- Our first look this week centers on health care.
After months of speculation and controversy
U.S. Senate Republicans unveiled their health care bill
on Thursday.
The goal, to bring down insurance costs by repealing
and replacing major portions of the Affordable Care Act.
The proposed Senate Republican health plan
would repeal Obamacare taxes,
roll back and eventually eliminate expanded Medicaid.
Base tax credits to help pay for insurance on income and age.
It eliminates the individual
and employer mandate to have insurance.
And cuts funding for Planned Parenthood for one year.
Four Republican Senators say they are not ready to vote
for the healthcare bill
including Senator Ron Johnson of Wisconsin.
In a joint statement, the four senators said the measure
fails to quote, repeal Obamacare and lower healthcare costs.
And Wisconsin's Democratic Senator, Tammy Baldwin,
also opposes the plan saying, quote,
it will make families pay more for less care
and increase the number of people who are uninsured.
GOP leaders hope to vote on the bill next week
and can afford only two no votes.
Just this week, Health Tradition Health Plan,
which serves 14 Wisconsin counties and Anthem Blue
Cross-Blue Shield announced the volatile marketplace is forcing
them to pull out of the federal healthcare exchange.
The Anthem move impacts 14,000 Wisconsin families.
Donna Friedsam is an expert on the implementation of federal
healthcare reform along with financing coverage and access.
Thanks for being here. - Pleased to be here.
- We wanted to ask you right out of the shoots as you might
expect who are the winners and losers
in this Senate Republican bill?
- There has been a lot written about the reduction in the tax
credits for lower income people and the tax cuts
for the funding of the bill.
So there will be some degree of redistribution of funding.
And people with higher incomes will have some benefit.
And lower income people will have some reduction in support
through this bill.
I think several analysts have said that.
Generally, I don't like to think of it about individual winners
and losers but rather look at it in a way of how is it going to
benefit our state and the goals that all of us share?
The goals that I think most people share are how is it going
to affect the price of health insurance broadly,
the way we get health insurance.
How it's going to affect our health and our economy.
And by those measures we can judge this bill and
consider whether we think it's going to be beneficial for us.
- What do you think?
- So at this point what it looks like is that the price --
the premiums for health insurance will likely rise
for many people.
But for some small group of the population they might see
lower premiums and that includes younger, healthier people.
While they might see lower premiums,
they will probably see higher deductibles.
And that is because the value of the insurance,
the amount of benefits the insurance covers will be lower.
But the premiums will likely go down
for younger, healthier people.
And hopefully that would bring
more younger, healthier people into the market.
The theory being that if younger, healthier people
come into the market that could bring down
underlying premiums for everybody.
- That's been the theory.
That was the theory in the Affordable Care Act,
hence some of those mandates to have insurance.
But those are gone now.
You think that simply lower cost for premiums
will inject the market with those healthy people?
- Well, a lot of people are -- have been writing in the last --
we've had 24 hours or 36 hours now to think about this bill
and one of the concerns is that
it eliminates the mandate for coverage.
But it does not replace it with
any other kind of particular incentive to make sure
that people who are not sick or older get that coverage.
The only thing there is an expectation that they will be
enticed by lower premiums.
If there is not any particular definite incentive,
there is a very strong concern that young, healthy
people will look at it and say why should I buy insurance?
- Why do premiums go up for other than young and healthy?
- Why do they go up?
Because their coverage--they need more services and they need
to access more services so they need more benefits covered
and that costs the insurance company more.
- Let's talk about Medicaid.
That's another really big item.
The expansion is more slowly phased out than in the House
bill under this Senate bill.
But then my understanding is those Medicaid funding is cut
deeper in the Senate bill.
Senator Ron Johnson, though, says that this is not, in fact,
a cut to Medicaid.
It is just putting the brakes on growth.
What are the implications for Medicaid in Wisconsin?
- I would say from my perspective that this bill that
we have from the Senate is more of a repeal and replace
of Medicaid than it is of Obamacare, frankly.
It radically changes the way Medicaid has been operating
for its 50 years as a safety net in this country.
It does significantly reduce the available federal funding
by 25% or possibly more in the out years.
And it brings the responsibility to states to handle whatever
reductions in federal funding that we'll be facing
in Wisconsin and in all the states in the out years.
And the amount of federal participation will decline more
in the out years than the immediate years but it will
continue to be increasing pressure on states to reduce or
to handle reductions in federal support.
- I know the CBO has not scored this yet but do experts like
yourself have a handle as to how many people might lose health
coverage under this kind of Senate Republican bill?
- We have to wait until the CBO weighs in.
That should be early next week.
We have the CBO score from the House bill.
We had additional estimates that came out more recently
from the CMS Actuary.
The CMS Actuary estimates were actually a little bit lower
in terms of loss of coverage.
They estimated about 10 million people losing coverage --
additional people losing coverage as opposed to
23 million people.
But nonetheless I think
we are going to see potentially similar losses in coverage.
If not that, what I think many people will expect would be
an increase in what we would consider to be lower insurance.
So people having much lighter coverage.
- We have just about a minute left and with that I want to ask
you about pre-existing conditions.
How are those treated under this Senate bill?
- The Senate bill, unlike the House bill,
the House bill said states could waive pre-existing protections.
The Senate bill says states cannot waive pre-existing
conditions.
However it allows states to waive the provision for
essential health benefits.
So basically it says that insurance companies will have to
continue to cover people with these high-cost conditions but
insurance companies might not have to provide the benefits
that the people need in their insurance.
- Really quickly.
Knowing what you know, how do you think Wisconsin might act
with any ability like that to get a waiver?
- I think that it's going to be difficult on the state level
to have our state legislature decide to waive the kind of
benefits that people have become accustomed to relying upon
for their healthcare.
- All right, Donna Friedsam, thank you very much.
- Thank you.