President Trump rode a populist wave into the White House. He was embraced by those who felt that both parties and were ignoring their pain. He promised to pay attention to their problems and get government working again for them. He promised healthcare insurance for everyone that would cover more and cost less. He also promised to protect Medicare, Medicaid, and Social Security.
His actions don’t reflect his promises.
His healthcare proposal is a tax cut for the rich disguised as a healthcare reform bill. It repeals a Medicare tax on those with high incomes. The loss of $117B over ten years accelerates Medicare insolvency by four years.
The bill does lower costs for the young and healthy at the expense of the most vulnerable older population who really need affordable insurance. In its first version, it reduces the deficit more than Obamacare, but does so by driving older sicker people out of the subsidized insurance market. While the latest version hasn’t been scored by the CBO yet, the math suggests that additional tax supports for older sicker people may keep more of them in the insurance pool. That could easily bring the total saving down below those projected for Obamacare. If that’s the case, Republicans are offering a plan that is more expensive AND covers fewer people.
The plan also caps Medicaid funding. More uninsured will turn to expensive emergency rooms for care. That drives healthcare costs back up. If passed along with additional proposed budget cuts, it would be the largest social welfare cut in our history.
Republicans tout increased competition across state lines as the missing ingredient to lower insurance costs. But Obamacare also encouraged selling insurance across state lines. Six states implemented it. No insurance companies chose to participate. That’s because the barrier to entry is not state regulation, it’s the cost for insurance companies to setup provider networks. The reasons why sparsely populated areas have few insurance providers is simple math. The same counties that Trump said are currently underserved, will continue to be underserved in this proposed plan.
If you are still unconvinced, Medicare Advantage programs are federally regulated effectively providing the national economies of scale that Republicans tout. 97% of the counties in this country have limited choices for Medicare Advantage plans because of sparse population, not state regulation.
Insurance premiums are driven primarily by costs of care. Utah and Colorado have young healthy populations and low insurance costs. An identical plan sold in Michigan costs more because of an older sicker population.
Expanding coverage to more people improves health and drives down costs. That’s because those with insurance are treated by primary care physicians rather than in the emergency room. They receive preventative care to keep them healthy rather than remediation when they are ill. This plan doesn’t to that. It’s regressive – punishing the poor, sick, and elderly in order to reward the wealthy. Please tell your representatives that they have to do better if they want your vote.