Thursday, November 5, 2009

This is the best the Republicans could offer?

Last Friday, Rep. Boehner, the Republican minority leader, promised "over the coming days, you're going to hear an awful lot about the specifics of what we would do to lower the cost of health insurance in America and really do this in a step-by-step gradual process."

In the same interview, Rep. Boehner went on to discuss differences in the Democratic and Republican approaches to expanding coverage and addressing pre-existing conditions, saying
Most of the 36 million that they say they're going to cover already have access to some type of government program, or even their employer program, or have chosen just not to have health insurance. When you really boil this down, there are about seven or eight million people in America, those with pre-existing conditions, those who are what I would describe as the working poor, and some early retirees who have a difficult time getting health insurance. We can help those people get health insurance and still bring down the cost of health insurance for the 85 percent of Americans who have it and think they pay too much for it.
Well the specifics are now here. Rep. Boehner and the Republicans this week unveiled their bill, the preamble of which states
The purpose of this Act is to take meaningful steps to lower health care costs and increase access to health insurance coverage (especially for individuals with preexisting conditions)...
For a bill that's supposed to help 7-8 million vulnerable people, the bill at best does precious little and at worst actually harms those who need insurance most.

First, the 219-page bill only uses the word "preexisting" three times: in the preamble, in a section title, and in a provision ordering the General Accountability Office to do a study. You would think that legislators concerned "especially for individuals with preexisting conditions" could bring themselves to mention those conditions a few more times.

Second, a CBO analysis of the bill indicates that by 2019 (ten years from now) it will only increase insurance coverage "by about 3 million relative to current law," far short of the 7-8 million cited by Rep. Boehner. The legislation would leave 52 million people uninsured; one out of every six nonelderly residents would lack insurance. Rep. Boehner did promise a "gradual" approach, but this is ridiculous.

Third and most importantly, the bill will likely hurt many of those who need help the most. From the same CBO analysis
...some provisions of the legislation would tend to decrease the premiums paid by all insurance enrollees, while other provisions would tend to increase the premiums paid by less healthy enrollees or would tend to increase premiums paid by enrollees in some states relative to enrollees in other states.
As an example of how the distribution of costs and enrollment might change under the Republican plan, the CBO states
For example, states that loosened rating rules in the market for individually purchased insurance to allow premiums to vary more on the basis of age would cause premiums for older people to increase and premiums for younger people to decrease. With other factors held equal, fewer older people (who tend to have higher health care costs) and more young people (who tend to have lower health care costs) would then sign up for coverage, and the improved average health status of insured people would lower average premiums; at the same time, the pool of people without health insurance would end up being less healthy, on average, than under current law.
The Republican plan does lower average costs for people who will have insurance. However, it does this in part by changing the mix of people with insurance, bringing in people who are younger and healthier and driving out people who are older and unhealthier.

Fourth, the Republican plan also reduces average premiums by reducing the types of services that would need to be covered in plans--that is, by reducing the quality of coverage. The CBO writes that provisions in the plan would
encourage states to reduce the number and extent of benefit mandates that they impose, and provisions that would allow individuals or affiliated groups to purchase insurance policies in other states that have less stringent mandates.
In short, insurance premiums go down because the insurance covers less.

The plan does have some good features, such as requirements for the government to improve electronic record-keeping and some extra funding for fraud investigations. However, in keeping with the Republicans' gradual and incremental approach, these could be enacted subsequently.

The bottom line is that the Republican plan is no substitute for the Democratic plan. The Republican plan doesn't even live up to Rep. Boehner's own diminished promises or its own preamble.