Cogito Ergo Non Serviam

CBO Says Trumpcare Will Save Less, Insurer Fewer

The Republicans in the House voted on their repeal and replacement of the Affordable Care Act before the Congressional Budget Office could run its analysis of just what it would mean. The Senate has announced it will likely draft its own version. That is probably wise because the CBO scoring came out yesterday. The American Health Care Act, as the House Republican plan was called, would save $119 billion over 10 years, down from $150 billion in a previous version. It would also insure 14 million fewer Americans next year, 23 million fewer Americans by 2026. As the CBO stated, "In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law." It's a public health disaster.

The Republicans claim that Obamacare is collapsing, and to the extent that the insurance cycle is catching up to the insurers who jumped in with low rates to attract policyholders, there is pressure on their bottom lines. Much of the pressure would be gone if the Republicans had not done their damnedest to undermine the Affordable Care Act. Had every state implemented the exchanges and the Medicaid expansion it offered, the situation would be different.

However, they did undermine it, and it is not running as well as it should. Senate Majority Leader Mitch McConnell (R-KY) said, "The status quo under Obamacare is completely unacceptable and totally unsustainable. Prices are skyrocketing, choice is plummeting, the marketplace is collapsing, and countless more Americans will get hurt if we don't act."

For example, Blue Cross and Blue Shield of Kansas City, a nonprofit insurer, has said it will pull out of the ACA market in 2018. It lost $100 million in 2016 selling individual policies. Yet, the insurer will continue covering the corporate policyholders it serves. That means, simply, that the insurer's administrative costs for individual policies are not under control. If those 67,000 individuals it serves were all employees of the same company covered by a corporate policy, the administrative costs would plummet, and the insurer would be more than happy.

The problem the GOP faces is straightforward. No one who currently has health insurance because of the ACA is going to meekly lose that coverage to suit some ideological need the right has for market-based solutions. Moreover, those who do have coverage are not thrilled with the high deductibles and the expensive policies that they do have. What they want is better health coverage for less money. It is a ridiculous demand, but no one said the voters had to make sense.

So, the legislators have a couple of options. They can do nothing, leaving the ACA in place. That will upset their base who elected them in large part to repeal and replace it. They will pay for it at primary election time. Alternatively, they can repeal it and create a Rube Goldberg system of tax credits and other market fiddles to replace it. Of course, if their system doesn't make things better, they will pay for that at general election time. If Obamacare is collapsing and if the GOP doesn't have a solution that they can get through Congress, a single-payer system is on the horizon as the only way out of the mess.

This journal has long espoused a national, single-payer system for health care in the US for national security reasons. Absolutely everyone must be covered and regularly see a physician in an age where barbarians like Al Qaeda and ISIS could gain access to biological weapons. Fees, deductibles and the rest are market arguments, and national security is simply more important. If the wealthy want to do something privately, that's just fine.

Public health is a public good. It should be funded accordingly.

© Copyright 2017 by The Kensington Review, Jeff Myhre, PhD, Editor. No part of this publication may be reproduced without written consent. Produced using Ubuntu Linux.



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