Thursday, February 20, 2020

The one executable healthcare reform plan put forward by a presidential candidate

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If I may cannibalize my Twitter thread, a reaction to last night's debate in four tweets:
Healthcare in last night's debate: More blah blah blah about public option vs. M4A and nary a word about Republican intentions to void the ACA, gut Medicaid, bring back medical underwriting, uninsure tens of millions and cut at least $1 trillion in HC spending in first decade.

You have to have goals, yes. But they remind me of old-time communists arguing about who'll clean the toilets when the state withers away.

"Everyone must have access to Medicare-plus, but you can keep your wonderful employer plan if you prefer!" "No, everyone must have free access to everything!" Meanwhile...

It'll be a minor miracle if we're not living in authoritarian austerity state and if a Dem president can wring Medicare drug negotiation, balance billing ban and improvements to ACA subsidies/access through a 51-49 senate.

This hunger for a little realism led me to reflect on the one clearly executable healthcare reform plan put forward by a candidate:
Do details matter in a presidential candidate's healthcare reform plans? Yes, when they concern executive action.   1/

The best healthcare plan out there is the administrative action part of Elizabeth Warren's transitional HC plan.

This plus "Medicare drug negotiation, balance billing protection and any coverage expansions we can get through Congress" would be optimal. Warren would... 2/

Use compulsory licensing authority to bypass patents on overpriced essential drugs

Enforce mental health parity

Kill Verma's ACA innovation waiver guidance encouraging subsidies for medically underwritten plans

Fund ACA outreach/enrollment assistance

Ban Medicaid work rqs  3/

Ban LGBTQ discrimination

Restore mandatory contraceptive coverage

Kill ban on Title X and USAID funding for orgs that do abortion

Fix ACA family glitch (providing subsidies to those for whom employer family coverage is unaffordable) by administrative fiat  4/

Expand ACA subsidy eligibility to all legally present peeps e.g. DACA

Expand medically necessary dental coverage in Medicare

Enable states to expand Medicaid eligibility beyond 138% FPL

Reverse Trump admin's Medicaid red tape barriers to Medicaid/CHIP coverage 5/

Ramp up antitrust enforcement on hospitals and health systems (everyone says they'd do this, but Warren is committed to real antitrust reform).  6/

It will take an administrative master to reverse Trump administrative damage in all government sectors, which means, above all, hiring the right people to heal executive branches. 7/

The account, I forget where alas, of the relentless pressure Warren put on Hillary Clinton to ditch the Wall Street elite and put public-oriented people in top financial positions tells me that Warren is best equipped for this administrative repair and reform. 8/ end
P.S. Just recalling that Warren has yet one more healthcare reform plan, in addition to her pay-for-Berniecare plan and  the "transitional" plan, divided into administrative and legislative parts. Warren also introduced the Senate's chief "ACA 2.0" bill, which mainly ramps up ACA premium subsidies and removes the income cap on subsidy eligibility. I took a look at that plan here.  And I'll note that Charles Gaba has been quietly tilling the vineyard for the House version of this bill, HR 1868, visiting reps' offices and urging them to cosponsor it, with some success. (This bill has been broken up into some dozen smaller bills, and Gaba mainly focuses on HR 1884, which would remove the income cap on subsidy eligibility.)  I share his conviction, along with David Anderson, that in the best case of a Democratic president and narrow Democratic Senate majority, ACA improvements, coupled with balance billing protection and hopefully some prescription drug cost control, is the  most sweeping reform we're likely to get in the short term. Hitting those marks has the added advantage of tracking with voters' stated priorities.

1 comment:

  1. Why is mandatory contraceptive coverage included here? Pills and patches generally cost less than $50 a month.
    Sounds like a feminist wish list sort of thing, not horrible but to me kind of embarassing.