The Crappy Coverage
Solution
By
Phil Mattera for the Dirt Diggers Digest
If
Congressional Republicans succeed in enacting either the Senate or the House
bill to repeal the Affordable Care Act, they will have carried out one of the
most brazen bait and switch moves in the history of U.S. public policy.
They
and Donald Trump campaigned on the idea that Obamacare exchange premiums were
rising uncontrollably, yet neither of the bills does anything to address that
problem.
They
did not vow to repeal and replace Medicaid — Trump, in fact, promised not to
touch it or Medicare or Social Security — yet that is what the bills would in
effect do, both for the ACA’s Medicaid expansion and traditional Medicaid.
It’s
been widely noted that the Republicans seem preoccupied with repealing the
taxes the ACA imposed on high earners to help pay for the cost of expanding
coverage.
Yet
less attention is being paid to the other giveaway in the bills: the repeal of
the ACA’s employer mandate.
This
provision should be called the Wal-Mart Windfall Act, because it
would allow large low-road employers to avoid ACA rules that oblige firms with
50 or more full-time employees to provide health coverage or else pay a
penalty.
The mandate is far from draconian, yet it was at least a partial remedy for the situation in which millions of workers at big-box retailers, fast-food outlets and similar workplaces were not provided affordable coverage and were encouraged to enroll in programs such as Medicaid.
Now
the Republicans seek to remove any obligation on the part of employers to
provide coverage while also undermining the social safety net alternative.
To
the extent that the Republicans have a solution to the healthcare problem it is
this: bring back junk insurance.
It
is often forgotten that the ACA was designed not just to address the problem of
the uninsured but also the underinsured.
Starting
in the 1990s, large insurers such as Aetna began selling bare-bones individual
policies to low-income individuals who did not get employer coverage and could
not qualify for Medicaid.
These
policies had relatively low premiums but sky-high deductibles and numerous
exclusions. In cases of a serious accident or illness, they were all but
worthless.
The
ACA put an end to this predatory market by establishing a set of essential
benefits that all plans would have to include.
Republicans
don’t like to admit that they are promoting a return to crappy coverage, so
they dress up their arguments with misleading phrases such as “patient-centered
reforms.”
Many
of them also realized that the idea of lowering standards directly was not very
popular, so they have returned to their favorite panacea of giving states more
flexibility.
This
allows them to pretend they are not scrapping essential benefits while knowing
that many governors and state legislatures would be all too willing to do so if
given the opportunity.
The
cynicism of Congressional Republicans is matched by that of the big insurance
companies, for whom the ACA was tailored and are now doing nothing to defend
the law.
Instead,
they still seem to be sulking about the two anti-competitive mergers
(Aetna-Humana and Anthem-Cigna) that were opposed by Obama Administration and
shot down in the courts.
Having
seen their oligopolistic dreams go up in smoke, they now seem to want to give
up the ACA market in favor of selling bare-bones policies.
It
is unclear whether the dystopian vision of the ACA opponents will come to pass,
but in the meantime the wellbeing of millions of Americans is being
unnecessarily endangered.
