Voting on something important not knowing the cost is malfeasance

Allow me to come right to the point. Voting on a repeal and replacement healthcare law without it being measured by the CBO for its financial impact is malfeasance. My old party has waited seven years for this, they can at least know what it costs, who is helped and harmed by it and its impact on the debt. Trying to ram something this complicated through is about as poor stewardship as can be found.

This especially true with at least two hospital groups and two doctor groups coming out against it, not to mention the largest lobbying group for retired persons, the AARP. This is especially true with the numbers of people impacted, in particular, the lower paid and older people. As a retired benefit actuary, consultant and manager, I am also troubled by the naysaying of the imperfect ACA in the first place.

The ACA is not in death spiral so says the American Academy of Actuaries. It could be improved, but it is not a disaster as spouted by Messrs. Trump, Ryan and McConnell. It frustrates me that a law that is working pretty good expanding coverage, is being beaten on to support a change that appears to be ill-conceived. It also frustrates me we are not using data driven analysis to decide what to do.

Medicaid expansion is a “no brainer” said Ohio Governor John Kasich, the most reasonable Presidential candidate in my view. This is also the view of The Commonwealth Fund, Economic Policy Institute, RAND Corporation, Kaiser Family Foundation and a study by George Washington University. We have data to contrast the results in the 19 states that did not expand to those of 31 states that did. What I have read is the states that did are seeing fewer personal bankruptcies than before and improved hospital accounts receivable rates.

But, a huge factor should be the following. The ACA administration is already built. As a former benefits manager and consultant, I have witnessed far too many mistakes in administration by reputable insurers and state and federal governments. While the ACA exchange roll out fits this bill, it has now stabilized and is working. My strong advice is to improve the ACA and not throw the baby out with the bath water. To be frank, there is so much in fighting in the Republican Party, that may be the only course of action achievable.

21 thoughts on “Voting on something important not knowing the cost is malfeasance

  1. I so agree with improving the system in place. I am a beneficiary of the ACA and also have and still do experience the many flaws in the system. However, I can still say I was better off with the passing and implementation than I had been before. Baby out with the bathwater is the perfect example of what action without deliberation usually achieves. Thank you Keith for another thought provoking and insightful post. ~~dru~~

    • Janis, my guess on your question is they have no idea, but some are about to find out. Others will remain clueless and hang on every word their man says. Keith

  2. Note to Readers: Two House committees have voted to approve the repeal and replace law without financials or a winners/ losers analysis. How can anyone at this level of governance vote on anything of this magnitude and potential impact without knowing the cost? It should be noted that Senator Mitch McConnell agrees in this case that the numbers are needed. Malfeasance is the appropriate word for the members of these committees who voted yes.

  3. Keith – What a wonderful analysis you have done here. If ever a financial plan for this new program is done, I hope they figure in the costs of replacing a platform already in position. As you say, improvements should be the action here, not replacement.

    • Susan, overlooking the administrative cost and burden is an age old problem. As an example of the cost of overlooking is Trump not understanding the communication and administration of his travel ban. As we know, it did not go smoothly. Keith

  4. I agree that they should know the full cost of TrumpCare before voting. I saw a recent poll that says more people now approve of the ACA; and the majority want issues fixed.

  5. It’s all about the Art of the Deal and we are unfortunate pawns in the mix. We literally have the most spineless houses of government in the history of this country. All of this nonsense to say “nanananananana our healthcare plan is better than yours.”

    • Lisa, it is all about telling the American people they killed it. The fact that is a worse program and should cause uproar, it will cause a retrenchment on our economy and likely add to our debt. Keith

  6. Dear Keith,

    What’s worse is that the majority of voters agree with you. The 3/6/17 Los Angeles Times cites a Hart Research poll, which concluded that 68 percent of those surveyed want the GOP-controlled Congress to simply fix the federal healthcare law. The remaining 32 percent are in favor of repealing the law and replacing it with something else.

    These US House republicans are only listening to its far right base, the health insurance executives and the heck with the rest of us.

    Ciao, Gronda.

