Michael Battalio

Saturday, December 02, 2017

Thoughts on the BRCA

I am as surprised as anyone that the Senate has a new healthcare bill, but they do. TL;DR: it’s called the Better Care Reconciliation Act (BCRA), and it’s just as terrible as the AHCA that I rejected in this post (https://www.facebook.com/battalio/posts/10102924918941056). Not only that, no health care provider, hospital, doctor’s or nurse’s association, or advocacy group affiliated with health care has come out in favor of this bill. This is a bad bill, and it will hurt people.
Instead of point by point saying why it is so bad, which would be redundant given how close it is to the AHCA, let me refute five popular lies that have been promulgated by various politicians and media outlets. 
One: Some Republicans say it will lower premiums. No. As I explained in my post lambasting the AHCA, you don’t get something from nothing. This bill eliminates the individual mandate, so fewer healthy people will get insurance. With fewer healthy people covered, it becomes more expensive for the insurance companies to cover sick people. Insurers aren’t going to just absorb those costs. They will pass them down to the people that keep coverage. The bill even explicitly allows insurers to charge the elderly 5 times as much as younger customers (up from 3 times in ACA). If you are older, this bill will cost you money. Period. (The AARP is against this bill.) This bill dramatically cuts Medicaid (by many hundreds of billions of dollars), which funds half of all births and almost two thirds of all nursing home occupants. If you are poor, this bill will cost you money. Period. The bill also limits those eligible for tax credits from 400% of the poverty line to 350%. Also if you do get sick, the BCRA only requires plans to cover 58% of your medical expenses; the ACA requires 70%. If you are middle class, this bill will cost you money. Period. No matter what your income or age, the BCRA guarantees that you will pay more. 
Relatedly, at first I wrongly thought the BCRA kept preexisting coverage intact. This is actually not true. States are given leeway to decide what costs are covered as essential health benefits. So preexisting coverage is simply gutted in a different form. I.e., an insurer may be required to give you insurance regardless of your preexisting conditions, but nowhere is it mandated that they must actually cover benefits for your condition. So you may have to pay for your condition out-of-pocket until you reach the yearly maximum out-of-pocket every single year. Incidentally, the BCRA also raises the maximum out-of-pocket and reinstates life-time maximum payouts (I.e., once a plan pays out a certain amount, they no longer have to pay for any of your costs, regardless of it you are otherwise still covered.) If preexisting coverage guarantees are eliminated, people will go bankrupt trying to stay healthy. 
Two: The bill cuts money to Planned Parenthood for a year. I know that to a lot of people will think this is a plus, but I don’t know why. It is illegal and has been illegal for years for federal funds to pay for an abortion. The BCRA does not change this. This isn’t a victory for people who view their pro-life stances as their most important political view (not that there is anything wrong with that). The wording in the bill is only there to manipulate you into liking the bill when you otherwise shouldn’t. 
Three: Healthcare is a privilege, not a right. This is one I will never understand. I’ve heard people of all creeds, backgrounds, education and income levels espouse this vile point of view, but the one thing all of them have had in common – every single one – is that they were healthy. *It’s easy to believe something is a privilege when you’re already privileged enough to have it.* I can guarantee you that people who are chronically sick would give their life’s income to have what we privileged healthy have been anointed with. It isn’t about people being greedy or wanting something just given to them. It is about people living. It’s about making the world as fair as we can.
Four: Personal responsibility. I’m as for letting people forgo insurance but then languish in debt if they get sick to teach stupid people a lesson as the next GOP’er, but the consequences of eliminating the individual mandate aren’t just about letting healthy people make stupid choices in the name of liberty. No amount of personal responsibility will protect you from a genetic disease. The small amount of individual liberty provided to people by giving them the option of not having to purchase health insurance is not worth the deprivation of liberty to people who need affordable insurance (through no fault of their own) to not suffer. Forcing people to buy insurance isn’t about protecting people from themselves because the government knows what’s best for them; it’s about the government protecting the public from those who would otherwise unduly stress the healthcare system through their foolish and cavalier attitude.
Finally, the argument (and yes, in so many words I’ve heard this) that because we had one political party lie to us about healthcare (e.g., “You can keep your doctor.”) means we should blindly let the other political party unilaterally alter healthcare is a stupid reason to be in favor of anything. Spite is a moronic way to make policy, but it seems that lately people think that if others they don’t like (or agree with) suffer more than them, then it’s a victory. Victory isn’t relative. You don’t win by making others lose more than you. The health insurance system is no where near bad enough in its current state such that any change is a good change. Fourteen million more people have insurance because of ACA. Millions of people are getting subsidized insurance through ACA. Millions more poor people finally have access to healthcare because of ACA. A lot of people have been helped. The BCRA will help no one who reads this status. It significantly hurts a lot of people you do know to minimally help a very small number of people (the very rich) you don’t know. I can envision no logical argument for any person I am friends with on Facebook being in favor of this bill. If you think you have a reason, I’d love to argue it in the comments before you unfriend me.
I want to take a moment to talk about the process of how this bill was made. It borders on undemocratic. That is not hyperbole. Senate Majority Leader Mitch McConnell (R-KY) appointed 13 senators to negotiate this bill. Except for a few lobbyists and staffers, those were the only people with input and the only people who knew what the bill was until last Thursday. The Majority Leader wants to have a vote on this bill this week. This is far too short a window to have a thorough discussion on the bill. The same senators who wrote this bill lambasted the process seven years ago when the ACA was passed; however, that process was far more transparent and deliberate than this one. ACA had 169 hours of open debate, 110 bipartisan meetings, and 35 weeks of time available for public review. 160 GOP changes to the ACA were accepted. The BCRA will have 20 hours of open debate, 0 bipartisan meetings, and only 1 week of review time. The bill isn’t bipartisan because the GOP doesn’t want it to be. This is the wrong way to pass legislation that changes 1/6 of our country’s economy.
Now the call to action: I don’t care where you live or who your senators are. I don’t care if they are Dems or GOP. I don’t care if they will never listen to you. Call them today, call them tomorrow, and call them every day after that. Tell them you are vehemently against this bill. We need to make every politician concerned about the public outcry against this bill.
Thank you for reading to the end.

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