Bipartisan Bailout?

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This week’s health policy news roundup curated by Dr. Jane Orient.

Senators applauded Sen. John McCain’s call for bipartisanship as he cast the deciding vote against the skinniest of repeals—not a trace of bipartisan support having emerged to repeal even the least affordable parts of the Affordable Care Act (ACA).

But Republicans are already rushing to support what Ted Cruz (R-TX) called a “bailout for insurance companies.” Of course, Democrats will support that, he said: “The Democrats are the party of the big insurance companies.”

Sen. Lamar Alexander (R-TN), chairman of the Senate Health, Education, Labor and Pensions Committee, announced that his panel would begin work in early September on legislation to “stabilize and strengthen the individual health insurance market” for 2018. In the meantime, he publicly urged President Trump to continue making payments to health insurance companies to reimburse them for reducing the out-of-pocket medical expenses of low-income people.”

Without these “cost-sharing subsidies” (paid for by taxpayers), premiums (paid by insurance subscribers) would go up by about 20%. If Congress would appropriate the money, the D.C. Circuit Court of Appeals would not need to act on the House of Representatives’ lawsuit concerning the illegal spending of money that had not been appropriated. https://www.nytimes.com/2017/08/01/us/politics/senators-launch-bipartisan-effort-to-shore-up-obamacare.html

Suggestions to spur some bipartisanship—but perhaps in the direction of repeal—are executive orders to end the ObamaCare exemption for Congressmen and staffers, and one demanding disclosure of all financial interests and ownership in healthcare related companies or stock by every member of Congress, including all family members and offshore accounts. https://townhall.com/columnists/wayneallynroot/2017/07/30/the-executive-orders-that-end-obamacare–once-and-for-all-n2361967

A huge barrier to bipartisan action involving the skinniest repeal is the supposedly nonpartisan Congressional Budget Office (CBO). A key argument against repeal is the predicted increase in the number of the uninsured. But CBO has refused to disclose the specific, year-by-year impact of that thing that it says is the primary reason that people will go uninsured in 2018 and beyond—the individual mandate, writes Avik Roy. The reason the individual mandate is in the law in the first place, he states, is that CBO told Obama that without it his health plan would cover 16 million fewer people. Recall that Obama had mocked the idea in 2008: “If a mandate was the solution, you could try that to solve homelessness by mandating that everybody buy a house.” https://www.forbes.com/sites/theapothecary/2017/07/22/cbo-three-fourths-of-coverage-difference-between-obamacare-gop-bills-driven-by-individual-mandate/#315052273627

In the spirit of bipartisanship, Daniel Horowitz writes: “We can agree to keep the entire Medicaid expansion and cover the same number of people if we actually reformed the program to grant direct access to care rather than destroy the market with an inefficacious crony insurance program. The key is to recognize that “the best way to give a handout is to give a direct handout.” https://www.conservativereview.com/articles/a-medicaid-reform-that-would-help-everyone-except-lobbyists

Avik Roy suggests a short-term bailout conditioned on long-term reforms. https://www.forbes.com/sites/theapothecary/2017/08/04/a-short-term-bailout-of-obamacare-only-if-accompanied-by-real-long-term-reforms/#d3acbba39f08

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