Friday, March 10, 2017

Ryan's Rush to pass GOPlin health bill before CBO analysis

TrumpBeat: How To Judge Trump, in this morning’s FiveThirtyEight Significant Digits email, covers Paul Ryan’s American Health Care Act - the repeal-and-replace action seven years in the making. (Not! Try about seven weeks. Ryan is trying to jam this bill through the House because if he waits too long the CBO report might well be the bill’s equivalent of a death panel.)

There are two articles on health care in the morning Significant Digits email. I’ll give you a very short version here and then you can read the reports below the break.

… The AHCA does cut essential health benefits [“basic services including prescription drugs, treatment for mental health and substance abuse, and pregnancy care”] from Medicaid expansion, a telling sign that Republicans would still like to see these benefits go.

Just because health plans will still technically cover a wide range of services, however, doesn’t mean patients will be able to access them in practice. The GOP bill changes the law so that insurers can sell catastrophic coverage, plans that would not pay for most health services until a deductible is met. Under the ACA, out-of-pocket spending (including deductibles) can be as high as $14,300 for a family in 2017, which is about a quarter of the median U.S. household income. That means essential benefits could be out of reach to many if the House bill passes.

The AHCA, aka Ryan’s Rush, is being fast-tracked through the House - even in advance of analysis by the Congressional Budget Office (CBO). Republicans, anticipating almost certain bad news from the CBO, are on the offensive trashing the report before it even exists.

… Republican Rep. Richard Hudson of North Carolina called the CBO analysis — an analysis that, again, does not yet exist — “a false argument that the Democrats have created.” …

It’s no mystery why Republicans are going on offense: They know that the CBO analysis, whenever it arrives, will forecast that millions of Americans would lose their health coverage under the GOP plan. That finding won’t be controversial among health care experts: The Republican plan would cut back insurance subsidies and phase out the ACA’s expansion of Medicaid, which together make a decline in coverage a near certainty.

FiveThirtyEight also reports on How Defunding Planned Parenthood Could Affect Health Care: “The Republican health plan would also block federal funding for Planned Parenthood. That would have profound effects on women’s health care.” If planned parenthood is defunded, the rest of the health care system, especially in rural areas, is not up to filling the resulting gap in reproductive services.

We might as well think of Ryan’s Rush as the America the Hopeless Care Act.

And where does Trump stand? He too supports health care coverage for the few. The NY Times reports on how After Halting Start, Trump Plunges Into Effort to Repeal Health Law.

Health care: When “covered” doesn’t mean “accessible”

As he frequently does, White House press secretary Sean Spicer brought along some props — two stacks of paper — to a press conference on Tuesday. The stacks represented the Affordable Care Act and the Republicans’ new (much shorter) replacement for it. “Look at the size. This is the Democrats,” he said, pointing to the bigger pile. “This is us,” he said pointing to the smaller pile.

Spicer’s point was that unlike the sprawling ACA, the GOP bill is a paragon of small-government efficiency. What he didn’t mention, however, is a big reason that the Republican plan is so much shorter: It isn’t really a full replacement, just an addendum, adding or changing various provisions of the existing law. To fully repeal the ACA would take 60 votes in the Senate, which Republicans don’t have. And so, the American Health Care Act, as the GOP bill is called, is likely to go through what’s known as the reconciliation process, which only allows changes to provisions that directly affect the budget.

The reconciliation process doesn’t just make the GOP plan shorter; it also affects what’s in it. In particular, the new bill doesn’t cut what are known as essential health benefits, an ACA requirement that insurers cover a list of basic services including prescription drugs, treatment for mental health and substance abuse, and pregnancy care. Republicans, including Health and Human Services Secretary Tom Price, have decried these benefits, which increase insurance premiums (though it’s not clear by how much) by requiring broader coverage than insurers would otherwise offer. But these benefits don’t directly affect the budget, meaning it would be hard to repeal them using the reconciliation process. The AHCA does cut essential health benefits from Medicaid expansion, a telling sign that Republicans would still like to see these benefits go.

Just because health plans will still technically cover a wide range of services, however, doesn’t mean patients will be able to access them in practice. The GOP bill changes the law so that insurers can sell catastrophic coverage, plans that would not pay for most health services until a deductible is met. Under the ACA, out-of-pocket spending (including deductibles) can be as high as $14,300 for a family in 2017, which is about a quarter of the median U.S. household income. That means essential benefits could be out of reach to many if the House bill passes.

More health care: Scoring the scorers

Republicans released their health care plan (and passed it through two committees) before the nonpartisan Congressional Budget Office had a chance to do its usual analysis of the bill’s impact. And in case the message wasn’t clear enough, Republicans then launched a pre-emptive broadside against the CBO and its record. “If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” Spicer said Wednesday. Republican Rep. Richard Hudson of North Carolina called the CBO analysis — an analysis that, again, does not yet exist — “a false argument that the Democrats have created.” (For the record, the CBO’s analysis of the ACA was imperfect but, on the whole, pretty good.)

Criticism of the CBO is neither new nor the exclusive province of Republicans. Back in 2009, it was Democrats who ripped the office over its analysis of a health care plan, in that case the bill that eventually became the ACA. But at least Democrats waited for the CBO to release its report before they attacked it.

It’s no mystery why Republicans are going on offense: They know that the CBO analysis, whenever it arrives, will forecast that millions of Americans would lose their health coverage under the GOP plan. That finding won’t be controversial among health care experts: The Republican plan would cut back insurance subsidies and phase out the ACA’s expansion of Medicaid, which together make a decline in coverage a near certainty. Several unofficial analyses have already reached the same conclusion.

One option for Republicans would be to concede that their plan would cover fewer people and then to argue that the benefits are worth the cost. Health care policy, after all, is all about tradeoffs — and plenty of people think the ACA got the balance wrong. That’s more or less the case House Speaker Paul Ryan made this week when he called coverage rates a “bogus” metric and said he was focused on cost instead.

The problem for Republicans is that Trump explicitly rejected that approach earlier this year when he promised “insurance for everybody” as part of the ACA replacement. In Trump’s telling, the Republicans can deliver more coverage (the ACA, after all, never achieved universal coverage), better care and lower prices. It doesn’t take a CBO report to know that’s a tall order.

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