The House health care reform bill faces an uncertain future in the U.S. Senate, but one of the nation’s leading health care experts says the legislation ought to make the Senate’s job easier while assuring wary consumers that the plan is poised to rein in costs without kicking anyone to the curb.
On Thursday, the House of Representatives voted 217-213 to advance the American Health Care Act. A number of Republican senators have indicated that they want to see the bill overhauled, but Galen Institute President Grace-Marie Turner says the House did most of the Senate’s work for it.
“The House bent over backwards to write it’s legislation in such a way that it could get through the torturous process in the Senate to get this to the floor only needing 51 votes,” said Turner, referring to the Byrd Rule, by which legislation is gauged to determine whether it can proceed under reconciliation and avoid a Democratic filibuster.
Turner says senators have a long history of believing their own rhetoric about the Senate being the world’s greatest deliberative body and, thus, seeing House legislation only as advice for them to write their own bill from scratch.
Either way, Turner says certain principles must be part of the Senate bill as well.
“They’re going to have to devolve more power to the states. They’re going to have to give people more regulatory relief in order to be able to make these premiums more affordable. They’re going to have to make sure there continues to be a safety net for those currently on coverage so they don’t lose it, as the House bill does,” said Turner.
“And they have to provide a structure of subsidies going forward for people to be able to afford health insurance who are at the lower end of the income scale or who just can’t afford the full cost of the premiums,” said Turner.
However, Turner expects the Senate to push for more generous subsidies for those struggling to afford insurance but make too much to qualify for Medicaid. She also wouldn’t be surprised if senators extended the expansion of Medicaid or devoted more dollars to the expansion while it lasts.
Senate leaders have indicated they plan to take a deliberate approach on this issue, but Turner says there is good reason to pick up their pace. Insurers need to decide whether they will participate in the individual market exchanges by June 22.
“So the Senate has to show some real progress over the next six weeks and help those insurers see what this legislation is going to look like so they can make their own decisions about whether they’re going to be participating in the health insurance markets,” said Turner.
The House bill failed to reach a floor vote back in March because too many conservatives and moderates balked at the original text. Conservatives, in particular, demanded a bill that would project lower premiums immediately. That led to the MacArthur-Meadows amendment.
“What they said was, ‘We will provide some additional funding to the states, very generous funding – $130 billion to the states. If they decide they want to take this as a grant instead of the entitlement structure of existing Obamacare, then they can have flexibility in revising the regulations in their own states,” said Turner.
The idea is to allow states to set their own standards for what qualifies as an approved health care plan, and then giving patients the chance to decide what type of plan and price structure best meets their needs.
Democrats allege patients with pre-existing conditions will find themselves on the outside looking in again. Turner says that’s just not true.
“There are three layers of protection for people with pre-existing conditions. Current law stays in place decide not to take the grant and make their own changes. But states also have a responsibility to their citizens, and now they have this money from (Michigan Rep.) Fred Upton’s negotiations to provide extra payment for people with pre-existing conditions,” said Turner.
However, Turner is adamant that reckless behavior by millions of people are adding to the problem, that they don’t get coverage until they have a medical problem. She says that drives up premiums for everyone else when healthy people signing up for coverage would bring costs down.
She says the difference between that and a mandate is that no one would order people to buy coverage but would provide more incentive by offering more plans at lower rates. Turner says the current law has led to young people in California, for example, to go from paying $50 per month for coverage to more than $600. As a result, they don’t buy anything.
Another concern is that millions will lose their coverage under the AHCA. The Congressional Budget Office estimated that 24 million would lose coverage under the original version of the AHCA. Turner says that statistic is horribly misleading.
“What they’re saying is people would decide to not purchase, not that the coverage wouldn’t be there for them or that it wouldn’t have subsidies for people that are currently on the coverage. But over time people would just say, ‘I don’t want to buy those policies.’ The thing the CBO can’t put into its formulas is realizing that the markets and consumer choice can make those policies more affordable so people will want to buy them,” said Turner.
