The GOP Wants More Health Care Choices. Is That Really a Good Idea?

The GOP Wants More Health Care Choices. Is That Really a Good Idea?

BY MAGGIE FOX

MARCH 12TH 2017

“Insurance is not really the end goal here”This is the Budget Directors statement- Mr. Mulvaney. If AHCA better known as Donald care- POTUS coined this appellation himself is an Act that was supposed ensure Insurance coverage for everyone per the POTUS himself.

Republicans pressing for repeal and replacement of the Affordable Care Act are stressing one broad theme over and over: Freedom of choice.

The House GOP bill, called the "American Health Care Act" and now moving through Congress, aims to free up health insurers from what conservatives see as oppressive regulations that they say drive prices up, push insurers out of the market, and leave consumers with higher costs and fewer choices.

"It delivers relief to Americans fed up with skyrocketing premiums and fewer choices," House Speaker Paul Ryan said in introducing the bill.

"The AHCA places trust in the decisions of individuals and families by making greater use of health savings accounts ... and respecting their ability to follow incentives to be continuously insured," Douglas Holtz-Eakin, president of the right-leaning American Action Forum and former director of the Congressional Budget Office, wrote in a commentary for the Washington Post.

But long before Obamacare was in the works, health policy experts on both the left and the right looked at the issue of freedom of choice. They decided having too many choices was a bad thing.

Health insurance is difficult to understand. And pre-Obamacare, some companies sold people bare-bones policies that looked cheap up front, with low premiums, but that saddled customers with high deductibles, co-pays and caps on coverage once people started getting sick

That's why Obamacare has a list of essential services, why it requires insurance companies to cover anyone who applies, and why it forbids them to dump undesirable customers.

In return, health insurance companies demanded a mandate or some other mechanism that made sure that more people bought health insurance — especially younger, healthier people who would pay in but not claim much back.

Polls show people like that aspect of the ACA, even if they don't like rising premiums. But the answer to higher premiums is not cutting back on coverage, medical groups argue.

"Freedom to choose junk insurance has nothing to do with getting the care we need," said RoseAnn DeMoro, executive director of the National Nurses United union.

She says that's what Ryan's bill threatens to do.

"In fact, it is the false choice of a faux freedom," she added. "This bill lets insurance shape what procedures doctors do, what drugs we take, and even which doctors we can see."

And before Republicans were against that mandate, they were for it.

The battle over health reform has been going on for decades. In 1989, economist Stuart Butler wrote a blueprint for reform at the Heritage Foundation, a bastion of conservative thinking. Called "A National Health System for America," one section is titled: "Mandate all households to obtain adequate insurance."

Butler, who has since moved to the nonpartisan Brookings Institution and who switched his thinking on the mandate, compared health insurance to auto insurance.

"If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate but society feels no obligation to repair his car," he wrote in the blueprint. "But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance."

That's the problem with letting people choose not to have health insurance if they don't want it, said David Cutler, an economics professor and health policy expert at Harvard University.

"One way or another, sick people cost money," Cutler said.

Treating heart attack victims in the emergency room is far more costly than preventing the heart attack with good medical care.

"The best thing that we can do to protect health is to prevent illness in the first place," said Dr. Leana Wen, Baltimore's health commissioner. "The emergency room is not the safety net. By the time that people get there, it's often too late."

Related: Health Care Bill Cuts Crucial Disease Prevention Fund

A patient with schizophrenia may cost $50,000 a year to treat, but left untreated, could end up in jail at the taxpayer's expense, Cutler said.

"You can say, 'I want to pay for them through taxes'. You can say, 'I want them to die because they don't deserve coverage'. But you can't say, 'I don't want to pay for them but I want them to get care,'" he added.

The new GOP plan seeks to encourage — but not mandate — people to get insurance by letting companies charge higher premiums for those who have gone without coverage.

"Insurance is not really the end goal here," White House Office of Management and Budget Director Mick Mulvaney told MSNBC.

And it also would let states decide what kind of policies insurance companies should offer.

DeMoro, of the nurses union, sees it as a recipe for disaster.

The Obama administration even had trouble controlling insurers who sought to trim what they offered, she said.

"Even through the ACA, health exchanges, insurers routinely change plan designs yearly in ways to increase out-of-pocket costs and limit patient choice through narrower networks," she said.

That was one of the biggest complaints about Obamacare — some customers lost access to doctors and hospitals they'd been using for years.

Related: Obamacare Creators Tell GOP: We Told You So

Cutler also worries people will try to game the system if they don't have to buy high-quality insurance.

"They can say, 'I am going to buy a crappy health insurance policy because I know if I get really sick someone will take care of me,'" he argued.