    • Thanks Gronda. There is a Monmouth poll that has a similar, but slightly less majority at 58% in favor of keeping the law, with most of those wanting it improved. Again, the devil is in the details and administration. Certain fixes can be done that can be readily accommodated. And, as you note a large body of Republicans benefit from the law, even if indirectly from a more stable hospital and better economy. Remember the NC Repiblucan mayor who walked to Washington to save his hospital since my state did not expand Medicaid? Keith

  7. This malfeasance is why the entire thing feels like vengeance. It’s not about doing what is best for the country, it’s about spiking a ball after a win. It’s about burning the enemy city after you defeat them.

    The worst part to me is that they kept all the most visibly popular things – the pre-existing conditions, kids under 26, and no limits on coverage. This makes it LOOK like a decent plan. But they strip mined all the supporting structures for those things. They paid for those things by taking coverage away from the poorest people.

    They hid terrible things in it like if you lose coverage for more than 6 months, insurance premiums can be raised 30% as a penalty.

    They are making the weaknesses of the current plan worse. There is a large group of working poor, who are basically under-insured. They can only afford the cheapest insurance and cannot afford the deductibles etc. They choose not to go to the doctor or fill prescriptions because they cannot afford to. This plan makes that worse.

    This plan is wealth-care. The biggest beneficiary of this plan is upper middle class younger Americans. They will pay less. Except they probably already had coverage through their jobs – so they are likely to experience any noticeable change.

    And all of it was done by a congress who gets FREE HEALTHCARE. A thing they voted on a provided for themselves. Apparently free healthcare is only important for them.

  8. Note to Readers: It is not just us bloggers who are saying this, but The New York Times reports on a Kaiser Family Foundation study that shows Trump voters are more negatively impacted by the repeal and replace bill over Clinton voters. This is the smoke and mirrors ploy of DT and the GOP. Here is a link.

  9. Isn’t it interesting how slowly legislation went through Congress over the past eight years, and yet now it seems to be able to move at warp speed? How long did it take to get Congressional approval for ACA? I don’t remember, but I know it was a loooonnnnnggg time in the works. It would seem that Congress is now living on energy drinks or speed, as they worked half the night on this new abomination they are calling “the greatest healthcare plan”. 😦

    • If the CBO scores it as increasing the deficit, it must get 60 votes in the Senate. If it is budget neutral or positive, then it needs 51 votes. Either way, they should be embarassed by the negative reaction and the fact they want to ram it through.

      By the way, Spicer is already whining about the CBO before they do their work. That should be telling.

      • With so much cut out of it, I cannot imagine it would increase the deficit. However, to move forward on ANY plan without first knowing the cost is the epitome of stupid. It is rather like going out and buying a new television without knowing how much money is in the checking account! I had not heard Spicer’s latest complaint … I shall have to check it out. Thanks!

      • Jill, you have little faith. The replacement plan provides a huge tax benefit to the wealthy, estimated at $256 billion over ten years, by taking out the fees. Plus, the elimination of coverage for so many will have an impact on the healthcare inflation. But, what so few GOP voters realize is the bill cuts healthcare for the masses and cuts taxes for the wealthy. But, he told us he is the champion of the common people. This is why Spicer is naysaying the CBO before they do their work and why Ryan wants to rush it through. Keith

  10. Note to Readers: There are two key takeaways from the CBO projections on the repeal and replacement plan released Monday. The numbers of uninsureds that will dramatically increase by 14 million in 2018 and 24 million in 2026. And, the large portion of the revenue savings of $337 billion over ten years that goes to the wealthy people in the country. Trump folks are touting the previous inaccuracy of the CBO’s initial projections, but the CBO did not likely anticipate the GOP strangling efforts to succeed by stiffing the insurers on adverse selection reimbursement, waylaying Medicaid expansion efforts and the general naysaying caused by 50+ repeal votes. On the flip side, I personally believe if this bill became law, it would have a retrenching effect on the economy, with less spending due to less coverage. And, it will hit rural areas hard, as noted by the Kaiser Family Foundation.

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