Color me unimpressed regarding the Cassidy health care bill, which attempts to replace Obamacare, but once again misses the mark.
Here is my analysis...
- States will receive block grants to use for subsidizing health insurance, instead of directly subsidizing individuals and expanding Medicaid.
Analysis: Sounds good in theory, but in reality states won't be ready for this in time (2020, which sounds far away, but in reality is only a little more than 2 years off). Also, the block grants will disappear by 2027, and the complicated formula to distribute the grants is flawed. This entire block grants plan is a mess, and it's likely to cause more problems than it solves.
- Medicaid expansion will be eliminated, and replaced by the above block grants.
Analysis: If the block grants were done right, then this could work. However, for the reasons explained above, this will result in failure.
- Cost-sharing subsidies (federal government paying deductibles and other out-of-pocket expenses for low-income citizens) will end. The block grants to states will be used as a substitute, which each state can distribute accordingly.
Analysis: On it face, this isn't a bad idea. I never liked "blank check health care" (basically making all medical care free to certain patients), because it leads to rampant over-utilization (unnecessary doctors visits and procedures), waste (too many tests and exams), and fraud. However, this isn't the solution. Again, this transfers the problem over to the states -- some of which will be underfunded by these grants (and the grants will keep decreasing, year by year), thus again creating a massive deficit.
- Tax credits to lower and middle-class Americans paying health premiums will be ended.
Analysis: This is a mistake. Tax credits which benefit the working poor should not be touched, and in fact don't even add up to very much money compared to the federal budget. Huge mistake to cut this -- both morally and politically (why alienate voters in this demographic?)
- Individual and employer insurance mandate will end.
Analysis: Many fellow Republicans insist that the mandate is unconstitutional and should not exist. They also insist that it's unfair and oppressive. I disagree. A mandate is required if your goal is to cover all Americans, regardless of pre-existing conditions. Otherwise, they can simply go without health insurance until an expensive treatment is needed, and then suddenly demand, "Cover me!" That defeats the entire purpose of insurance. It's like going without car insurance, and only signing up AFTER you've had an accident! The only way I would support the lack of a mandate would be if people could choose to opt out of guaranteed acceptance. That is, if you choose not to pay for coverage now, then it's tough luck on you if you get sick and can't afford care. Otherwise, it's not fair to those paying into the system when healthy. I will concede that the employer mandate is unnecessary, and should be dropped. Health care was given as part of employment decades ago when it was typical for a person to stay at a company for decades (or for life), and their company almost took on a parental role. It's no longer like that in America, and health care is much more expensive (even adjusted for inflation). This simply pushes down salaries, and forces companies to sign up for inefficient, expensive group plans.
- States can apply for waivers to the "10 Essential Health Benefits", basically removing one or more of the 10 elements as "essential".
Analysis: I agree with this, but the Cassidy bill doesn't do it right. The 10 Essential Benefits were included in Obamacare as a response to garbage health care plans, where people (usually low income, uneducated citizens) would buy "cheap" health plans which in reality covered almost nothing. So it set a baseline on coverage, thus shutting down these scam plans. Great in theory, yet poor in practice because Obamacare was a poorly written law. Obamacare over-corrected the problem, to where men are paying for maternity care, and adults are paying for pediatric dental care. You read that right. A portion of my health insurance premium goes to covering the potential expenses if I get pregnant. Absurd. That's also why I lost the medical plan I liked -- because it didn't have such "coverage". The 10 Essential Benefits simply needed to be modified, removing mandatory coverage for areas which either don't apply to everyone (maternity care) or ones which everyone may not want (maternity care again -- such as something a 50-year-old woman would never want to pay for).
- Price restrictions on older Americans would be possibly modified on a state-by-state basis. States could apply for waivers to allow for different premiums based upon age. At the moment, the same plan cannot be more than three times as expensive for an older American than the cheapest younger American.
Analysis: I don't think it should be on a state-by-state basis. These price caps simply need to go away. It is insane that a wealthy older American should be subsidized by a lower-middle-class younger American -- and that's exactly what is happening here. If it's expensive to insure you because of your age, and you can afford to pay the premium, then you should pay it. I would be okay with a government subsidy in these cases for the older Americans who cannot afford it.
Notice that there is no cost reform in this bill, meaning that the BIGGEST problem with American health care -- its insane per capita cost as compared to all other developed nations -- is not addressed.
Like Obamacare itself, this bill is just a shell game as to who pays for the incredibly bloated and opaque system known as US healthcare.
I grade this latest attempt by the GOP to be a FAIL, and it should be put onto the scrap heap.