Marco Rubio and Scott Walker both revealed their alternatives to the Affordable Care Act, and if you’re anything shy of a millionaire, prepare to get excited: you’re not going to live too long under either of these plans!
Scott Walker’s plan makes the interesting decision to subsidize healthcare, like the ACA, but to base the size of the subsidies on age rather than income level. Obviously this is a very smart idea, as Vox’s Sarah Kliff explains:
For high earners, this might be great. Under Walker’s plan, Taylor Swift would get $1,200 to help buy coverage because she’s 25, while Obamacare would give her nothing on the grounds that she’s superrich. For lower-income people, this is a lousy deal: A 25-year-old earning $17,000 at a low-wage job would get a $1,962 credit under Obamacare.
Who wants to see Taylor Swift suffer? Nobody, that’s who. She deserves that money, dammit, and, well, I’m not gonna say that those of us who can’t sell 5 million or so albums deserve to die, but we certainly don’t deserve to not die if we get pneumonia or whatever, OK?
Walker’s plan also
leaves in place the ACA’s protections for people with pre-existing conditions ha ha ha, of course it doesn’t really do that:
Walker’s plan says it would “protect all Americans with pre-existing conditions,” but when you read the fine print, you realize that’s not accurate. It would only bar preexisting conditions for Americans who have continuous coverage — who never have a lapse between their plans. But there aren’t any protections mentioned for people who do drop coverage at some point. This group is big: One study found that between 2004 and 2007, 89 million Americans had at least a one-month gap in coverage.
Yeah, so the idea that Walker’s plan would “protect all Americans with pre-existing conditions” is just a straight-up lie. On the plus side, if you’re poor enough to qualify for Scott Walker’s Medicaid, you won’t have to worry about pre-existing conditions — not because Medicaid covers you anyway, but because you’re probably not going to get on Medicaid and you wouldn’t be able to afford private insurance anyway:
The Walker plan would turn Medicaid into a block grant program. In its simplest form, turning Medicaid into a “block grant” simply means handing control of the program — and the funding for it — over to the states. Instead of paying a set percentage of each enrollee’s bill, the program would pay a specific amount to each state. It would then be up to the states to figure out how to best spend those funds.
In theory, there’s nothing about a block grant proposal that commits the government to cutting Medicaid funding. In actuality though, Republican plans to block grant Medicaid universally make significant cuts to the program — cuts that experts say can’t just happen by making the program more efficient.
The astonishing thing is that Walker’s plan, which would royally screw people who are unfortunate enough to be poor and/or sick, is being derided as too generous by Walker’s Republican rivals, with Bobby Jindal calling it “Obamacare-lite.” This is how far out on the right-wing edge this primary field is.
Rubio’s plan proposes leveling the health insurance playing field, which means he intends to screw people who are on ACA plans, but also to screw people on employer-based insurance even more. Here’s Kliff again:
The crux of the plan is to slowly wind down what is known as the tax exclusion for employer-sponsored health insurance. This standard makes it a lot easier for an employer to buy insurance than an individual, driving up the demand for really robust health insurance packages that may be well beyond what workers need. But since health insurance is tax-preferenced, it’s a cheaper way to pay employees. The federal government loses more than $100 billion in revenue each year by not taxing health plans. Economists love the idea of reducing — or even eliminating — tax preferences for health insurance at work.
Economists may love it, but people who get their health coverage through work are going to want to know what Rubio is planning to do to keep them whole. The answer is: nothing! Rubio believes that if we all have to pay a whole lot more for our health insurance, then people will become “savvier” consumers of healthcare or whatever. We’ll shop around more and reject unnecessary treatments, which will bring health costs down. This is one of those ideas that sounds great in a classroom (free market!) but is incredibly shitty in the real world, where the vast majority of us lack the specialized knowledge necessary to be discerning healthcare customers. The practical result here is that, say it with me, poor people will be royally screwed as the price of health insurance goes up, while people who can afford it will pay out the wazoo for world-class treatment whether they really need it or not.
But don’t worry; Rubio’s plan makes up for this problem by also destroying Medicare and Medicaid:
There’s another big proposal in Rubio’s plan: converting Medicaid to a “block grant” program and moving Medicare to a premium support model.
You can read more about Medicaid block grants here and premium support here. In their simplest form, turning Medicaid into a block grant program or Medicare over to premium support simply means handing control over to the states or beneficiaries, respectively. Instead of paying a set percentage of each enrollee’s bill, specific amounts would be handed out to a state (for Medicaid) or an enrollee (for Medicare). It would then be up to those states and enrollees to figure out how to best spend those funds.
But there’s usually another policy goal to these proposals: saving money. Previous Republican plans for block grants and premium support would significant reduce the benefits that Medicare beneficiaries receive, or throw millions of Medicaid enrollees off the rolls.
Kliff says that 4/5 of Americans are insured through either Medicaid, Medicare, or their employer. Marco Rubio plans on making life worse for all of them. His plan will reduce healthcare spending by increasing sickness and death. Sounds good to me!
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