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Mainly because of the way it radically transforms Medicaid

Forbes' Avik Roy: Senate bill would be 'greatest policy achievement by a GOP Congress in my lifetime



If you're a conservative and you want to like the Senate health care bill, but you're concerned because Ted Cruz and Mike Lee say it doesn't go far enough, you could do a lot worse than to listen to Avik Roy. Roy writes about health care policy for Forbes, in a column known as The Apothecary. He doesn't pretend the bill is perfect, but even so, he is enthusiastic enough to have tweeted the following this morning:
Pretty high praise, although I suppose you'd be clearing a pretty low bar compared to other recent GOP legislative achievements. Let me know if you think of one. In a way, though, that's sort of Roy's point. Conservatives like Cruz and Lee love to hold out for better and better bills, only to see nothing at all get passed and then see Democrats retake control. They will pass anything that moves the ball in their direction, regardless of how little or how much. They don't care. They will take as much as they can get and come back later to try for even more. That strategy has given us the big-government monstrosity we are desperately trying to dismantle today. But often when you make the case that something is better than nothing, people infer that the something you're defending must not be very good. Roy makes a very strong argument that this is not the case at all with the Senate bill, particularly when you consider how it changes Medicaid, whose enrollees now get outcomes no better than those of the uninsured:
The reason that Medicaid’s health outcomes are so poor is because the outdated 1965 Medicaid law places a laundry list of constraints on states’ ability to manage their Medicaid programs. As a result, the main tool states have to keep Medicaid costs under control is to pay doctors and hospitals less and less each year for the same care. Hence, many doctors don’t take Medicaid, and Medicaid enrollees struggle to gain access to care.

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The Better Care Reconciliation Act of 2017 addresses these problems in several ways. First, the bill repeals Obamacare’s Medicaid expansion, and replaces it with tax credits so that low-income Americans can buy the coverage of their choice at an affordable price. Second, the bill gives states a new set of tools to make their Medicaid programs. For example, under Obamacare, states are only allowed to check if someone is eligible for Medicaid once a year, even if that enrollees has moved to a different state, or become no longer eligible, or is no longer alive. Jonathan Ingram of the Foundation for Government Accountability, in a recent report, recommended allowing states to redetermine eligibility more frequently and thereby culling their rolls of ineligible individuals. Third, the bill puts the legacy Medicaid program on a long-term per-capita cap tied to medical inflation through 2025, and conventional inflation (CPI-U) thereafter. This change is important, because Medicaid per-enrollee spending is growing at a slightly slower rate than Medical inflation; hence, making the program sustainable requires the use of CPI-U. The fiscal sustainability of Medicaid is essential to making sure that those who depend on the program can know it will be there for them in the future.

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To sum this up, Medicaid is performing poorly because states have to follow insane rules for how they manage it, and they have no flexibility to control their costs or make sure they limit enrollment to those who are actually eligible. By cleaning all of this up, and moving those who are not truly poor into private coverage with the help of tax credits, Roy believes the changes in the Senate bill will finally make Medicaid an effective program for people who truly need it, while giving others more market-based options. If the Medicaid overhaul isn't enough for you, and you're still not satisfied with the repeal of the individual mandate, the conservative Wall Street Journal editorial page notes the bill's firm stand on ObamaCare taxes: Importantly, the Senate bill also repeals all of ObamaCare’s tax hikes, including the industry taxes that are passed on to consumers and the 3.8-percentage-point surtax on investment income. Some Senators pushed to keep the surtax to avoid the tax-cuts-for-the-rich label and spend the revenue on something else, but the payoff in economic growth and rising incomes outweighs the temporary political hit. I cannot emphasize enough the importance of repealing these taxes to the economy and the nation's long-term fiscal health. They are slowing growth today, but they're poison pills for both economic growth and the federal fisc over the long term. The longer they stay in place, the more trouble the nation will be in.


Roy's tweet seems to be an appeal to the likes of Cruz and Lee to not let the opportunity for such a massive step forward slip away for the sake of a perfect free-market bill that simply isn't politically possible. (You'll never get Rand Paul on board, but he's a libertarian utopianist who would rather preen to his fellow utopianists about how principled he is than solve anything, so who cares about him?) If you've been under the impression that this bill is a pile of crap that makes nothing better, and isn't a serious attempt to change health care in this country, the two analyses excerpted above should make you feel a lot better. No, it's not perfect. But it's much, much, much better than ObamaCare - which is what we'll remain stuck with if the Senate bill doesn't pass. Any conservative willing to let that happen in order to make some sort of a point isn't really a conservative, and in fact, isn't a serious person at all.

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Dan Calabrese -- Bio and Archives

Dan Calabrese’s column is distributed by HermanCain.com, which can be found at HermanCain

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