The Senate health bill omnibus post

In one sense, not much new to say.  It has been eminently and transparently predictable for some time that the Senate Bill is a complete policy disaster.  And, at heart, little more than a massive transfer of wealth from the sick and poor to the rich and healthy.  That said, today’s CBO score confirms just how bad it is.  I think quite notably– from a political perspective– it predicts millions of Americans to lose employer-based coverage next year.  Now, that ought to scare the hell out of just about everybody.  Democrats need to use this like a barb-wire-wrapped club.

Some various excerpts, but stick around to the end for my final political thoughts…

1) Drum with a very nice summary in bullet point form:

  • By 2026, spending on Medicaid will be slashed $772 billion. (Page 5)
  • There will be 15 million fewer people on Medicaid. (Page 16)
  • By 2026, spending on subsidies for private insurance will be slashed $408 billion. (Page 5)
  • There will be 7 million fewer people with private insurance. (Page 17)
  • This sums to a total of 22 million more uninsured people by 2026, compared to 23 million under the House version of the bill…
  • Because of the reduced value of health care policies under BCRA, premiums will go down. (Page 9) However, net premiums after accounting for subsidies will go up for most people. Among those with modest incomes, net premiums for silver plans would go up $500 for 21-year-olds; $1,300 for 40-year-olds; and $4,800 for 64-year-olds. Among those with higher incomes, net premiums would go down except for 64-year-olds, who would face increases as high as $13,000. (Table 5)
  • The share of uninsured older folks with low incomes would skyrocket from about 11 percent to 26 percent. (Page 16)…

Reading the CBO report in its entirety, it’s hard to see that BCRA offers any improvements over Obamacare aside from cutting taxes for the rich. Net premiums go up for most people—quite massively in the case of older consumers; deductibles go up; out-of-pocket expenses go up; the working poor are virtually shut out of the insurance market; the quality of coverage gets worse; and 22 million people lose insurance. [emphasis mine]

Yep, there you go.

2) Atul Gawande with an excellent post in the New Yorker:

To understand how the Senate Republicans’ health-care bill would affect people’s actual health, the first thing you have to understand is that incremental care—regular, ongoing care as opposed to heroic, emergency care—is the greatest source of value in modern medicine. There is clear evidence that people who get sufficient incremental care enjoy better prevention, earlier diagnosis and management of urgent conditions, better control of chronic illnesses, and longer life spans.

When more people get health-insurance coverage, as they did following the implementation of the Affordable Care Act, they get more incremental care. This week, the New England Journal of Medicine published a paper that I co-authored with Katherine Baicker and Ben Sommers, two health economists at the Harvard T. H. Chan School of Public Health, in which we analyzed the health effects of insurance coverage. We looked at dozens of studies put out over the last decade, and found that insurance-coverage expansions—including not just the A.C.A but also past Medicaid expansions and the health-care reform that Massachusetts passed in 2006—have consistently and significantly increased the number of people who have a regular source of care and who can afford the care they need. Insurance expansions have made people more likely to get primary and preventive care, chronic-illness care, and needed medications—including cancer screenings, diabetes and blood-pressure medicines, depression treatment, and surgery for cancer before it is too late.

These improvements in care help explain why people who have health insurance are twenty-five per cent more likely to report being in good or excellent health. It also explains why they become less likely to die. Proper health care saves lives, and the magnitude of the reduction in deaths increases over time… 

Conservatives often take a narrow view of the value of health insurance: they focus on catastrophic events such as emergencies and sudden, high-cost illnesses. But the path of life isn’t one of steady health punctuated by brief crises. Most of us accumulate costly, often chronic health issues as we age. These issues can often be delayed, managed, and controlled if we have good health care—and can’t be if we don’t. [emphasis mine]

3) Drum also with an excellent post on the importance of Medicaid.  Yes, the Oregon study showed no real impact on short-term mortality, but raise your hand if you feel you have had value from your health care plan other than, you know, not dying.

4) Chait on the pathetically dishonest lies from Republicans:

There is one solid, coherent argument for the Senate health-care bill: If you believe the government redistributes too much money from the medically and financially fortunate to the unfortunate, then Trumpcare is a huge step forward. Its large regressive tax cuts and even larger cuts to low-income health-care subsidies would rebalance the tax-and-transfer system in a way that’s more fair, from a certain moral perspective.

But since that moral perspective is shared by very few people, Republicans have long ago internalized the need to find different public rationales. In the health-care case, what they have come up with is a simple, blunt-force denial that their plan to reduce health-care spending is anything of the sort. Fanning out on the media. Republican officials have spread word that nobody would lose any benefits at all. “We would not have individuals lose coverage,” says Health and Human Services Director Tom Price. “No one loses coverage,” echoes Republican senator Pat Toomey. “These are not cuts to Medicaid,” insists Kellyanne Conway.

Trump has taught Republicans one new big thing– be utterly shameless in the boldness and brazenness of your lies.

5) Here’s the Post’s main story.  Just wanted to get this graph in here:

6) EJ Dionne with the lies, lies, and more lies Republicans are telling about the bill.

7) Meanwhile, this score has supposedly really upset the GOP “centrists ” (please don’t ever call them that!!).  Give me a giant, giant break.  This bill is similar enough to the House bill and so transparent in its motives (take away Medicaid from poor in exchange for tax cuts for the rich) that it is breattakingly disingenuous to pretend that this score is actually news at all.  I’m shocked, shocked that there’s gambling in Casablanca. I still think it very possible, if not likely, that there will be some minor tweaks– only 21 million lose insurance!!– that allow these “centrists” to vote for the bill after all their hand-wringing.

8) That said, I think we might be putting a little too much faith in Mitch McConnell.  Yes, he really is an evil genius.  but even evil geniuses make mistakes.  This bill with this CBO score really may be a road too far for at least 3 member of his caucus.

9) Thus my case for optimism.  I think there’s actually a decent chance that Republican health care “reform” dies here.  And, if not, I really do think passing this “reform” will be politically disastrous and ultimately lead us to better, more universal health care.  Downside to that– many millions of Americans seriously suffer in the interim.

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About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

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