With all eyes on the congressional showdown over the American Health Care Act, the possible impacts closer to home were lost.
The rushed bill, the arm-twisting and the ultimatum glossed over what was about to occur, because the architects didn’t reach out to those who would be living under this new roof. Rather than thoughtfully address the concerns of doctors, patients, hospitals, insurers, consumers and state and local leaders, the strategy was: Your house will collapse any day now!
As the Congressional Budget Office pointed out, the ACA is not in danger of imminent collapse. The sheer uncertainty was a huge problem for insurers, and that has been alleviated for now. But the Trump administration could still undermine its foundation, as Larry Levitt, senior adviser for the Kaiser Family Foundation, has pointed out.
For example, the ACA has a cost-sharing subsidy for insurers to keep them in difficult markets. Under President Obama, the House of Representatives challenged the administration’s authority to make these payments. If the current administration cuts them off, some markets will suffer, and insurers will pick up the message that Trump isn’t interested in making the system work.
The other important piece of the ACA is expanded Medicaid, which was a great deal for states because the feds pick up 90 percent of the costs. Washington state accepted it, and Idaho didn’t.
Under expanded Medicaid, many low-income men were suddenly covered. This, in turn, meant they could get the mental health and addiction care they’ve always needed. This includes men released from jails or diverted into treatment by the criminal justice system, a growing trend. Medicaid is the largest payer for such services, picking up 25 percent of the total U.S. tab for mental health care and 20 percent for substance abuse treatment, according to USA Today. Expanded coverage is an important part of the solution to “frequent fliers” filling up jails, rather then getting the help they need.
Rolling back Medicaid coverage shifts the burden to state and local governments. It’s ultimately more costly and less humane.
Under the AHCA, more than 700,000 Washingtonians would’ve lost coverage by 2023, unless the state could find an extra $1.3 billion. The bill would’ve climbed to $2 billion by 2028. The current Legislature is already struggling with a crisis created from an inadequate mental health care system, not to mention financing basic education. When the state doesn’t find the money, the problems shift to local governments. As a result, jails become de facto mental health care facilities. More than 70 percent of Spokane County’s budget goes to the criminal justice system.
All of these impacts are well-known, but in the rush to repeal and replace the ACA, they were ignored. Hence, the scant support for the AHCA from the key players.
The ACA has always been a fixer-upper, and it needs more work. But only in the world of D.C. politics did it make sense to tear it down without a better place to move.
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