There’s a bad joke that goes like this: What’s your plan to pay for the high cost of health care? No worries. I’ll win the Powerball.
Except the new Republican plan to repeal and replace the Affordable Care Act ends that option (and somehow takes it seriously). There are detailed instructions to prevent lottery winners from getting Medicaid coverage. That probably fixes a huge problem that we never heard about before.
It’s funny that the House Repeal and Replace plan (The American Health Care Act) includes several pages on that non-problem while the draft doesn’t even get around to mentioning the Indian Health Care Improvement Act.
But don’t get too worked up about this miss. Here are the three things you need to know about the House plan.
First: This plan is an urgent call for American Indians and Alaska Natives to sign up for Medicaid, children’s health insurance, or the Exchange Plans. This plan makes it clear that there is time to sign up as an act of defiance and that adds new money to the Indian health system.
Second: There will be fewer people covered under the House plan. We won’t know the numbers until it’s scored by the Congressional Budget Office. But it’s clear fewer people will be covered. And to top it off the plan will cost older Americans more. A lot more. Insurance companies would be allowed to charge older people five times as much as young people. (And to make that more odd: Older people are a GOP constituency.) There is no requirement that people carry insurance, but if there is a lapse in coverage, the cost goes up.
Third: The politics are a lot like President Trump’s election plan. Tick off everybody. Create chaos and hope there are enough votes left to win. I don’t think so. Conservatives already don’t like the provision to include tax credits. And state governments aren’t happy with a punt on Medicaid expansion (keep it until 2020 and then cut the heck out of program). And to top it off, the White House comment is at best only mild support. This plan is politically dead. A plan that looks so much like Obamacare is going to be really difficult to sell as change. It keeps, for example, the essential health benefits package, including family planning and maternity benefits. Yet at the same time it ends funding for Planned Parenthood. That means two very different constituent groups will be opposed. Finally the tax credits are complicated and unfair. They are based mostly on age. So someone under 30 gets a credit of $2,000 while someone who’s 60 or older could get $4,000. Once again that’s contradictory logic. Take from old people. Then give something back. Good politics? We shall see.
I just don’t see how this plan — or anything like it — gets out of the House of Representatives. Let alone become the law. So don’t get too excited. You’re better off buying a Powerball ticket. — Mark Trahant