How did the GOP come up with this awful health-care bill? - By Jennifer Rubin
By Jennifer Rubin March 10 at 10:45 AM
The Affordable Care Act proceeded from the belief that the government needed to make sure most everyone had access to health-care insurance, meaning that those with preexisting conditions or insufficient income would get help. Once that decision was made, the individual mandate was needed to deal with two problems: the “free-riders” (i.e. people without insurance who would show up in emergency rooms) and, more important, adverse selection. As to the latter, unless insurance companies had enough younger, healthier people in the exchanges who paid premiums and didn’t use much health care, they could not afford to cover the older, sicker people who used a lot of health-care services. It didn’t work out, because people gamed the system (going in and out of the exchanges) and many people simply didn’t sign up, willing to incur the penalty for not buying insurance. Carriers started losing money and then raised premiums or pulled out. The exchanges in some cases were left with a single provider, which naturally raised premiums.
House Speaker Paul D. Ryan (R-Wis.) seemed to suggest on Thursday in his PowerPoint presentation that the very idea of risk-sharing (healthier people subsidize sicker people) was the problem. If he really means that, then taxpayers shouldn’t be helping to support a cost-shifting, risk-sharing system at all. Then again, taxpayers wind up paying for Medicaid and Medicare (people get more out than they ever pay in). Moreover, Ryan’s support for health-care savings accounts (HSAs) becomes hypocritical, because the taxpayer subsidizes pretax deposits. (HSAs benefit richer people with disposable money to deposit.) Does he want to cost-shift for the very poor (Medicaid), the elderly (Medicare) and the rich (HSAs) but not for the working poor and the middle class? That’s essentially what his plan does — which is a problem, because President Trump’s campaign was all about helping the working poor and the middle class. (Since this bill socks it to the older, poorer and sicker people, Trump doesn’t want his name on it. He has, however, embraced it, so Trumpcare it is.)
That refusal to subsidize health care for everyone else is where we were before the ACA; apparently it’s where the Freedom Caucus and others wish to return. They are convinced that, when left alone, the “market” will provide competitive, affordable health care. We know, however, that’s not right. The market is already distorted by Medicaid and Medicare; moreover, this effectively says that those with preexisting conditions get priced out of the market and those who just don’t have enough income and don’t get coverage through their employer do not have insurance that allows them to access the health-care system.
In other words, it seemed that Americans have come to view health-care insurance as something the federal government should guarantee (by credits or subsidies, as well as through Medicaid and Medicare). Ryan says that this is not really decided, and the right-wing opponents say, “Hell no!”
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