Extremists mount new attack on health care

Bill Knight column for Mon., Tues. or Wed., August 13, 14 or 15, 2018

At a time when U.S. health care faces a “reckoning,” according to an insurance executive, conservative extremists are threatening to make things worse in another attempt to roll back the Affordable Care Act.

Chester Burwell, president and CEO of CareFirst BlueCross BlueShield, shared his concerns at the 2018 conference of the National Hispanic Medical Association, and said physicians and patients alike face an obesity epidemic, disappointing new models on payment procedures, and three bad consequences of government policies:

* The “congealing” of the U.S. health-care system. “You’ll see large integrated delivery systems built around academic medical centers – good quality care [but] 50 to 100 percent more expensive than the community average.” 

* The erosion of the private health-care market. “Just recently, we have gotten rid of the individual mandate, and the [cost-sharing reduction] subsidies that were in the omnibus bill ... were taken out of the bill,” he said. States are now trying to develop alternatives like short-term insurance policies, but they don’t have to provide Affordable Care Act (ACA) coverage requirements, Burrell said.

* Results from the tax reform passed 51-48 in the Senate in December. “If the full effect of this tax cut is experienced, then the federal debt will go above 100 percent of GDP [Gross Domestic Product] and will become the highest it’s been since World War II,” said Burrell. “We’ve got a huge problem if [the economy] ever goes back into recession,” he said. “This will stimulate higher interest rates, and higher interest rates will crowd out funding in the federal government for initiatives that are needed,” including health care.

Burrell noted that 74 million people are covered by Medicaid, 60 million by Medicare, and 10 million by the Children’s Health Insurance Program (CHIP), and another 10 million people are getting federally subsidized health insurance through the ACA’s insurance exchanges. “What happens when interest’s demand on federal revenue starts to crowd out future investment in these government programs that provide health care for tens of millions of Americans?”

Despite such concerns, a seven-page report titled “The Health Care Choices Proposal,” released June 20 by the Health Policy Consensus Group, including the Hoover Institution, Heritage Foundation and other right-wing think tanks, proposes changes that would dump many of the ACA’s insurance protections and shift hundreds of billions of dollars provided by the ACA to states in the form of block grants, an idea that Congress defeated last year.

Under the conservative proposal, states could come up with their own systems, as Burrell said, with different standards and requirements from state to state. However, the report omits how the proposal would function.

Like last year’s doomed effort to repeal the ACA outright, the new proposal may face considerable opposition from citizens and Congress alike. But its existence shows how some Republicans still want to scrap the ACA, and even if it fails in the short term, the proposal could be a blueprint for GOP lawmakers next year if Republicans retain control of the House and Senate after November’s elections.

The AFL-CIO issued a statement that said, “Last year, Democratic legislators and a few principled Republican lawmakers beat back repeated efforts to repeal health-care reform, which would have thrown more than 20 million people off health insurance.

“The new proposal would gut protections for people with pre-existing conditions; impose an age-tax on older adults by allowing insurance companies to charge them much higher premiums and eliminate guarantees that health insurance must cover maternity care, prescription drugs or other essential health benefits,” the federation added. “More than 27 million working people gained health coverage through the insurance exchanges and Medicaid expansion because of the Affordable Care Act.”

Meanwhile, Burrell alluded to the possibility that progressives have pushed for years: Medicare For All.

“Does that [all] mean we move to single-payer, some major repositioning?” he said. “I don't know, but in 35 years in this field, I've never experienced a time quite like this.”