The Blog

"Don't Get Sick": The Truth About GOP Health Plans?

The GOP's Patients' Choice Act is deeply flawed. It would likely cause many people who now are insured to lose their current coverage.
This post was published on the now-closed HuffPost Contributor platform. Contributors control their own work and posted freely to our site. If you need to flag this entry as abusive, send us an email.

Republicans reacted wtih outrage last week after Rep. Alan Grayson (D-FL) offered a blistering attack on the nearly-invisible Republican healthcare proposals: "The Republican health care plan is this: Don't get sick, and if you do get sick, die quickly."

Unfortunately, the White House isn't doing all it can to push the public option. Indeed, The Hill reported Friday, the White House staff and the President didn't make any phone calls to Senate Finance Committee members before last week's vote on health reform to press for that provision. The upshot is that the odds have increased that only reform-lite may pass, although there's still a strong grass-roots effort, including by union members, to push for the public option.

But SEIU's Andy Stern and other progressive leaders have noted that Grayson, despite his hyperbolic rhetoric about "die quickly" and a "Holocaust," was correct about the impact of inaction on health reform: 44,000 people die each year because they lack health insurance. Indeed, Stern said at an Atlantic Magazine-sponsored conference last week:

"[Republicans] have no healthcare plan and they are letting people continue to suffer," he said. "That is an issue and they should be held accountable."

Yet during the President's healthcare speech before Congress last month, many Republicans were shown holding up copies of their 37 House bills to counter the well-deserved notion that they're the "Party of No," dedicated to obstructionism.

But even some Republican proponents of their own legislation quietly concede that the Republican leadership hasn't seriously pushed its own alternative healthcare plan. One Republican staffer, when asked about the Republican over-emphasis on attacking Democratic plans, told me for a new In These Times article, "I don't disagree...There hasn't been enough attention to the ideas in [our] plan."

So what's the real story about Republican health plans?

Republicans have actually offered various bills, almost all emphasizing combinations of tax incentives, individual subsidies and vouchers that supposedly give individuals more control over their healthcare and promote portability of insurance, but they haven't united behind a single bill or set of core principles.

It's been well over 100 days since House Republican leader John Boehner and other House GOP leaders promised to introduce their own legislation.

The upshot of all the various plans, however, remains basically as Grayson described it: "Certainly from what I've seen of the 37 bills, the lesson is still 'Don't get sick,'" says Dr. Lesley Russell, a Fellow at the Center for American Progress who specializes in health policy. Indeed, as Think Progress summed up the view of progressive experts:

A close look at the GOP's so-called "principles" shows that they would break-up employer-based coverage, endanger the coverage of Americans with pre-existing conditions, and drive-up health care spending.

On top of that, several of the basic ideas in the various bills have been around for over a decade and could have been introduced in the Bush administration, if the GOP cared to do so. As one Center for American Progress memo noted, according to the Wall Street Journal:

Eight of the ideas have already been incorporated into Democratic legislation; five lie outside the jurisdiction of the relevant committees; and five have been around for more than a decade, so Republicans could have enacted them when they were in power.

In fact, as Russell found, despite complaining that Democrats have ignored their ideas only five provisions from the 37 bills were even offered by Republicans as amendments in any of the three House committees considering the Democrats' health bills.

Even if they're not serious about pushing for their own health reform agenda, American Progress's Wonk Room has highlighted their ostensible goals (as opposed to a possible hidden agenda of simply enriching health insurers):

These [GOP] alternatives claim to expand access by giving Americans a tax credit to purchase health care coverage outside of the employer-based system and control health care spending by capping awards for malpractice claims, and eliminating "waste, fraud, and abuse" from the system.

But perhaps one reason they haven't been pushed forward is that they could easily draw fire and raise alarms for potentially destroying employer-based care and wiping out Medicaid coverage for mothers and children.

Critics say they essentially force many workers and Medicaid recipients to fend for themselves with relatively modest tax grants that apparently don't cover even half the cost of premiums, nor effectively ban insurers' restrictions on pre-existing conditions.

