.@SenAngusKing It all comes down to money – add enough into the system and the details of what you call it (hidden pool, reinsurence etc) less important
— Mitchell Stein (@mhstein) May 1, 2017
The core issue of the AHCA is not the decision to gut pre-existing conditions protections by gutting community rating requirements where everyone has to be offered a policy at the same price. It is the decision to pull out almost a trillion dollars of spending on healthcare and redistrisbute those resources towards upper income tax cuts. Everything else is a detail.
Those details matter. Paying for healthcare at Medicaid rates instead of rental network commercial rates is far cheaper and buys a lot more units of service. Using smart value based insurance design buys more efficient and effective units of care at a given price. Visible or invisible risk sharing and risk pools alters incentives of carriers. Market design matters.
But all of this matters at the margin. The core short run problem in healthcare is the conservation of issues. No matter what the law is in July, the same people will present with the same problems. The question is who bears the cost and how it is financed. The pre-ACA system had employers a significant element of the cost if the individual had a good job. Medicare and thus society as a whole bore the cost if the individual was old or permanently disabled. Medicaid and CHIP bore the cost if the individual was a kid or pregnant or in a nursing home or severely ill. And then fifteen to twenty percent of the people bore all the cost and the risk themselves. The ACA has altered that equation. The AHCA will push a massive amount of risk back onto that fifteen to twenty percent of society plus add some more people at full risk of their own health.
That is one way to lower federal government costs. But the issues are conserved. It is just a cost shift to people without the reserves to actively handle risk efficiently. The issues don’t go away because the money goes away.
evodevo
GREAT summary. Thanks…. can I steal this?
David Anderson
@evodevo: yes
rikyrah
Ok, I will spread the word.
Is there any point where we can exhale and know that we will get Obamacare through 2018?
SFAW
Thanks. Concise explanation, something all voters and Congresspersons should understand. (“Understand” as in “be aware of”; I realize there is a significant part of the population whose jobs or self-esteem require that they not comprehend it.)
And it’s something Tom Perez (or his surrogates) should be hammering on every day.
“The Republicans want to give their rich friends a One Trillion Dollar gift, and stick you with the bill!”
SFAW
@rikyrah:
No.
Well, I’ll qualify that: if Paul Ryan and his “brain trust,” and Shitgibbon’s Adminstration, all have a Col. Nicholson moment, then things might change. But since that’s about as likely as the Jets winning SB LII, I wouldn’t get my hopes up.
laura
Ryan will never give up on his desire for tax cuts for the wealthy and emiseration is every form for the rest of us.
It is truly all he cares about. It’s where he puts in the effort. It’s for those that own him outright. He’ll work on tax reform like a dishwasher at a soup kitchen, and he’ll plan to gut healthcare in the fall when the fiscal year begins.
It’s his life’s work.
Barbara
I reposted this on my Facebook feed. It’s times like this that I wish I had more not fewer FB friends. Hopefully a few will repost as well.