A historic retreat on health care

Detroit Free Press (MI)

March 23--Unlike their counterparts in most Western democracies, Americans and their elected representatives in Washington have never fully embraced the proposition that affordable health care is a basic human right.

Even so, no U.S Congress controlled by either party has ever adopted legislation designed to reduce the number of citizens who enjoy medical coverage.

That could change Thursday, when the U.S. House takes up a GOP health care plan that Michigan's Republican governor has warned could erode coverage for 2.4 million Michiganders enrolled in traditional Medicaid and the state's Healthy Michigan Plan.

?Related: With vote looming, here's county breakdown on Obamacare recipients

Despite its name, the American Health Care Act President Donald Trump and House Speaker Paul Ryan have been flogging for the last three weeks has little to do with health care. Its primary purpose is to abolish both Obamacare's requirement that most Americans carry health insurance and the federal subsidies that enable them to do so, and to redistribute hundreds of millions of dollars in consequent tax savings.

Candidate Trump's pledge that Trumpcare would achieve those objectives while providing better, less expensive care to the same number of Americans covered under Obamacare was preposterous from the get-go. But it has been disconcerting to discover just how much the White House is willing to sacrifice in the name of shrinking government and cutting taxes for the donor class.

The Congressional Budget Office -- whose nonpartisan assessments are still the gold-standard for forecasting the economic impact of legislation proposed by either party, notwithstanding the Trump administration's cynical campaign to discredit its credibility -- projects that the Trump-Ryan plan would leave 24 million fewer Americans with health insurance coverage by 2026. Republican assurances that some of those millions are healthy individuals who would relinquish coverage voluntarily once relieved of the mandate to carry it have done little to assuage health care providers' concerns. The anticipated reduction is equally worrisome to insurers, who require a broad base of healthy ratepayers to sustain a stable health insurance market.

The ACHC is cynically designed to assure that wealthy taxpayers taxpayers reap their windfall long before any collateral damage to older and low-income health care consumers becomes apparent -- ideally on some other administration's watch. But a study comparing winners and losers in a lottery awarding Medicaid coverage to a limited number of previously uninsured Oregonians suggests what's in store for those who will lose coverage if the Republican plan is adopted.

Oregon's Medicaid lottery losers were less likely to seek preventative care and more likely to suffer depression and/or serious financial setbacks than their insured counterparts. If Oregon's experience is instructive, the consequences of dramatic reductions in coverage will reverberate throughout the national economy, as well as the homes of the newly uninsured.

The uninsured will still get sick, of course, and require hospitalization for serious illnesses and injuries. But under the Republican plan, more of the cost would be absorbed by urban and rural hospitals. The most strongest of these would distribute those costs among a smaller pool of insured patients, while others would simply go out of business.

In a series of letters urging members of Michigan's congressional delegation to reject the House plan, Gov. Rick Snyder warned its adoption would leave hundreds of thousands of Michiganders -- including many who reside in districts Republicans carried last November -- without access to affordable health coverage. But the early signals are that eight of Michigan's nine GOP lawmakers are more interested in repealing the individual mandate and cutting taxes than in assuring that the whatever health care system survives delivers high-quality, low-cost care to the largest possible number of Americans.

That's a short-sighted approach, even for lawmakers whose primary interest is preserving their own political health. Trump, with characteristic subtlety, has promised to "come after" Republican lawmakers who place their constituents' welfare ahead of his administration's government-shrinking agenda. But he is drawing on dwindling reserves of credibility, and it is hard to imagine any of Michigan's current GOP incumbents being elbowed aside by primary opponents whose only advantage is the backing of an unpopular president.

The more prudent course -- the one counseled by Michigan's data-driven governor -- would be to acknowledge the substantive inadequacy of the Trump-Ryan plan and demand a do-over that more responsibly addresses the health care needs of Michigan families.

The Hippocratic Oath warns medical providers against doing harm to their patients. The AHCA violates this foundational injunction, and the Michigan lawmakers who support its adoption will bear both the moral responsibility for that violation and the political consequences sure to follow.

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