As Senate Republicans mull the Wealthcare Act, the God-King’s mouthpieces are in full-on Lie and Deny mode. (More)

“We don’t see them as cuts”

Kellyanne Conway would insist that a bowl of moldy oatmeal is a fresh macadamia, if you compare the oatmeal to a bag of lawn clippings:

Conway: If you are currently in Medicaid, if you became a Medicaid recipient through the Obamacare expansion, you are grandfathered in. We’re talking about in the future. You know, Obamacare took Medicaid, which was designed to help the poor, the needy, the sick, disabled, also children and pregnant women, it went way above the poverty line and opened it up to many able-bodied Americans who should probably find other, should at least see if there are other options for them. If they’re able-bodied and they want to work then they’ll have employer-sponsored benefits like you and I do.

[George] Stephanopoulos: Kellyanne, hold on a second. There’s no way you can say that a 15-year-old who’s on Medicaid will not be affected by the cuts in the future.

Conway: I didn’t say that.

Stephanopoulos: Well, you said everybody who’s on Medicaid now is grandfathered in and will not face cuts, and that simply is not factual if you have $800 billion in cuts.

Conway: Well you keep calling them cuts, but we don’t see them as cuts. It’s slowing the rate of growth in the future and getting Medicaid back to where it was.

Note how she rejects present circumstances as the baseline. Instead, she turns the clock back to before the ACA was passed, when 20 million fewer Americans had health insurance. She insists that, by that baseline, the Wealthcare Act has no “cuts” to Medicaid. And compared to a bag of lawn clippings, a bowl of moldy oatmeal is pretty much like a fresh macadamia.

“Inconsistent with the other big change they would make”

But even by her Turn Back The Clock baseline, the Wealthcare Act does cut Medicaid:

As for the idea that the House and Senate GOP bills would strengthen Medicaid by focusing on its more traditional populations, that claim would appear to be inconsistent with the other big change they would make.

Both proposals would fundamentally change Medicaid by ending the federal government’s open-ended commitment to providing its share of funding for the program, no matter how many people become eligible and no matter how much their care ends up costing.

Federal payments would likely fail to keep up with costs, forcing states to make cutbacks that would inevitably affect all groups that depend on the program – very much including the disabled and elderly, whose predictably high medical needs mean their bills account for roughly half of all Medicaid expenditures, even though they represent a minority of enrollees.

Both the House and Senate versions of the Wealthcare Act would put a per-capita cap on federal Medicaid spending. They also block-grant that funding to states, so your state could make that an individual annual benefits limit, like the annual limits that many private health insurance plans had before the ACA. (More on that momentarily.) If your state does that – and if you’re on Medicaid and get a serious illness or injury that would exceed the annual limit – well, no more treatment for you. That can’t happen to Medicaid patients right now, and it couldn’t happen before the ACA. So that’s a “cut.” Period.

No problem, Conway insists. Just get a job. Also from the previous link:

When ABC’s George Stephanopoulos asked Conway about this possibility, she offered an increasingly familiar argument – that Obamacare had over-extended Medicaid by taking the program away from its historic mission of covering children, pregnant women, the elderly and the disabled.

“Obamacare took Medicaid, which was designed to help the poor, the needy, the sick, disabled, also children and pregnant women, it took it and went way above the poverty line to many able-bodied Americans who … should at least see if there are other options for them.”

She added: “If they are able-bodied and they want to work, then they’ll have employer-sponsored benefits like you and I do.”

But as the Huffington Post’s Jonathan Cohn explains in that story, most Medicaid recipients already have jobs:

The problem is that many work in low-paying, temporary, or part-time jobs that don’t offer coverage. In 2014, just 30 percent of working adults with incomes at or below the poverty line had employer-sponsored coverage available to them.

Conway would probably parrot the boilerplate conservative response: “Get a better job!”

But here’s the thing they never admit. Those low-paying, temporary, or part-time jobs would still exist, because we still expect someone to serve our food, cut our hair, care for our children, clean the floors and empty the trash in businesses and hospitals, clean the rooms and make the beds in hotels, mow lawns, and so on. Most of those jobs don’t offer health insurance and – because both the House and Senate versions of the Wealthcare Act eliminate the employer mandate – those employers would have no incentive to start.

Sure, one hotel maid could get training and move into a “better job” with health insurance. But if every hotel maid did that, who would clean the toilets, replace the towels and soap and toilet paper, vacuum and mop the floors, empty the trash cans, and make the beds? We expect someone to do that – just as we expect someone to do the other jobs I listed. How do all of those Someones get health insurance?

“Maximize the number of Americans who can afford to buy health insurance for themselves”

Conservative health care pundit Avik Roy says they should buy their own, and will under the Wealthcare Act:

For decades, free-market health-reform advocates have argued that the single best idea for improving U.S. health care is to maximize the number of Americans who can afford to buy health insurance for themselves, instead of having to depend on the government or their employer. The Senate bill transforms the American health insurance landscape in this direction.

