Radical government: The Obamacare repeal | Arkansas Blog

Friday, September 22, 2017

Radical government: The Obamacare repeal

Posted By on Fri, Sep 22, 2017 at 7:14 AM

Apart from the damage that pending Republican legislation will do to millions of American in terms of lost health insurance, it represents conservatives' long-sought upending of the Medicaid safety net for 74 million poor, disabled and elderly (Medicaid pays for most nursing home costs).

A roundup of news of note on the progress of the Graham-Cassidy legislation toward passage:

* REVOLUTION: The New York Times captures the sweep of the impact, apart from immediate disruption in insurance markets and health care coverage.

It dismantles the Medicaid expansion and the system of subsidies to help people afford insurance. It gives the states the right to waive many of the consumer protections under President Obama’s landmark health law. And it removes the guaranteed safety net that has insured the country’s poorest citizens for more than half a century.

“This is by far the most radical of any of the Republican health care bills that have been debated this year,” said Larry Levitt, a senior vice president with the nonpartisan Kaiser Family Foundation. “And the reason for that is that this would be the biggest devolution of federal money and responsibility to the states for anything, ever.”

It’s hard to overstate the potential effects. Medicaid now provides medical care to four out of 10 American children, and covers the costs of nearly half of all births in the United States, as well as care for two-thirds of people in nursing homes and also for 10 million children and adults with physical or mental disabilities.

“It would unleash massive health care debates in every state capital,” said Mr. Levitt, at Kaiser. “All these tough decisions would no longer be on Congress’ plate but on the plates of governors.”

Can they get the job done in the short time available? Will some states even decline the money (think Mississippi and many hard-liners in Arkansas)?

* OPPOSITION: The board of the National Association of Medicaid Directors, a bipartisan group that represents all states, has written to oppose the legislation. They object to a massive burden placed on states without safeguards.

States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities."

The statement is unsigned, so there's not a clear expression of the Arkansas Medicaid director, Dawn Stehle, on the statement. Presumably, she wouldn't dispute her boss, Gov. Asa Hutchinson, who is cheering this legislation.

The Republican governor of Nevada has also sharply criticized the legislation for what it will cost his state.

* HUMAN COST: The Congressional Budget Office has not and will not be heard from before a vote on this legislation, but independent analyses continue to predict a staggering toll — 32 million people by this assessment based on past number crunching. That analysis, as reported by Andy Slavitt, Medicaid director under President Obama, would mean a loss of coverage to more than 400,000 Arkansans, many of them working people.

And still Arkansas's political leaders want a vote without congressional analysis, without debate, without consideration of alternatives now. The repenting period will be long.

In case you missed it, be sure to see Benji Hardy's assessment of the pending legislation in this week's Times.

Bottom line is arithmetic. A fixed limit on spending inevitably means less money which means less coverage of health costs for people.

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