GOP Retries ACA Repeal as Single-Payer Surges
Monday, September 18, 2017
AARON MATÉ: It’s The Real News. I’m Aaron Maté. After failing to repeal the Affordable Care Act earlier this year, Republicans are trying again. Senator Lindsey Graham of South Carolina says it’s the party’s last hope.
Lindsey Graham: “Our bill levels out an inequity in funding. It allows flexibility that Obamacare would never embrace. It gives patients a voice in the healthcare they’ll never have through a single payer healthcare system. From my point of view, it’s the best and last hope for the Republican Party to show that we have ideas and that our ideas are better than our friends on the other side.”
AARON MATÉ: Graham and his co-sponsor, Bill Cassidy of Louisiana say they’re closing in on the votes. Joining me now is Dr. Ed Weisbart, member of Physicians for a National Health Program. Dr. Weisbart, welcome.
ED WEISBART: Aaron, thank you.
AARON MATÉ: Thanks for joining us. So interesting timing. Last week just as Senator Bernie Sanders unveiled his measure with an unprecedented number of Democratic co-sponsors, the Republicans rolled out this last ditch effort they say to once again try to repeal the Affordable Care Act. An effort that most of us thought was over after Republicans’ failure just a few months ago. Your thoughts right now on what’s happening?
ED WEISBART: Well, it’s not a big surprise. We knew that we had scored an advance by having the bills die, but we knew that they were going to come back with something. I’m hopeful that they will not be able to proceed with this. I’m hopeful that it won’t get through, but if they were actually to proceed, we would have devastating consequences on the healthcare system around the country. It’s needless for it to go like this because we do have such great alternative strategies that we could be pursuing right now.
AARON MATÉ: You know, before we get to alternatives including Sander’s most recent measure, let’s talk about what that impact would be. Remind people of what this Republican effort to dismantle the ACA would mean.
ED WEISBART: Sure. This would really change things dramatically. It would end many of the advantages that the ACA has brought to us. For example, the ACA we take for granted some of the things it accomplished. It, for example, has defined an important list of essential health benefits. Benefits that for an insurance company to be in business in the marketplace they have to offer these core benefits. These aren’t crazy extreme benefits. These are really essential health benefits. One of the things in this new proposal would be to completely eliminate that, and to say that it’s up to the states to decide what is and is not an essential health benefit, which makes no rational sense. What’s essential for your health in Alabama is just as essential in Maryland and in Alaska and in Texas and in California. There’s no fundamental difference in what is needed for health in any place in the country, so why would you want to introduce variations from state to state by that? The ACA created a standard set of essential health benefits, really a minimal set, and this would end that. This would say that the states can decide this.
The ACA has put in other protections that are going to be eroded by it. For example, the ACA created the opportunity for some states to expand Medicaid. Indeed, we have Medicaid in some form in every state in the country. This would in may ways end that. This would say no longer is the Federal Government going to be an equal participant in supporting Medicaid in terms of for lower income folks and others, but instead suddenly the states would be getting a block grant of income from the Federal Government on a per capita basis to do whatever they wish basically on a health care basis. So they could continue Medicaid as it happens today or they could profoundly transform it in a way that is nowhere near as supportive of the health needs to the community, in particular of the underserved community in their state.
The amount of funds that would go into this are tremendously ratcheted down gradually and quite severely. As a consequence, there’s really no reason to think that people living in the states that are affected by this would have anywhere near the healthcare that they need at the end of this process. So I haven’t seen an exact calculation on it because the scoring is not really complete in that sense, but we could expect that this is going to have a dramatic impact. People will lose insurance, certainly will have much less insurance than they have today, and I have to imagine that we’re going to see worsening of the health of the nation, which means that it creates a huge new burden on the business community because workers won’t be in as good health as they were. We’ll have problems from it.
AARON MATÉ: You know, just one more on this front: One of the ACA’s most popular provisions was its protections for people with preexisting conditions, the idea that you can no longer not give someone insurance based on their prior medical history. This Republican measure would essentially allow insurers to charge people with preexisting conditions far higher premiums effectively making them out of reach for many people.
ED WEISBART: Correct. I think the current rule is that older folks can be charged up to three times what younger folks are charged. This bill explicitly says that that difference can go up to a rate of five or even higher depending on what a particular state might decide. So, you’re right, it’s profoundly dangerous for folks. It would also send the requirement for people to have insurance, which I guess some people would celebrate. But that is incredibly corrosive to the entire model of health insurance. If you permit healthy folks to simply go uninsured and become free riders on the system until they get sick, if you permit that, then they’re not paying for the burn unit a day before they need to go into the burn unit.
Who’s supposed to pay for the burn unit a day before you need it? Who’s supposed to pay for these healthcare needs until you get sick? So if you let folks go without insurance, which I guess is what some people would like to do, what that means is that the sickest among us have to pay the most, frankly at a time when they’re usually the least able to do it. So, there’s a reason why we want every American to have health insurance.
Number one, it protects every American from an unexpected catastrophe. That’s why they call it a stroke. You don’t have a stroke. Then you have a stroke. That’s why they call it an asthma attack, because things change in your health abruptly. So it’s important for everybody to be protected against I guess the economic impact of these catastrophic events.
But we also need everybody in an insurance system or we can’t absorb the costs. The costs of only insuring those who are desperately sick are outrageously expensive.
