Ronald Reagan famously said that the most terrifying words in the English language are, “I’m from the government and I’m here to help”. The line garnered laughs and applause whenever he delivered it. We’ll never know who wrote the quip or whether he really believed it. But he had been an actor and he delivered the line with style and it was well received. People in the southeast, an area ravaged almost annually by hurricanes from the Atlantic or the Gulf of Mexico, failed to see the irony. The people living in the tornado alley states of Oklahoma, Kansas, Iowa, and others also cheered the line. And so it became apparent that federal help (money) is good help as long as it is for you and wasted if it is for someone else.
Some of us are looking for a bigger picture, a way to describe the value of federal help, money, and regulation that can potentially help large segments of the American public. The expansion of Medicaid, a federal-state partnership to provide health insurance to the poor and working poor, is one of those programs. The Medicaid expansion was a key component of the Patient Protection and Affordable Care Act (Obamacare).
I had the great pleasure of hearing freshman Congresswoman Lauren Underwood (D-IL) speak while I was in Washington a few months ago. Prior to her election she had been a nurse. She drafted H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2019. Her legislation was designed to expand Medicaid services a full year postpartum. The logic was clear. “The majority of pregnancy-related deaths happen after the day of delivery, and nearly one quarter of deaths happen more than six weeks postpartum.” It took a nurse to bring this to Congress’s attention. I was so impressed with her presentation that I went to her office and got more information from her legislative aide. Who benefits from this expansion of Medicaid? Obviously the families of the women who have just given birth. These are families in urban, suburban, and, importantly, in rural areas. This also helps to make sure that medical providers, doctors and hospitals, are compensated in these settings. Rural hospitals suffer from uncompensated care. This is a solution.
H.R. 1425 – The Patient Protection and Affordable Care Enhancement Act includes Congresswoman Underwood’s Medicaid expansion.
The House of Representatives passed H.R. 1425 earlier this week. The goal is to make the PPACA more effective. Like the bill it is tweaking, this enhancement is neither perfect nor likely to garner a lot of support from the Republicans in the Senate. The point is to put forth constructive, useful rules to make it easier for Americans to access and pay for health care.
My blog post from eight years ago today scoffed at the intellectual dishonesty of repeal and replace and asked instead for revise. H.R. 1425 is a good starting point for an honest debate about revising the PPACA. Sadly, you can only have a serious policy debate if you have participants from both political parties and the attention of the president.
H.R. 1425 has its detractors. Some are just the usual suspects who appear to believe that they were elected to Congress simply to disagree with whatever the other side does. We won’t waste time on them. Nor will we mention some of our Congressional delegation more intent to have their pictures taken than to ever do anything. There is a good chance that these Congressmen have not bothered to read the bill. They have legislative aides for that.
The American Action Forum “is a center-right policy institute providing actionable research and analysis to solve America’s most pressing challenges.” Christopher Holt, the Director of Health Care Policy, published an executive summary of H.R. 1425 on June 25, 2020. This is the link. It is only 7 pages and worth the read. Spoiler Alert – he is not a fan.
Mr. Holt’s analysis is instructive. You may like what he dislikes. Or, your thoughts find a home in his words. What is clear is his honesty about how his perspective impacts his view of the law.
Here are some of the key goals and provisions of the Enhancement:
- Reduce premiums by bringing healthy people into the insurance pool. This is done by limiting and/or eliminating short term policies
- Expand the Tax Credit Subsidy to make insurance more affordable
- Fix the “Family Glitch”, the problem when the employee has coverage from work, but the coverage for dependents is too expensive. This was determined to be a huge issue since 2014.
- Provide funding for reinsurance on the state level. The states that have done this have shown real savings on insurance premiums. We keep hoping Ohio would do this. The funding would help.
- Incentivize the states that haven’t expanded Medicaid to finally do this. This might be what it takes to get states like Kansas and Missouri across the finish line.
- Money for outreach and advertising for the annual open enrollment
- The Medicaid postpartum expansion
- The government would be allowed to negotiate with the pharmaceutical companies over pricing. This was H.R. 3 passed earlier in the term.
Those are some of the highlights. Mr. Holt has his thoughts. For a different perspective, you might also want to look at Katie Keith’s article in Health Affairs. She is a touch more positive. But whether you are in one camp or the other, an honest reading of H.R. 1425 is to see the beginning of a conversation, a path forward. It is construction not destruction. After 10 wasted years where little has been accomplished, wouldn’t it be great if the people we elected to help make our lives better focused on that job? Health insurance, the way most Americans access and pay for care, is an issue for all of us. I’d love to hear our Congressmen tell us that they are from the government and that they are here to help and mean it.
Picture – Clearing A Path – David L Cunix