There doesn’t seem to be much health or care in the U.S. Senate’s health care legislation. What’s worse, there’s not much viable legislation, either. So far, the measures that have been voted down in succession on the Senate floor are uniformly flawed vehicles aimed at repealing or replacing the Affordable Care Act, or both.
Even Hawaii residents, who have enjoyed relative security in the Prepaid Health Care Act for more than 40 years, are watching with concern. The PHCA does ensure employer-mandated health coverage, but more than one-fourth of the state’s population is on Medicaid — a target for major cutbacks that could dramatically increase costs for the state or severely reduce coverage.
One thing is for sure: The current Senate proceedings are no way to make improvements in health care, which encompasses 17 percent of the U.S. economy.
Hawaii’s Democratic U.S. Sen. Mazie Hirono and Arizona’s Republican U.S. Sen. John McCain, both battling cancer, have rightly called for a return to “regular order,” with the full process of congressional committee hearings and debate, and experts on hand to provide insight and help draft the language.
Both Hirono and McCain have expressed disappointment with Senate leadership’s decision to embark on a rollercoaster ride — a series of bills crafted in back rooms, each in turn designed to garner a bare minimum of 50 votes to pass under the special rules of budget reconciliation, and each in turn failing.
Some bills have promised to curb Medicaid for lower-income earners, as well as cut back on the expansion of Medicaid enabled under the ACA.
The GOP hopes to horsetrade its way to passing a bill, which would then move to a House-Senate conference committee. There negotiators can, in theory, develop a unified bill for each chamber to approve and send to the president’s desk.
Currently, the last hope of that happening lies in a “skinny repeal” measure that would keep most of the ACA provisions, deleting only the insurance mandates and at least one of the taxes financing the system.
But even if this bill leaves Medicaid provisions largely intact, and even if Hawaii feels insulated by its own health law, the repercussions could be severe.
Eliminating mandates for individuals and employers would mean that younger, healthier consumers would stay out of the insurance pool. Insurance companies would have to manage the expensive, popular provisions such as no denial of coverage for pre-existing conditions, with the beneficiaries being an older and sicker population.
Premiums would go up to cover the difference, more people would drop out of paying into the system, creating higher costs for the remaining subscribers.
Policy wonks describe this dynamic as the “death spiral,” leading to insurers losing subscribers and dropping out of markets. And this would accelerate the problem generated under the ACA, which enforced the mandate too weakly, leading to a similar drop-out rate.
Far better would be the outcome described by McCain, brought in from his post-surgical sick bed to be the 50th vote needed to start debate this week. The veteran, now suffering from brain cancer, advocates that the Senate end its process, wholly lacking in transparency, and bring in both Democrats and Republicans.
“Why don’t we try the old way of legislating in the Senate, the way our rules and customs encourage us to act?” McCain asked Tuesday in a dramatic speech. “If this process ends in failure, which seem likely, then let’s return to regular order.”
This approach is far more likely to find a middle ground, reforms to the ACA that can ease some of the regulatory burdens and stabilize the insurance markets.
Following that course would serve the public much better than playing political games.
