In an unusual move, health insurers have weighed in on the current Senate repeal and replace bill. They state that the Cruz Amendment, which would allow states to waive the 10 essential benefits coverage required under the ACA, would encourage healthy people to buy cheap policies and result in exorbitant premiums for people who would need the more comprehensive coverage. Without the individual mandate or the more comprehensive (and expensive policies), insurance companies would have less money to cover the expenses of the sickest patients.
Governors of Both Parties Oppose Senate Repeal and Replace Plan
At the nation's Governors' annual summer meeting on Friday, 7/14, there was strong opposition to the Senate Republicans' Repeal and Replace Plan - an not just from democratic governors. John Kasich, governor from Ohio, stood out as the most vocal Republican governor opposing the current Senate plan. He is calling for a bipartisan solution.
Gov. Sandoval of Nevada plays a pivotal role, because he has been skeptical of the plan, and he provides support for Senator Heller, who is a likely no vote on the Senate plan. If the governor endorses the Senate plan, Senator Heller may follow suit and put McConnell within striking distance of passage. Other Republican governors critical of the plan include Scott (Vermont), Walker (Wisconsin), and Bevin (Kentucky).
McConnell, Pence and Trump have been courting the governors and senators who are critical of the plan, offering special deals to win their support. Republican leadership is adamant that they must deliver on the repeal and replace promise they have been running on for seven years.
What Do We Mean By Single Payer?
As the Republicans push their latest (and likely final) Repeal and Replace plan, survey after survey shows that the vast majority of Americans do not support it (between 12-17% overall). The calls for bipartisan solutions are increasing, as are the demands for Medicare for All, a single payer solution.
This is the link to an article that discusses some of the very basic issues that must be decided before we can move forward. Click here to read.
For instance, Medicare for All is a convenient way to discuss reforms that guarantee healthcare, but it does not necessarily mean single payer. Up to 1/3 of those with Medicare are covered under Medicare Advantage which are insurance-managed policies. 2/3 of Medicare recipients receive the bulk of their coverage from the government, but still purchase MediGap plans from insurance companies to cover additional services.
California's SB 562 is a true single payer system in that there is not a role for insurance companies. The coverage provided is comprehensive; even so, the government does not provide your care - your doctors, nurses and other providers do. It is not like the Veterans Administration where the hospitals are owned by the VA and the doctors and nurses are employed by the VA. The government appointed board would determine the very broad parameters of medical care (including hearing, dental and vision), and then negotiate reimbursement rates for providers and drug prices with pharmaceutical companies.
As Americans start to develop a systems that guarantees healthcare for all of us, we will have to be careful and precise in the language we use.
Critical Time for Senate Repeal and Replace Plan
Mitch McConnell is determined to push the Republicans' Repeal and Replace bill for a vote next week, by July 21. He needs only 50 Senators to close the deal, because VP Pence will step in to cast the deciding vote to pass it.
The BRCA, as they have named the bill, dramatically changes the ACA. The CBO estimates that 22 million Americans will lose their coverage in the coming years. Here are four main changes:
1. The individual mandate would be abolished under the Senate plan. Without a requirement to buy a policy, many healthy people will go without coverage or buy a new bare bones policy. That means prices will sky rocket for anyone who wants to buy a policy that covers the 10 essential benefits of the ACA. Insurers would prefer that everyone bought a policy, and have advocated for raising the penalty for not purchasing a policy because it wasn't high enough to compel people.
2. Older Americans on the individual market will see enormous premium increases. Currently, insurers are only allowed to charge those aged 50-64 3 times the premium of younger Americans. The BRCA will increase that from 3 to 5 times the premium. If a 20 year old pays $300/month for a platinum plan (current price in LA), an older American would pay up to $1,575/month. That would be $18,900 premium for an individual, $37,800 for a couple - until they qualify for Medicare.
3. Pre-existing conditions would be undermined indirectly, but with devastating consequences. States would be allowed to seek waivers for insurance companies to offer bare bones policies, as long as at least one plan is offered that would cover the essential benefits in the ACA. Many healthy people would go with the cheap, minimal policies, making the market for the essential benefits policy incredibly expensive.
4. Medicaid funding will be dramatically altered to limit its growth in many ways. (1) It would eliminate enhanced funding for Medicaid expansion by 2021 (2 months after the 2020 election - what a convenient coincidence). (2) Then federal spending would decrease each of the following 3 years. (3) Finally, there would be overall limits to eligibility that would affect the 70 million American children, disabled, elderly and poor who receive benefits. States would not be able to absorb the steep cuts, so there would be draconian cuts to enrollment qualifications, benefits and provider rates.
Pelosi on Defending the ACA and Catholics on Abortion
An interesting interview with Pelosi in today's Washington Post. It explains Brownley's unwillingness to discuss single payer. It is also reflects Pelosi's realistic acceptance of some Catholics' position on abortion. Read article
SB 562 - Healthy California Act
The Healthy California Act, SB 562 (Sen. Lara and Atkins), would create a single payer system in which every Californian is guaranteed comprehensive healthcare services. It's like Medicare for All, but better. There would longer be any co-pays or deductibles. Comprehensive care would include medical, dental, vision, hearing and reproductive care. Healthy California would be authorized to negotiate prices with pharmaceutical companies. Patients can choose their doctors freely without being limited by networks. Go to www.healthycaliforniaact.org to read the bill and learn about the most current developments.