Senate Health Care Bill Goes From Bad to Worse

The Senate’s latest version of its atrocious health care bill, introduced last Thursday, retains nearly all of the damaging provisions from the previous draft while adding some new ones to make it even worse. The Better Care Reconciliation Act keeps the draconian cuts to Medicaid and the drastically reduced subsidies for people to purchase individual plans on the state exchanges. It expands the use of tax-advantaged health savings accounts to pay for insurance premiums, which mainly benefits those with higher incomes. The most notable—and potentially damaging—addition to the new bill is Ted Cruz’s “Consumer Freedom” amendment, which would allow insurance companies to sell bare-bones policies on a state exchange as long as they also offered at least one Affordable Care Act-compliant plan. These minimal policies would likely feature skimpy coverage, low premiums, and high deductibles; those who actually needed health care would be forced to buy comprehensive plans, the costs of which would then skyrocket. It would amount to a return to the pre-ACA days when insurance companies could deny coverage to those with pre-existing conditions or make it prohibitively expensive. The result would be a two-tiered risk pool in which the younger and healthier could purchase cheaper policies that effectively cover nothing, while those with greater health care needs—chronic conditions, mental health requirements, age-related demands—would face unaffordable premiums, causing enrollment to drop and premiums to spike even higher.

For Republicans and others on the political spectrum who espouse a free market approach to health care as the ultimate way to cut costs and expand choice, this is essentially what it would look like. It’s worth noting that in addition to the American Medical Association, American Hospital Association, AARP, American Cancer Society and dozens of consumer advocacy organizations, the trade group for the nation’s insurance industry has come out against the bill.

Insurance is supposed to protect against unforeseen costs: an auto accident, tornado damage to one’s home, the theft of one’s belongings on vacation. If we could anticipate all of our expenditures, we wouldn’t need insurance. The objective of health insurance has expanded from its original purpose of income stabilization to include the administration of health care with the aim of maintaining or increasing wellness. As studies have shown, personal bankruptcies and medical debt are down since the passage of the ACA, and Americans appear to be healthier.

The Senate bill does not address either of these goals, and in fact would detract from both. Because the Republican Party lacks a coherent vision of what a workable health insurance system should look like, or even if it’s the government’s role to provide health care for any of its citizens in the first place, they have given us a mess of a bill that would decrease coverage by millions while doing nothing to keep health care costs down. It’s a world in which anyone who is poor, sick, or old will have the freedom to replace their health care with no health care at all.