The good, the bad, and the ugly: Ryancare edition

Last updated on: March 7, 2017 at 12:41 pm by Jane the Actuary

The good, the bad, and the ugly: Ryancare edition 2017-03-07T12:41:48-06:00 Jane the Actuary

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Stupid, stupid, stupid, stupid, stupid.

That’s my overall reaction to the GOP’s new healthcare bill. You can read the text here, and the GOP’s spin on it here. Lots of sources for summaries of the bill; you can start with Politico. So far I’ve read the text itself (which admittedly means missing a lot because so many of the changes are done by means of amending other laws in that crazy way that legislation works) and a bit of commentary and wanted to write up a few thoughts before starting my workday. (Update: OK, I ended up finishing typing this at lunch. Also, here’s a more detailed summary of the changes in this bill.)

So let’s take this in three parts.

The good:

Planned Parenthood is (temporarily) defunded. Now, to be sure, I don’t see the point of a one-year defunding. I guess it’s symbolic. And the law doesn’t, as a general principle, establish that no organization which performs abortions is eligible for federal funding, but it specifically defunds Planned Parenthood, by that device of describing the affected entities so specifically that only they are covered — which admittedly isn’t hard to do as they’re the only nationwide “chain” of clinics, so the bill says it applies to any entity:

for which the total amount of Federal and State expenditures under the Medicaid program under title XIX of the Social Security Act in fiscal year 2014 made directly to the entity and to any affiliates, subsidiaries, successors, or clinics of the entity, or made to the entity and to any affiliates, subsidiaries, successors, or clinics of the entity as part of a nationwide health care provider network, exceeded $350,000,000. (page 4 as numbered in the linked text)

Abortion coverage is wholly removed from “exchange” plans. (And, so far as I can tell, the “exchange” mechanism remains — but I need to check on this later.)

The age differentials have been widened from 3:1 to 5:1 so that young people won’t be subsidizing the near-retirees to the same degree. Yes, supporters of those restrictions painted it as “unfair” that oldsters had more expensive premiums, but the reality is that they also, on average, have higher wages, and, in any case, requiring the young ‘uns to pay more than is actuarially fair simply causes them to reject health insurance.

The employer mandate eliminated. So far as I understand, this had not had much, if any, beneficial effect in terms of increasing coverage, but had only resulted in hourly workers at low-wage jobs being reduced to 29 hours per week.

The caps on HSAs have been increased; these caps had primarily impacted people with disabilities or chronic high healthcare costs, not the wealthy that they were intended to hurt.

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