This is an archived article that was published on sltrib.com in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
The Senate Republicans' health-care plan, like the House Republicans' health-care plan, is objectively terrible.
It would result in 22 million Americans losing insurance. It would dramatically raise premiums for the poor and old. Its Medicaid cuts would harm people with disabilities, nursing home residents and even babies.
But we knew all that was coming.
The surprising thing about this bill is not that it forsakes the indigent, elderly and vulnerable. It's that it forsakes so many of the Republicans' own vaunted values.
As cases in point, here are three Republican health-care principles violated by the Republicans' own health-care plan.
Principle No. 1: Return power to the states.
For years Republicans complained that Obamacare crimps states' style. Federalism must reign supreme, they argued, and so they promised to enhance state sovereignty.
And it's true that the Senate bill makes it easier for states to opt out of some Obamacare rules designed to protect consumers (e.g., capping out-of-pocket spending).
But in some critical ways, it also severely undermines state sovereignty.
The most important of these has to do with insurance plans that can be purchased by small businesses. Under current law, an association of small businesses (e.g., a bunch of dental practices) can market insurance to its members. The coverage must be regulated by the state insurance department under the rules of the state in which it's sold.
Not so under the Senate bill, which allows this same association to choose any state it wishes to be its insurance regulator. It can choose, for example, to be regulated by states that no longer require coverage of prescription drugs.
This would create a race to the bottom. It would also mean states would no longer have a say over what plans were sold within their borders. State officials might not even be able to block the sale of an insurance plan in their state if the insurer were insolvent, explains Timothy Jost, professor emeritus at Washington and Lee University School of Law.
This is hardly the only way in which the Senate bill would take power away from states. For instance, it would also place new restrictions on how states can finance their own Medicaid programs.
Principle No. 2: Emphasize access to health care, not health insurance coverage.
Republicans have long bellyached that rising insured rates are misleading. Their argument: Having insurance coverage is meaningless if your deductible is so enormous that you can't afford to see the doctor!
It's a fair point. But the Senate bill does nothing to improve access to care. In fact, it places care further out of reach.
It does this not only by causing people to lose insurance coverage and raising after-tax premium prices, but also by making "insurance coverage" an even less useful gauge of whether a person can afford to see a doctor.
That's because the bill pegs subsidies available on the individual market to plans that cover a much smaller fraction of expected health costs (58 percent, rather than 70 percent under Obamacare). In more practical terms: Out-of-pocket costs for people with insurance are going to go way, way up.
For example, for those near the poverty line buying plans on the individual exchanges, deductibles would rise more than 2,000 percent, from $255 to over $6,000, according to a Kaiser Family Foundation analysis.
Some health experts have wondered aloud whether this means doctors, fearing bad debt from people in these ultra-high-deductible plans, would refuse to even see such patients. Such a problem would be made worse by the fact that Republicans plan to blacklist the country's largest provider of reproductive health services.
Which brings me to the last major principle they've violated:
Principle No. 3: Give consumers more choices.
Forget making sure plans offer an adequate number of "choices" of doctors. This bill would lock millions of people out of the "choice" of Medicaid.
It would make individual market premiums, even after including subsidies, prohibitively expensive, effectively locking millions out of the "choice" of individual insurance, too.
In fact, for some unlucky people, subsidized individual plans would disappear entirely. That's because the Senate bill says that people offered any employer coverage would become ineligible for subsidized insurance on the exchanges — even if they can't actually afford the plan their employer offers.
I suppose lots of sick people will newly have the "choice" of buying an expensive plan that covers none of the services they need. So there's that.
When all's said and done, there's just one major Republican health-care principle this bill remains loyal to: tax cuts for the rich.
That's not actually a health-care principle, you say? Could have fooled me.
Twitter, @crampell