To make the Senate Republicans' health care bill more palatable to far-right members, Senate Majority Leader Mitch McConnell (R-Ky.) added a provision crafted by Sen. Ted Cruz (R-Texas). For health care advocates, that's not good news.
The basic idea behind Cruz's proposal is to empower insurers to sell plans that ignore the ACA's insurance safeguards alongside plans that include those safeguards. So, consumers could purchase a good plan, with protections for pre-existing conditions and essential health benefits, or a bare-bones plan, that wouldn't meet any of the existing standards under the Affordable Care Act.
As health care experts have repeatedly explained, this would create an unsustainable two-tiered system, with older and sicker patients buying real coverage, and younger and healthier consumers buying cheaper insurance. This, naturally, would lead to vastly higher premiums for people who need coverage the most.
The GOP approach would try to ease the burden by creating a fund to help offset those costs, creating what would, in practice, become high-risk pools. And while that's inherently problematic for all kinds of reasons, as TPM noted, Sen. Susan Collins (R-Maine) raised a separate concern: the money her party's plan sets aside is being used more than once.
[The Cruz] amendment takes money already appropriated in the bill for other needs and says it can be used for these payments to insurers under the Cruz Amendment."It seems to me you're using that money over and over again," she said. "It's supposed to relieve the cost of high premiums. It's supposed to solve the problem with deductibles being unaffordable. It's supposed to be available for high-risk or reinsurance pool. It's supposed to be available under the Cruz Amendment to help prevent a huge increase in rates for people with pre-existing conditions."Matthew Fiedler, a fellow at Brookings Institute's Center for Health Policy, confirmed this double-dipping to TPM.
TPM's report also quoted Tim Jost, a health care law expert and professor at Washington and Lee University, saying the Republican "gives an additional $70 billion to the states and then the Cruz amendment gives it to insurers that offer compliant plans in addition to noncompliant plans."
Putting the same money in multiple pots obviously won't work. How do Senate GOP leaders intend to fix this? So far, they apparently haven't acknowledged that the problem exists.
I mention this for a couple of reasons. First, obviously, Senate Republicans haven't done a good job writing a coherent bill. Given the fact that this is life-or-death legislating for much of the country, the carelessness should scare Americans quite a bit.
Second, problems like these -- double- and triple-counting the same money -- has popped up from time to time in other bills, but the legislative missteps are nearly always noticed during committee scrutiny. Remember, up until six months ago, important bills have been subjected to months of hearings, examinations, debate, and the traditional committee process. It's a feature, not a bug, of how legislating is supposed to work: the process helps identify flaws in bills and gives proponents time to fix them.
But in 2017, that process has been replaced with ... let's call it an alternative system embraced by Trump and his allies.