March 15 2017
Health policy expert Avik Roy points out something that isn't receiving sufficient attention in all the discussion of the CBO's scoring of the American Health Care Act (AHCA). One of the key findings of the CBO, Roy asserts, is "an implicit but powerful indictment of Medicaid."
A core part of the Great Society programs, Medicaid, which is designed for those under a certain economic level, offers medical care with copays that cannot exceed a token amount. Federal law mandates a vast array of services that must be covered. What's not to like?
And yet the CBO scoring indicated that five million fewer Americans would sign up without coercive penalties for those who don't have health insurance. What gives? Avik Roy writes in today's Wall Street Journal:
Medicaid is the largest or second-largest line item in nearly every state budget. But for all practical purposes, the main tool states have to control costs is to pay doctors and hospitals less than private insurers pay for the same care. As a result, fewer doctors accept Medicaid patients, making it very hard for Medicaid enrollees to get access to care when they need it. Poor access, in turn, means that Medicaid enrollees—remarkably—have no better health outcomes than those with no insurance at all.
. . .
Still, it’s remarkable that the CBO believes people need to be fined into signing up for Medicaid. That tells us something about the CBO’s assessment of Medicaid’s value to those individuals—and it buttresses the GOP’s case that Medicaid needs substantial reform.
It is unfortunate that the opportunity to reform health insurance comes at a time when the Democrats in Congress feel they must join The Resistance and almost can't engage in sane discussions with the GOP lest they be perceived as not sufficiently knee jerk. Roy finds some positives in the bill before the Congress:
The AHCA has its imperfections. The bill could do more to assist those just above the poverty line, so that they have a smooth transition from Medicaid into the individual health insurance market. But all in all, truly affordable health coverage is coverage that Americans want to buy of their own free will. The American Health Care Act promises to make historic progress toward that goal.