Editor: Rep. Comstock, like many of her colleagues, is being besieged by constituents who see their health care threatened by Republican promises to “repeal and replace” the Affordable Care Act—or with their more recently chastised moniker, “repeal and repair.”
While Rep. Comstock and her colleagues could take a more analytical and deliberative approach to health care reform; they are instead falling back on policy platitudes that will not help those folks screaming at town hall meetings. In fact, their quick fixes would make coverage worse.
Take high risk pools, a tried and failed approach of clustering all the sick and expensive people in state structured plans—presumably making coverage for the young and healthy less expensive. The problem is that these plans have substantial waiting periods—a slight problem for someone suddenly diagnosed with cancer—and a limited pool of funding. If there are 10,000 people who qualify for coverage in a high-risk pool, but only enough dollars for 5,000; well, then, tough luck for those who didn’t get sick quickly enough.
Similarly, with Republican plans to block grant Medicaid or impose per capita caps on recipients. This would place a limit on the amount of medical care that eligible recipients could receive. Either services will not be available and/or these people would have to pay out-of-pocket beyond their cap. More than a third of children with cancer depend on Medicaid for their treatment. What happens to them and their families when they’ve reached their cap?
Then we have another Band-Aid: health savings accounts. The insured places money in a tax-benefited account to pay for medical expenses in a high-deductible health plan. Really? For those who desperately need the insurance and live paycheck to paycheck, putting money away in an HSA is not an option. Similarly, for tax credits. If my kid gets desperately ill in June, a tax credit next April—even if it covers the cost—does me very little good.
Finally, we have the great canard: allowing insurance plans to be sold across state lines. This is race to the bottom in coverage for everyone. Health insurance is regulated at the state level. If policies can be sold across state lines, insurance companies will base their plans in the most hospitable state (least coverage required) and sold nationwide. Think Mississippi plans sold in Northern Virginia or New York. This is a license for snake-oil health plans.
To be clear; the one thing all these “solutions” have in common is that that they ration health care. And not only do they ration care, they limit it to the sickest, poorest and most vulnerable so the healthy and the wealthy can have cheaper care. It’s not only inequitable; it’s immoral.
Republicans claim that their plans will drive down costs by making health care more competitive. The irony is that the ACA was built on Republican free-market strategy that’s been kicking around Washington think tanks for decades and its state-based health exchanges are designed to do exactly that.
So now, backed into a corner and vilifying a health care strategy they at one time championed, Republicans are clinging to policy scraps as solutions to systemic problems.
Sometimes slogans and platitudes can substitute for substance. But this is one of those instances where policy matters. Rep. Comstock and her colleagues would do their constituents—and themselves—a great favor by taking a deep breath and a comprehensive look at the cost drivers and incentives that make care expensive and craft a plan that is balanced and guarantees access for everyone.
George Dahlman, Purcellville