Republicans say the Affordable Care Act provides health insurance that manages to be both lousy and expensive. Whatever the flaws of these policies, the new Trump administration is trying to pull off a con by offering Americans coverage that is likely to be so much worse that it would barely deserve the name insurance. It would also leave many millions without the medical care they need.
This reality became increasingly clear when President Trump’s choice to run the Department of Health and Human Services, Tom Price, testified before a Senate committee last week. He looked pained as he described the terrible predicament of people who earned around $30,000 to $50,000 a year and had to deny “themselves the kind of care that they need” because they had Obamacare policies with deductibles of $6,000 to $12,000. Yet, earlier in the same hearing, Mr. Price extolled the virtues of policies that would be woefully inadequate — policies that cover medical treatment only in catastrophic cases. Such policies often have deductibles of around $14,000 for family coverage. This is simple hypocrisy. Condemn the policy you don’t like, propose something far worse as a replacement and claim that it is much better.
Mr. Price and Mr. Trump have recently said that their goal is to offer health care to many more people than are covered by the current health care law, which has driven the uninsured rate to historic lows. Mr. Trump went so far as to say he would provide “insurance for everybody” — something his press secretary, Sean Spicer, later walked back. But Mr. Price’s testimony and the legislation he introduced in the House, where until recently he was the Budget Committee chairman, show that the new administration will make decent health care less affordable and less accessible for most people. And Mr. Trump was already trying to undo parts of the A.C.A. through an executive order on Friday, just hours after being sworn in.
At last week’s confirmation hearing, Mr. Price suggested that Congress and the new administration could improve health care by expanding health savings accounts, in which people can put aside money, tax-free, to pay for out-of-pocket health costs in the future. But those accounts would not help families earning the median household income of $56,000 a year because these families would never be able to sock away enough money to, say, pay for cancer treatment or major surgery. These accounts would primarily benefit the wealthy, who want to shield more of their income from taxation and can easily afford to pay high out-of-pocket costs.
The best description of what Mr. Price stands for can be found in a bill he introduced in 2015, the Empowering Patients First Act. It would “empower” Americans by eliminating the health care law’s expansion of Medicaid that has helped more than 10.7 million newly eligible people enroll in that government-run insurance program. It would also drastically cut subsidies that have helped 11.5 million people purchase private insurance on federal and state health exchanges. Under his bill, people buying insurance for themselves would get between $1,200 and $3,000 a year in subsidies, down from an average of $4,600 that people get now on HealthCare.gov. The bill would even get rid of the requirement that allows young people to stay on their parents’ insurance policy until age 26, a provision that is widely popular. And it would hurt people who get insurance through their employers by setting a cap on how much of that expense businesses can claim as a deduction on their taxes. Experts say that over time this would encourage companies to stop offering health benefits to workers.
When it comes to health care, Mr. Price and other Republicans say their goal is to give people more choices. It is hard to argue against choice. But in the ideological world inhabited by Mr. Price, House Speaker Paul Ryan and many other Republicans, choice is often a euphemism for scrapping sensible regulations that protect people.
Some Americans might well be tempted by this far-right approach. They would have to pay less up front for these skeletal policies than they do now for comprehensive coverage. But over time, when people need health care to recover from accidents, treat diabetes, have a baby or battle addiction, they will be hit by overwhelming bills. The Trump administration seems perfectly willing to sell those people down the river with false promises.
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