Holtz-Eakin doesn't think that's a risk.

"It's never been the case that we've had a race to the bottom with health insurance," he said. "That's not my model of how markets behave…Insurers offer policies that people want to buy." 

NBC News

Five Things to Know About the New GOP Health Care Bill

BY MAGGIE FOX

MAR 10 2017, 5:04 PM ET

The American Health Care Act (AHCA), the Republican plan to replace the Affordable Care Act, is wending its way through the congressional approval process.

It's catching heat from virtually all quarters — doctors and nurses, hospitals and the AARP, conservatives, liberals and even the right-wing Heritage Foundation.

And yet President Donald Trump has given it his blessing — and GOP leaders say they are determined to push it through. Here are five things to know about the plan:

The American Health Care Act (AHCA), the Republican plan to replace the Affordable Care Act, is wending its way through the congressional approval process.

It can't fully repeal Obamacare

"Repeal and replace" has been the refrain of Republicans for years; Trump issued an executive order on the very day he took the oath of office that directed agencies to ease the regulatory burdens it imposed. But a president cannot repeal a law passed by Congress, and Congress can't even repeal one of its own laws without the votes.

To repeal Obamacare, the Senate needs 60 votes. There are only 52 Republican senators, so the Republicans are instead using a budget process called reconciliation to pass the AHCA. That only takes a 51-vote majority. The catch? Every measure has to have a budgetary impact.

It would redefine Medicaid

Some experts believe this could be the biggest overall effect of the AHCA long term if it is passed.

Obamacare required states to expand the Medicaid program — the joint state-federal health insurance plan for the poor, disabled, pregnant women and for some elderly — to cover more people. The Supreme Court ruled that was voluntary and only 30 states, plus Washington, D.C., opted to expand. An estimated 11 million people got health insurance through this expansion, which was 100 percent paid for by the federal government at first before gradually rolling back to 90 percent.

Related: Many Experts Say the GOP Plan Won't Work

Republicans argue this open-ended federal spending is out of control. The AHCA provides a per capita federal contribution to Medicaid starting in 2020. This starts to put the onus back on states to pay rising health care costs for Medicaid enrollees. Supporters of the AHCA say this provides an incentive to keep costs down and gives states flexibility to decide what's best. Critics say it's a formula for weakening Medicaid, which currently covers about 70 million people.

It may take away benefits

Obamacare lays out 10 "essential benefits" that most health insurance policies must cover. They include outpatient care, emergency services, hospitalization, maternity and newborn care, mental health services and addiction treatment, prescription drugs, rehabilitative services, laboratory tests, preventive services (including cancer screenings and vaccines) and pediatric services.

The AHCA takes away the requirement that Medicaid cover these benefits. That means some states can drop them for Medicaid enrollees — and many almost certainly will as they get into cost crunches. This could hit mental health and addiction coverage especially hard.

It also takes federal funding away from Planned Parenthood and any other health provider that offers abortion, even though federal law already prohibits the use of taxpayer dollars for abortion.

It will probably make health insurance more expensive

Obamacare heavily subsidized insurance premiums. An estimated 85 percent of the 10 million to 12 million people buying individual insurance on the exchanges got a federal subsidy. Plus, it provided help with other costs. The AHCA stops the subsidies, which varied state by state and according to a customer's income using a complicated formula. Instead, the AHCA provides a much simpler tax credit of $2,000 to $4,000 per person.

Related: Health Care Bill Cuts Crucial Disease Prevention Fund

The nonpartisan Kaiser Family Foundation estimates the credit averages out to $1,700 less per person. Almost all projections say the tax credit will help higher-income people more and lower-income people less.

People complained that insurance premiums rose under Obamacare and they did. But they were rising long before Obamacare, and rose for non-Obamacare plans, also.

Fewer people will have health insurance

Few dispute that the Obamacare law got more people covered by health insurance - 20 million people more, by most estimates. It was also designed to ensure that this was quality insurance that would actually cover people for their claims. Republicans say they want to expand access to health insurance, which is not quite the same thing as making sure people get covered, and they say they want people to have the choice to choose bare-bones plans if they want to.

Related: Paul Ryan's PowerPoint on the AHCA

The Brookings Institution projects that 15 million fewer people with end up with health insurance under the AHCA. The nonpartisan Congressional Budget Office is due to release its estimate next week.

"Insurance is not really the end goal here," White House Office of Management and Budget Director Mick Mulvaney told MSNBC this week.

One way Obamacare aimed to make sure people had coverage was through mandates. People had to pay an extra tax if they didn't have health insurance for most of the year. The new plan would let health insurance companies charge clients 30 percent higher premiums for a year if they do not stay continuously insured.