From last night’s very long live blog of my first read through of Cassidy-Collins, there are two comments I really want to highlight:
Admittedly, my view on this is strictly selfish, but it does have some larger utility.
“Does this kill me?” is pretty much how I judge any Potemkin Village “replacement”. If the answer is “no” then at least they acknowledge that leaving the ACA largely intact is the only viable way going forward. If the answer is “yes”, then a whole lot of other Medicaid and individual-insurance folks are going to die with me, and it means they still only care about ‘repeal’ with ‘replace’ being nothing more then a fig leaf to hide the mass graves.
For those who don’t know his story, Archteryx has a chronic condition which requires regular nursing and surgical care. He moved from a non-Medicaid expansion state to a Medicaid expansion state as soon as he could in order to guarantee his access to care. Under the 2009 status quo, the national health policy for him is “Be quiet and die quickly in the corner”. Cassidy-Collins won’t kill him.
Here is a lesson I learned over the many years I have been working on health care regulation: things that are tweaks or forward looking can be changed and improved. Things that dismantle or gut the structure of a program will be, for all intents and purposes, permanent. They certainly won’t be revisited for at least 15 years. The two cardinal examples of this during my career were prescription drug and long term care coverage for Medicare beneficiaries (passed in 1988 and repealed in a mindless fury a year later, with drug coverage not re-examined until 2003 and long term care still not covered); and health care reform (killed in 1994, not revisited until 2009). Based on that simple analysis here is my reaction to what I have seen so far:
Hills to die on: Medicaid block grants
Hills to keep fighting on: high deductibles that mostly leave the rest of the ACA structure in place.
Let’s keep these two evaluation lenses in mind when we look at what comes out of this Congress and whether or not Democrats decide to engage on policy.