Fixing One Problem with the Senate Health Bill: Medicaid Expansion

So simple, a Senator would never have thought of it:

Although there’s no CBO score on the bill yet, it will probably come out similarly to the House Bill since it keeps much of the same structure for slowing Medicaid Expansion and although I’m critical of the way the CBO score was arrived at, it won’t matter in terms of a Democratic talking point; 26 million will lose their healthcare. You’ll hear it all over cable news until the vote, then in campaign ads for the 2018 election.

How to solve this issue? Here is the difference between politicians and regular people; I can conceive of a fairly simple answer that would never occur to a professional, and it’s not one I’ve yet heard either in public policy articles or blathering about on cable news.

Consider: There are about 14 and a half million people covered under the Medicaid expansion from Obamacare. You can criticize Medicaid all you want in terms of studies on health outcomes or availability of providers, but if you’re on it, it’s free (to you). There are no premiums, deductibles, or co-pays. So even if you provide market alternatives to that, none of them are going to be as cheap to the patient as free Medicaid is. People being kicked off Medicaid will generate stories for years for the Democrats. There will be no end to the number of hard luck stories (and the children! Think of the children!). That will fill nightly news and newspaper stories for years to come.

So just let those people keep Medicaid.


That’s it. No complicated policy issue or complicated public/private program. Just allow the people who are currently covered by the Medicaid expansion, as long as they meet their income eligibility, keep their Medicaid healthcare. It’s not a new entitlement since it won’t be open to any new applicants; it will just cover those who currently have it. Eventually those numbers will shrink, either by people improving their lot and exceeding the income eligibility, or worst case, aging into Medicare.

Will it cost money? Yes, but frankly, the Republicans seem to be under some sort of delusion that they can turn health care into a tax cutting bill. I don’t see how that’s realistic. At some point they are going to have to realize that the bill is going to have to be revenue neutral.

 

So exactly what problem is that solution designed to solve? I mean if you think that is great why not try the same solution for Medicare and Social Security. Lets just assume that no more people will ever need assistance from any government program than are currently enrolled.

Heck, lets just assume that all the wars we need to fight are the ones that we are now engaged in and then we can eventually phase out all military spending. The potential of your idea appears limitless.

 

The problem I'm trying to solve is twofold.

1. The political problem. Based on how the CBO scored the House bill, the CBO assumes that without a mandate forcing people to buy healthcare, they won't get any healthcare to replace the Medicaid expansion. That doesn't seem realistic to me, but it is highly likely that there is a good portion of that population that won't bother unless it's free.

2.. The insurance market problem: I don't see how this bill fixes the individual insurance market that Obamacare screwed up. If anything, it will make the problems worse since they're keeping all of the insurance mandates except the one requiring people to buy insurance. So the deterioration of the individual markets will continue, only it will be the Republicans fault. They are going to need time to fix this, and this bill doesn't do it, so continuing the Medicaid expansion for the people already on it keeps those people out of the exchanges until they figure out the right mix of reforms to repair the damage that Obamacare did.

 

The deterioration of the insurance marketplace is already the Republicans fault. They did it deliberatly to try and promote their draconian plan and yet it looks like the Republican plan is going to fail.

Neither Obamacare or the Republican plan is going to fix healthcare in America. Time to look seriously at what other countries have done or single payer or something different.

The real issue is the incredibly high percentage of GDP spent on healthcare in America and neither plan addresses that issue.

 

The deterioration of the insurance marketplace is the Republican's fault? How did they do manage that? They've not even passed a bill yet.

 

On a simple level just the uncertainty of knowing that the Republicans were going to repeal Obamacare had a negative impact. And then of course Trump saying that they would not pay the insurance subsidies if the insurance companies lost money.

And then there were the gleeful Trump tweets about destroying Obamacare.

 

Sorry, the exchanges were falling apart long before Trump.

 

You are wrong about one thing. States can make medicaid patients pay co-pays/deductibles, etc. I think I heard someone tell me they have to pay a $4 copay on prescriptions for instance. Beyond that, your proposal probably has equal protection issues...

 

The original Medicaid law allows some very limited copays. Back in the 90's Florida tried to impose a 5 dollar office visit copay on clients, but they refused to pay and eventually the stopped requesting it.

 

Pharmacies have an advantage--they got the goods they really wanted in going to the doctor