We have seen this film before. Legislators propose a new law that they claim will improve health care, but pushes millions off of health coverage, strips away protections in current law, tells cash-strapped states to pick up the tab, and gives big breaks to the wealthy who don’t need help.
Did you walk out of the theater the first two times? Will you stay for this one? More importantly, will our senators?
In the coming days we will get an analysis of the new Senate bill from the nonpartisan Congressional Budget Office (CBO). The analysis may come with little time in advance of a vote, as the Senate leadership is attempting to rush to a vote before the public, let alone Senate members, have a chance to fully evaluate it. (That is not new, either.)
We all need a sense of what to look for in the official analysis of the new proposal — not what Senator McConnell or Sunday morning-show spin-masters tell us the bill would do.
First, what is the comparison point? To understand the impact on Iowans, the comparison should be to current law, not just to previous proposals.
More than the minor changes it makes to the previous Senate bill, or how it differs from the House-passed bill, we need to know from the new official analysis how this bill differs from current law that has extended health coverage to tens of millions across the country, and some 200,000 in Iowa.
We know, for example, that about 150,000 Iowans are covered by only one piece of the Affordable Care Act (Obamacare), the Medicaid expansion, and that this number will be 177,000 in 2019 if the expansion is preserved.
However, the Medicaid expansion would effectively be eliminated under the new Senate plan, as in the previous, stalled Senate proposal and the House-passed bill. In none of these proposals do we see opportunities to further increase access to insurance for those who are most vulnerable.
In the end, isn’t that what we would expect health care reform to do? Provide more coverage, more efficiently, to all. Continual tweaks in the current and recent Washington plans don’t change a fundamental problem: Millions nationally, and hundreds of thousands in Iowa, would lose health insurance.
Put in stark terms: When people lose health insurance, they can lose access to health care. When that happens, they become sicker. Or they take on debt they can never overcome. Some die.
Ultimately, our state leaders in Iowa — the Governor, and state legislators of both parties — might want to consider how they would cope with the results of this legislation. Are they content with the U.S. Senate and House pushing more budget problems onto their desks, and to Iowa taxpayers? That is the choice Senators Grassley and Ernst will have in the coming days.
Mike Owen is executive director of the nonpartisan Iowa Policy Project in Iowa City.