By Dan Calabrese ——Bio and Archives--September 22, 2017
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One of the problems with having the national discussion led by lightly informed celebrities such as Jimmy Kimmel is that people begin to believe their own rhetoric, in this case that Republican health-insurance reformers are motivated by sheer malice or by obscure financial considerations. (Never mind that the biggest financial players in this case, the insurance companies themselves, oppose current Republican reform efforts and largely supported the ACA.) That makes discussing the actual problems at hand, and potential solutions to them, difficult or impossible. Republicans made a critical mistake in 2008 and 2009 when they rejected the enterprise of health-insurance reform per se, repeatedly insisting only that “we have the finest health-care system in the world,” oblivious to the fact that a great many Americans were unhappy about that system or anxious, with good reason, about the security and cost of their own health-care benefits. Democrats are today making the same mistake: Obamacare is now sacred writ so far as they are concerned, and the prospect of revisiting it a profanity. But, of course, many Americans remain dissatisfied with the current state of health insurance, and Republicans are taking small, awkward steps toward addressing that. It is not the case, as Kimmel and others insist, that the Graham-Cassidy bill would throw 30 million people off their insurance plans or that it would simply cut off federal funding for insurance subsidies in 2026. Such dishonest histrionics do not advance the cause of responsible health-insurance reform. It would permit the states to seek waivers from the federal preexisting-conditions regulation and experiment with different approaches of their own. Ironically, the effectiveness of the Democrats’ charge that modifying the preexisting-conditions rule would see Americans dying in the streets illustrates why such painful changes are unlikely to be proposed or to pass: Such measures are unpopular, and state governments are held democratically accountable to their people, often in a much more immediate and rigorous way than the federal government is. Experimenting with different approaches to preexisting conditions would in fact be desirable; there is no reason to suppose that the best solution for New Jersey is also the best solution for Oklahoma, and the only thing that is entirely clear about the preexisting-conditions approach put forward in the ACA is that it is not working.
The left spent weeks declaring this dead on arrival, but now that Republicans appear close to a majority here come the tweets. The Graham-Cassidy proposal “eliminates protections for people who are or ever have been sick. GONE. Insurers back to denying coverage for the sick,” Connecticut Democrat Chris Murphy claimed this week. In fact, a state that receives a waiver from ObamaCare’s regulations must show plans that retain access to “adequate and affordable” coverage for people with pre-existing conditions. ObamaCare’s rules are not the only way to do this, despite the claims of Jimmy Kimmel. The Affordable Care Act’s price restrictions have in practice degraded the quality of care for the ill and sent insurers shopping for healthy patients who are more profitable. States could set up high-risk pools, for example. These pools subsidize care for those who need costly treatment without concealing the expense across healthy patients, who may drop coverage if they can’t afford it. This can lower premiums for everyone.So Kimmel has a major problem here in understanding the bill. He simply assumes the ObamaCare mandate is the only way to help uninsured people who wait until they're sick to seek insurance. Graham-Cassidy requires states to find a way to do this as a condition for getting their block grants, but doesn't mandate one way to do it. Kimmel thinks that means no one will do it. That's a complete misread of both the bill and of health care markets, but that's what you get when you look to emotion-driven celebrities to understand matters of public policy.
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