The Recorder

‘Skinny’ is not better

Does the “skinny repeal” of the Affordable Care Act amount to what has been missing in Washington — a willingness compromise? A Congressional Budget Office evaluation of an earlier version reveals the fallout would be less harmful than the repeal-and-replace measure that cleared the House and the proposal put forward by Mitch McConnell, the Senate majority leader. It would be better than a straight repeal.

The “skinny” would end the individual and the employer mandates, along with the tax on medical devices. So it is much less comprehensive. The calculations show roughly 16 million people losing their health coverage, as opposed to the 22 million to 32 million under the other proposals considered by Republicans.

If you’re thinking that 16 million still translates to considerable wreckage, you are right. Removing the individual mandate invites turmoil to the marketplace exchanges for those buying health insurance on their own. It results in a sicker pool of the insured, pushing premiums, deductibles and co-pays higher for coverage that delivers less.

Writing on the op-ed page of The New York Times this week, J.B. Silvers, a professor of health care finance at Case Western Reserve University, described the complications. Those most vulnerable to losing coverage would be middle-income people. They would become “emergency room patients and bad debts for doctors and hospitals.”

Those still with coverage would benefit from higher subsidies (to keep pace with rising costs). They would become, as Silvers explained, similar to Medicaid recipients, leading, ultimately, to “a much bigger tab for the government.”

So, the “skinny repeal” isn’t a compromise of any sort. Rather, it is a legislative gambit, a way for divided Senate Republicans to advance something and reach a conference committee with their House counterparts where a new bill would be written.

A process already without traditional hearings, lacking transparency, especially in the Senate, would get worse. If conference committee members are tapped by legislative leaders, there is nothing to prevent McConnell and Paul Ryan, the House speaker, from a gathering a core of allies to craft a bill essentially in secret.

No doubt, that bill would mirror in many ways the structure apparent in the House and Senate discussions. That includes dramatically altering the way Medicaid works, ending the expansion, applying a per-capita limit on federal funding with a heavy burden falling on states, reducing coverage for poor children, seniors and the disabled.

The much discussed weakening of protections for pre-existing conditions and essential benefits also surely would be on the table.

Then, there’s the prospect, surfacing Thursday, of the Senate approving the “skinny repeal” and the House moving quickly to give its approval, upending the reassuring talk of something better emerging from the conference.

The “skinny repeal” doesn’t merit support. Republicans have had seven years to plan a replacement for the Affordable Care Act. That they don’t have one signals they need help in the form of joining Democrats to make the needed repairs.

— Akron Beacon Journal