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Health care limbo

schmidt

Congress makes policy changes nowadays in mammoth budget bills. I guess they chat about who gets what over bourbon or martinis, then lump it all together in a thousand pages and trillions of dollars.

Health care policy took a left turn last week when congress and the president agreed to fund the government at the last minute and approved $1.4 trillion in spending that will take us to September 2020.

The health care twists were costly. First, a couple weeks ago I had hopes that “surprise medical bills” would get addressed, but it seems the lobbyists won and no such action was taken. This was despite bipartisan voiced support. Some congressmen muttered something about “next year” as they twirled their ice cubes.

But the real damage came as Fiscal Responsibility was vomiting in the bathroom. He couldn’t handle the booze.

One of the only redeeming aspects to the Affordable Care Act (despite what many Republicans said) was that it did have a balanced budget. The costs for private insurance subsidies got paid for with taxes on insurance companies, taxes on medical devices, taxes on “Cadillac Health Plans”. But, to appease the poor insurance companies, all of these taxes were delayed. And then Democrats lost the House, then the Senate, and then the presidency. With each step, the delays were postponed even further, but with this budget bill, they were repealed.

So now, the Republican whine of 2010-2012 about the ACA “We Can’t Afford it!” has come true. But this budget fiasco was a bipartisan abandonment of good sense. The Republicans get to keep chipping away at Obamacare, since they couldn’t muster a full repeal or manage a weak replacement. Democrats made their union bosses happy with the “Cadillac Tax” repeal, made their big business donors happy with the medical device tax repeal, and have finally given up on holding big insurance companies’ feet to the fire. I guess there was something in this deal for everybody to love.

These sell outs present us with a ten-year cost of over $370B, about a fourth of the cost of the Trump tax cuts. When Mr. Fiscal Responsibility came out of the bathroom, pale, sweaty, wiping his mouth with a handkerchief, he found the Senators and Congressmen had left him the tab. He turned a whiter shade of pale. He was heard to mutter, “Full employment, no war, no downturn, why the deficits?” The young waitress asked about her tip.

Meanwhile, down in Louisiana, two out of three judges made Trump’s takeover of the Federal Courts official when they decided the individual mandate was indeed unconstitutional. It was very anticlimactic, since the penalty was reduced to zero in the Trump Tax Cuts. The judges punted on overturning the whole law; instead they sent that question back down to the lower court. It seems likely this will get appealed all the way to the Supreme Court.

Of course, the irony here is thick. Republicans haven’t been able to craft any sort of replacement for the ACA. The law is relatively popular, since it got rid of exclusions for preexisting conditions, mandated young adults could stay on parents’ coverage, and established an individual marketplace. But it has in fact failed to provide affordable coverage for many, and it has not accomplished universal coverage. There are 20M more people with insurance now than before Obamacare, but still more than that (27M) uninsured even now. Further, it has only had a weak effect in controlling health care costs overall.

The irony will come when the Supreme Court takes this up, probably not until 2021. Who will the president be then? Who will control congress? When Gorsuch and Kavanaugh (and maybe Ginsberg’s replacement?) tip the scales, and the whole law is struck down, will there be any stomach for addressing this?

Happy New Year. I’ve heard Mr. Fiscal Responsibility is buying the next round. Drink up.
 

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