Roy’s reasoning is that the Senate bill would lower the bottom threshold to qualify for premium subsidies, moving people from Medicaid into the individual marketplace. But how will they afford it? Well, first unicorns poop Skittles…:

The Senate bill contains a plethora of measures that will lower premiums and bring competition back to the market. In particular, the bill would end Obamacare’s destructive practice of massively overcharging young people for their coverage by overregulating the prices at which they can buy coverage. The bill provides resources to states that will help stabilize insurance markets, especially for vulnerable populations, in ways that will bring premiums down for the healthy.

The Senate bill repeals Obamacare’s Medicaid expansion – an expansion that has trapped more than 12 million people in a program that researchers have shown has health outcomes no better than being uninsured. In its stead, the Senate bill offers low-income Americans robust tax credits to buy affordable private health insurance, just as those formerly enrolled in Obamacare’s exchanges will be able to.

First, the idea that Medicaid “has health outcomes no better than being uninsured” is a wingnut canard based on a biased reading of a single study. That (in)famous Oregon study found that being on Medicaid had no statistically significant impact on blood pressure, blood sugar, or cholesterol levels, but did result in significant decline in clinical depression and self-reported financial stress. Roy and other conservatives simply ignore the depression and financial stress findings, and the folly of measuring health solely by blood pressure, blood sugar, and cholesterol levels … and declare that Medicaid is “no better than being uninsured.”

Second, the “overregulating” of premiums translates to “premiums that reflect your health risks over your lifetime, not just this year.” Yes, under the ACA, young, health people pay higher premiums than their health at that time would usually justify. But when they get older and sicker – when the big hospital bills start rolling in – their premiums will be lower than their health risks would justify. Put another way, young and health people’s premiums pay for the treatment of older and sicker people … and when those young and healthy people get older and sicker, other young and healthy people’s premiums will pay for their treatment.

That’s called community rating, and it’s how employer group plans work. It’s also how the ACA was set up to work. But both the House and Senate versions will do away with community rating. So yes, health insurance will be cheap, when you’re young and healthy and don’t need it. And when you get older and sicker – when you need health insurance – you may no longer be able to afford it.

Finally, the Senate bill expects individuals to pay more for less coverage. It both raises the maximum percentage of income that a family must spend on a benchmark plan and lowers the actuarial value of the benchmark plan from 70% of medical costs under the ACA to 58% of medical costs. And your premiums may go even higher if you want coverage for preventive care, maternity care, mental illness, and other currently “essential benefits,” because the Senate bill would effectively eliminate those “essential benefits” from insurance.

So Senate Republicans want you to spend more of your income on insurance that covers less of your medical costs, and Roy calls that “a thriving, consumer-driven individual insurance market.”

I call it a casino where insurance companies are the house. Just sayin’.

“We don’t really know what to do right now”

And back to that lifetime benefit cap. Both the House and Senate versions of the Wealthcare Act could revive that beast, not only for individual plans but for employer-based insurance as well:

A little-noticed provision in the Republican health care bill could allow insurers to reinstate lifetime limits in health insurance. This change would affect Americans in the individual market as well as the 159 million Americans who get health insurance at work, and it would be particularly dangerous to people or families with chronic conditions that require millions of dollars in medical treatment.

Before the Affordable Care Act, 91 million Americans were enrolled in health insurance plans that capped the amount of benefits a given enrollee could receive. Many of these caps were around $1 or $2 million, meaning that once a patient went over that amount, their benefits simply expired.

The American Health Care Act, which the House is set to vote on today, would give health insurance plans a way to once again set up lifetime and annual limits. This would be true not just for states that pursued the bill’s waiver, but for the entire country.

The way it works is, if you live in California but your employer is based in Atlanta, and if your employer buys group insurance from a Georgia company, then the “essential benefits” of your health insurance are governed by Georgia law. That’s not a big deal right now because the ACA set nationwide standards, including a prohibition on annual and lifetime benefits caps. So there’s very little difference between the “essential benefits” in California and the “essential benefits” in Georgia.

But the Wealthcare Act would make it easy for states to get waivers on those “essential benefits.” So even though you live and work in California, if Georgia got a waiver for the annual and lifetime caps, your Atlanta-based employer’s Georgia-governed health insurance plan might stop paying when you reach the annual or lifetime limit.

At the previous link, Vox’s Sarah Kliff gives a real world example:

I wrote about one of those patients earlier this year, a 6-year-old boy named Timmy Morrison who was born extremely premature. He blew through $1 million in medical bills by time he was 6 months old.

His parents’ plan used to have a $1 million cap, but he was born six days after Obamacare banned lifetime limits, so it didn’t apply.

His parents are worried about what bringing back lifetime limits could mean for Timmy.

“We don’t really know what to do right now,” his mother, Michelle Morrison, told me in February. “Should we start pressuring his doctors to do a surgery now so he can get it in time? That doesn’t feel right. Insurance is supposed to cover things that you can’t anticipate – and for us, this is one of them.”

I’m sure Conway would insist that’s not a “cut” because it’s just back to how things were before Obamacare. But problems like that are exactly why President Obama and Democrats passed that landmark law, and poll after poll shows most Americans don’t want to go back to that.

Tomorrow we’ll look at whether those polls will matter.


Photo Credit: CNBC


Good day and good nuts