people really trying to make it so insurance does not have to cover maternity? What kind of twisted nonsense is this?
Jay S
@Starfish: I didn’t see this, but my guess is that they want to implement pick and choose insurance as opposed to bundles, so single men and older women don’t have to pay for things that can’t happen to them. There were a lot of complaints about required coverage for “things that can’t or won’t happen to me” in the ACA arguments. Ala carte rather than prix fixe. In theory, people buy policies that cover maternity if they think they will need it. In practice it probably makes it unaffordable or unavailable with adverse selection.
nanute
David Anderson,
Reading yesterday’s post, is it true that the bill removes the mandate that everyone has insurance? If so, it would seem the gap in coverage trigger to allow no coverage for preexisting conditions, is a neat little coercion mechanism. Hey, you don’t have to buy insurance, but if you don’t and exceed the gap, too bad, no preexisting condition coverage for you. Am I reading this wrong?
buskertype
@Jay S: I’m not totally sure if this has a snowballs chance or not, but it will definitely be bad politics for them to cut 20 million people (including me) off their health insurance, and this is a credible but worse alternative that could give them cover for having spent years claiming they will repeal obamacare.
the angry part of me hopes they reject it so I can spend the next 1.8 years before the election smacking them upside the head with it. the reasonable part of me hopes they adopt it because it would be a better-than-nothing outcome.
David Anderson
@nanute: In Option 2 which is the state elective HSA alternative pathway which makes up 90% of the bill, the individual mandate is removed. However it is replaced with two pool maitenance mechanisms. The first one is the auto-enrollment with opt-out. This will capture the vast majority of the young Exchange eligible but not enrolled into low AV plans because very few people who are so disconnected from the current system will be motivated enough to be connected to the new system to turn down free hit by a bus coverage.
And secondly, for the people who do opt out of auto-enrollment, there are significant underwriting daggers plus late enrollment penalties.
Option 1 states (ACA as is) would still have the individual mandate.