Friday, April 21, 2017

Tom MacArthur doesn't want you to know he's ready to uninsure millions

Defending his support of the ACA repeal bill, the American Health Care Act (AHCA), Rep. Tom MacArthur scolds a constituent who accused him of hypocrisy for "partisan finger-pointing." Yet MacArthur's rebuttal is riddled with obfuscations and errors.

1) MacArthur claims that a court found the ACA's Cost Sharing Reduction subsidies, which reduce out-of-pocket costs for low income enrollees, unconstitutional. Not true. A lower court agreed that if Congress does not allocate funds for those subsidies, as the ACA drafters intended and for which they budgeted, the executive branch lacks authority to pay insurers for them. If Congress allocates the funds, they are unambiguously legal. There is nothing inherently unconstitutional about them, and the Republican Congress's refusal to appropriate the budgeted funds is pure sabotage.

2) MacArthur implies that he's protecting the 11 million Americans and 500,000 New Jerseyans who gained coverage through the ACA's Medicaid expansion. Yet he supports repeal of enhanced federal funding for new expansion enrollees as of 2020. That effectively ends the expansion, as people typically churn in and out of Medicaid at short intervals. The Congressional Budget Office (CBO) forecast that if that cut occurs, the higher federal payments will apply to just 5% of enrollees by 2024.

3) As MacArthur asserts, CBO forecast that a majority of the projected 24 million reduction in insured people under the AHCA would result from repeal of the "individual mandate" to obtain insurance. But CBO also forecast that the AHCA would reduce Medicaid enrollment by 14 million over 10 years. Some of the Medicaid losses would result from repeal of the mandate, as the process of applying for Medicaid can be onerous for low income people, particularly in conservative states that strive to make enrollment as difficult as possible. But the fact remains that 14 million fewer people are forecast to be enrolled in comprehensive, free or near-free coverage through Medicaid if The AHCA becomes law.

4) To mitigate the bad effects of the AHCA as originally introduced, MacArthur touts $160 billion in new funding over ten years that his amendments would provide. But that's a minor offset to the $1.2 trillion in healthcare spending cuts in the original bill, designed to "pay for" $900 billion in tax cuts for the wealthiest Americans and healthcare industries. It's a small fraction of the AHCA's $880 billion ten-year cut to Medicaid -- a ruinous 25% reduction in overall Medicaid spending, according to CBO.

Rep MacArthur has no cause to point fingers at critics who call him out for trying to obscure the drastic cuts in insurance coverage he is working to enact.

1 comment:

  1. Regarding the CSR's:

    Does Congress actually "allocate the billions of subsidies that flow through Part D as well as Medicare Advantage? I again sense that massive double standard between the elderly and poor workers.