“The Most Vulnerable” versus “The Able Bodied”

House Speaker Ryan offered up on Friday a Healthcare Policy Brief. For my money it boils down to several key points:

• Medicaid is for those who are the “most vulnerable patients“ versus the “able-bodied adults”, who will have to find coverage elsewhere. Further Medicaid will be largely controlled by the states. The state governments will be able to control how they spend these dollars. Lastly, states will get limited funds from the federal government for Medicaid, and the big question here is how much? I think we know one thing it will be less, perhaps far less than we see today.
• So Medicaid shrinks and the private market grows. To help contain the cost of insurance he offers several items.
  • Health Savings Accounts – This is wonderful if you have money for Health Savings accounts. Also if you have an actual health issue you could burn through such an account pretty damn quick, at least with today's healthcare regimes and costs.
  • A market solution to the the lack of healthcare insurance products - the breaking down of “barriers that restrict choice and prevent Americans from picking the plan that is best for them and their family”. This is basically allowing insurance to be available across state lines. State lines are the barriers he refers to. It ultimately takes away the States rights to regulate the insurance products available in the states. My reading of this idea is that it is an assault on Federalism.
  • A tax credit, which all adults will seem to be given, regardless of whether you pay into the federal coffers or not. The question here is how much of a tax credit? What will this actually amount to?

These are the solutions he is offering. These are the solutions that he has been offering for the past five or six years now. He is promising that the “most vulnerable patients“ will continue to have some type of Medicaid product. Those who are “able-bodied adults” will go to the market place and get coverage. Further, the federal government will give all “able-bodied adults” a check to take to that marketplace. Lastly, the federal government will strip the states of their right to regulate insurance within their borders, with the intent of stimulating market choice. 

My criticism of these is that I expect little in regard to tax credits and poor quality insurance plans for those at the lower end of the income scale and market. Regarding Health Savings Accounts, I see little use for them as you will burn through them very quickly if you have an actual health care problem. And you can only burn through those funds, if you have those funds to set aside in the first place. In short, the upper-middle class get little or nothing. Those at the bottom get some kind of care, which is largely contingent upon where you live. Those who are “able-bodied adults” who are simply poor, you might have some type of coverage, maybe, but it will not cover much.

If after five years of talking, thinking and discussing these matters this is the best that the Republican leadership can offer, we are in trouble.

OBAMACARE REPEAL AND REPLACE - Policy Brief