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"Donald Trump famously claimed that he had “concepts of a plan” when it came to healthcare. For once he was actually telling the truth.
Just ask Republicans. The only agreement among them is that there is none. As Rep. Ralph Norman (R-SC) told NBC News yesterday, “The consensus is we need to come up with something.”
Truth bomb moment: Republicans do not, and have never had, a healthcare plan. And now they’re out of time. Senate Majority Leader John Thune promised a vote today on a healthcare plan, in exchange for Democratic votes to reopen the government, to head off the looming crisis from soaring ACA premiums. But the GOP plan is little more than a joke.
Despite efforts by a handful of Republicans to come up with something that would prevent economic catastrophe for tens of millions of Americans come January, the proposal Majority Leader Thune has blessed amounts to a meager cash handout that Republicans know will help no one.
And desperate families shouldn’t look for solutions over in the House either, where there is also nothing to show after years of promises.
The crap plan from Crapo-Cassidy
The Senate will reportedly vote today on two plans.
The Democratic proposal is simple. It would extend ACA premium subsidies cleanly with no conditions for 24 million Americans for another three years.
And the Republican proposal? For some time, it wasn’t clear whether the Republicans were going to even offer one of their own. A compromise plan authored by Sens. Susan Collins (R-ME) and Bernie Moreno (R-OH) would have extended ACA premium subsidies for two years with income limitations and minimum premiums. But it failed to gain traction among the GOP.
Instead, Majority Leader Thune is greenlighting a different Republican proposal from Sens. Mike Crapo (R-ID) and Bill Cassidy (R-LA). That plan would not extend the ACA premium subsidies. Instead it would replace them with modest direct payments to people earning less than a certain maximum amount and who purchase health insurance plans with high deductibles and low premiums. Payments would be deposited into health savings accounts, with $1,000 for those below 50 and $1,500 for those aged 50-64.
This proposal aligns loosely with Trump’s call for people to receive cash to spend as they like instead of handing it to insurance companies. The money could be used on medical services except abortion services or gender affirming care, because of course they exempted those.
But this “fix” is laughable.
As Sen. Bernie Sanders noted, insurance premiums on the ACA marketplace would spike, and families would be required to switch from gold or silver health insurance plans to bronze or catastrophic plans. Under such plans, they would face crushing deductibles of $7,500 and $10,000 for individuals and up to $21,200 for households.
Sanders’s office provided three examples of how this would play out for different insured individuals and families:
A 62-year-old couple in Miami, Florida, making $85,000 would be forced to pay $21,654 more in premiums than they do today and see their deductible go from $0 to $7,700.
A family of four living in Kansas making $45,000 could be forced to pay $4,500 more for surgery after a heart attack than under current law.
A 46-year-old living in New Orleans, Louisiana, making $32,000 could pay $2,560 more for breast cancer treatment and premiums than under current law.
These cost increases are not doable for any of these people.
Sanders noted that the Cassidy-Crapo plan “would make an already broken and outrageously expensive health care system even worse.” Premiums would go up two to four times for millions of Americans. The plan would not address rising costs of prescription drugs. And it would do nothing to make it easier for Americans to see a doctor.
Sanders concluded, “The Cassidy-Crapo bill would lead to more medical bankruptcies, more unaffordable care and more Americans going without the health care they desperately need. That would be absolutely unacceptable.”
Yet this is the only plan the Senate GOP intends to advance at this time.
Bullet points are not a plan
The healthcare plan situation in the House is no better. It’s hard to fathom, but as of yesterday, when Speaker Mike Johnson called his conference to a meeting, he offered them only healthcare plan bullet points. Per Politico,
Speaker Mike Johnson presented attendees of a closed-door conference meeting with [a] list of 10 possible policies that could get votes in the coming weeks or months, according to five Republicans in the room.
These points are so broad as to be meaningless. “Innovation” is just a concept, not a plan. And notably, as with the Crapo-Cassidy plan, the ideas did not include an extension of the existing ACA premium subsidies, the very crisis driving the urgency to act.
The continued lack of any actual GOP healthcare plan is causing considerable consternation among Republican House members who will have to face angry voters next fall. They expressed frustration at how poorly the whole topic has been handled.
“There was a general uneasiness because nothing is coming together,” said a House Republican to Politico.
“We wasted so much time,” one conservative Republican declared, lamenting that there was no unified GOP plan with just seven session days left in the year. Recall that Johnson sent his conference home for most of the last few months when they could have been working on a healthcare plan.
A bipartisan group of “moderate” House members, including Republicans in vulnerable swing districts, is hoping to force a vote on the House floor to extend the ACA premium subsidies via a discharge petition. But that effort seems stalled, and there isn’t time under the rules to succeed before the clock runs out on 2025.
So where does this leave us?
Without 60 votes for either proposal in the Senate, and with no viable House plan to address the looming healthcare affordability crisis, the ACA premium subsidies will expire and millions of Americans will face not only sticker shock but a Hobson’s choice: 1) going without health insurance or a plan with inadequate coverage, or 2) shelling out two to four times as much for an ACA plan with worse coverage and very high deductibles.
The hard truth is this: Republicans are fully prepared to let the ACA subsidies expire and send healthcare soaring for everyone. Why? A solid number of them absolutely hate Obamacare, and they believe that making it unaffordable will ultimately kill it.
Democratic Whip Katherine Clark said it best. “The GOP health care plan has been the same for 15 years. Repeal the ACA and return to when millions were denied coverage for pre-existing conditions.”
There is a terrible irony at work here. One group most vulnerable to a healthcare system that excludes or prices out those with pre-existing conditions is Trump’s own voter base in deep red states. Per a report by KFF, the share of adults with “declinable pre-existing conditions” exceeds one-third of all adults under age 65 in states like West Virginia (37%), Arkansas (34%), Kentucky (34%), and Mississippi (34%).
Without the protections of Obamacare, these Republican voters would be shifted into different “risk pools” with higher premiums, or they might not be insurable at all.
Extending the ACA premium subsidies is a costly proposition, and it admittedly doesn’t fix the underlying causes of rising healthcare costs. We still need to move toward universal healthcare coverage, perhaps under some kind of single payer plan that cuts out the insurance companies. But the idea that we will suddenly throw millions off their health insurance by ending the subsidies on January 1 is both morally reprehensible and economically foolish. And it is a move the Republicans, who control government, will own.
The only silver lining is that millions of Republican voters will soon experience what the rest of us have been warning about. Along with Democrats and independents, their wrath might finally be directed where it belongs: at the party that took away their insurance, their Medicaid and their food security, all to fund tax breaks for their super wealthy donors."