AARON MATÉ: Let’s talk about some of the rhetoric here that’s been deployed in the service of this Republican attempt. When they talk about their effort to repeal the Medicaid expansion, they’ll talk about empowering the states. It’s interesting to contrast that to their response when states take health care measures that they don’t like. For example, when California tries to pass universal healthcare, that gets a very angry response. Wondering if you can talk about this contrast?
ED WEISBART: Yeah. Well, it’s obviously not about what they’re talking about. It’s not about states’ rights. That’s just a dodge as an excuse to look like they’re empowering the states whereas in reality it’s like you’re saying it’s just a cover strategy to try to reduce funding for the states, reduce funding for these programs. Because indeed States like California have tried very hard to do things, and that’s quite different when a state wants to do something out of step. So it’s not about states’ rights. It’s clearly not the goal. The goal is to reduce funding for these programs that are perceived as helping folks who, I guess, they don’t think need to be helped. That’s deadly for people when you do that.
We as a country, for example, decided that if your kidneys stop working and you need to go on a Medicare that for almost no one in the nation would be willing to say no you have to die. We pay for dialysis for people whose kidneys stop working. But I would rather see us be sure that we pay for their hypertension treatment and for their diabetes treatment so that we can avoid dialysis. If you start cutting people off of these preventive measures, you wind up seeing these end stage diseases getting grossly out of control and far more expensive to treat. Unless you’re willing to tell those folks go off into that corner and die, unless you’re willing to do that, and very few Americans are willing to do that, unless you’re willing to do that it just makes more business sense, frankly, to deal with these things earlier in a more comprehensive and proactive way, which is what the Affordable Care Act was trying to do and only got there part of the way.
AARON MATÉ: Let’s talk a bit about the politics of this. Part of the reason or the reason why Republicans are doing this with such a sense of urgency is that if they don’t pass this by the end of next week, I believe, then they lose this procedural loophole that they have where right now they can pass the repeal with a simple majority. But if they wait until later on, until after next week, then they’ll require again the 60 vote threshold. Your thoughts on that and also the timing coinciding with this effort by Bernie Sanders with, as I mentioned before, unprecedented democratic support unveiling a measure for single payer?
ED WEISBART: Yeah. Well, I’m not privy to the inside to know whether this was coincidental or responsive from one to the other. But it’s true that the Republicans have allowed themselves to get into this trap, this bind, because the issue is that the Democrats would filibuster any attempt to do this and to break a filibuster you need 60 votes and they don’t have that on the Republican side. So that’s right. They have to use this arcane rule, which expires at the end of September. So they’re trying to do that.
I’m hopeful that this will go the same way as the two previous efforts that they’ve made and that they will not be able to pass this. If they don’t hit the deadline, of course, there’s no way in the world they can get 60 votes to do something this damaging to the country. 51, they might. 60, there’s no way they could do that.
AARON MATÉ: Finally, Dr. Weisbart, the cornerstone of this Republican plan is this concept of block grants, giving states a certain amount of money that’s capped and giving them the authority to spend it on healthcare as they see fit. Can you talk about what that means and your concerns with it?
ED WEISBART: Sure. Again, I view that as a very risky procedure to take. There would be a finite amount of money for every state to live within, which if things don’t change maybe could be done with all the amount of money they’re talking about for the block grants is a fraction of what states are receiving today. But say something happens. Say a new life saving drug emerges on the market. Say a pandemic emerges. Say something happens and healthcare rightfully actually becomes temporarily or long term more expensive, this would mean that we couldn’t do that. It would mean that there would have to be these incredibly egregious decisions to make in states.
Most states today have Medicaid programs that are so arcane, so tight, so restrictive, that it’s already hard enough for Medicaid patients to get the care they need. Medicaid today is far better than not having insurance. There’s tons of evidence that Medicaid today is life saving even with these limitations to it. But if you make it tighter, if you tell the states we’re going to give you this finite amount of money that you have to live within, that’s fine we all live within budgets, but we’re going to make this even more restrictive than you have today. There’s no way they can do that.
Where are the dollars being spent on Medicaid? So if we wanted to cut Medicaid budgets, where are the dollars being spent? They’re being spent in nursing homes, right? That’s the biggest single dollar amount for most Medicaid programs. Very few people choose to be in a nursing home because that’s where they want to spend their time. Most folks in nursing homes are there, there are many good great nursing homes, but most folks choose to go there almost as a last resort because they’ve become so debilitated in some way that their family is no longer able to really attend to them in their house without some huge medical problem. So they’re there because they have to be there.
If a state has to manage on a tighter budget for Medicaid than they do even today, you can’t ignore the single biggest dollar item on the Medicaid budget which is nursing homes. So what happens to your mother, to your grandmother? What happens to the older folks in your family who have already migrated into a nursing home as their last resort because your family decided that they couldn’t possibly keep up with the nursing needs and medical needs in the house anymore? What happens to them? Where do they go when the state says we’re no longer going to fund your nursing home care?
What happens to the kids? You know, Medicaid also pays for kids. It pays for disabled folks. What happens to them? How are we supposed to deal with this? It’s a incredibly dangerous situation for us to try to further reduce the amount of money we spend in Medicaid.
AARON MATÉ: Just to underscore the risk there when it comes to nursing home residents as you were discussing. We’re just not to long after eight residents of a nursing home in Florida died during Hurricane Irma, that’s still being investigated, but what’s clear is that what we know is that that nursing home was across the street from a hospital with air conditioning and they weren’t taken there until it was too late.
We have to leave it there though. Dr. Ed Weisbart, member of Physicians for a National Health Program, thanks very much.
ED WEISBART: Thank you.
AARON MATÉ: Thank you for joining us on The Real News.