My In These Times article looks at some of the risky or draconian provisions in major GOP House and Senate health bills, drawing on the research of experts at the Center.for American Progress, the Center for Budget and Policy Priorities and advocacy groups. What's particularly striking in some of the bills is how much they take dead aim at the fragile government safety net for the poor and aged -- as well as undermine employer-based health plans.

Take the purportedly well-meaning, sweeping ideas in the so-called "Patients' Choice Act," introduced by physician Sen. Tom Coburn (R-WI), among others.

It's especially troubling to critics that it would requires about 45 million non-disabled mothers and children to leave Medicaid and enroll in private insurance. "Our plan transforms Medicaid!" one Republican staffer told me.

Indeed, it does, but not in ways likely to appeal either to Medicaid recipients -- or those who care about public health and the needs of the poor. As the Center for Budget and Policy Priorities (CBPP) warned:

Plan Would Jeopardize Needed Care for Tens of Millions of Medicaid Beneficiaries

The bill's failure to make coverage affordable for many low-income people is especially serious because the bill would also eliminate Medicaid coverage for low-income children, parents, and seniors, pushing tens of millions of vulnerable people into the private insurance market. Low-income Medicaid beneficiaries tend to be in poorer health and are more likely to have chronic illnesses than people enrolled in private insurance; if forced to purchase coverage on their own, many likely would find the premiums unaffordable.

In addition, low-income seniors who are eligible for both Medicaid and Medicare would face substantially higher costs, because under the bill as drafted, Medicaid would no longer pay their Medicare premiums and cost-sharing.

On top of that, unlike those enrolled in employer-plans, patients in Medicaid auto-enrolled in private health insurance exchanges apparently couldn't return to Medicaid if they wanted to: they'd have to choose between private insurance companies in the exchanges and other companies outside the exchanges.

As their prescriptions and doctors' visits dry up during the inevitable snafus of waiting to transfer to coverage by for-profit private insurers, they'll graciously be offered "counselling" on their choices.

From the Republican perspective, this plan--which has already been rejected when offered as an amendment in the Senate health, education and labor committee -- isn't a Dickensian effort to rob impoverished mothers and children of affordable, accessible healthcare. Its announced goal is not just to put Medicaid on a sound fiscal path, but to "take the Medicaid stamp off their foreheads," as one staffer describes it, and allow recipients access to a broader range of care since as many as 65% of physicians don't participate in Medicaid.

The miracle of the free market would then be set into motion -- although this plan doesn't limit cost-sharing for the ex-Medicaid recipients or set meaningful minimum benefit standards tailored to the needs of low-income families and children.

But can't they just remain with their clinics and doctors in Medicaid? "They're not allowed to stay [in Medicaid]," a Republican staffer points out, excepting the disabled and the aged in long-term care. So much for the much-vaunted freedom in health care promoted by Republicans.

Senator Coburn and his co-sponsors, though, had a far sunnier view of their legislation when they introduced it in May:

Earlier today, U.S. Senators Tom Coburn, M.D. (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA) introduced health care reform legislation that delivers on the shared principles of promoting universal access to quality, affordable health care, and does so without adding billions of dollars in new debt or taxes.

"The Patients' Choice Act of 2009," transforms health care in America by strengthening the relationship between the patient and the doctor; using choice and competition rather than rationing and restrictions to contain costs; and ensuring universal, affordable health care for all Americans. "The Patients' Choice Act" promotes innovative, State-based solutions, along with fundamental reforms in the tax code, to give every American, regardless of employment status, age, or health condition, the ability and the resources to purchase health insurance.

The CBPP's January Angeles has a far darker assessment:

Plan Fails to Create a Viable Alternative for People Losing Employer Coverage

Of particular concern, many of the people who would lose employer-based coverage would likely be unable to find affordable, comprehensive coverage on their own. The bill fails to address the significant shortcomings of the existing individual health insurance market that make it difficult for individuals who are older or have various medical conditions to obtain coverage...


The Patients' Choice Act is deeply flawed. It would likely cause many people who now are insured -- including millions of workers who are in below-average health and currently are covered through their employer, as well as millions of poor children and parents -- to lose their current coverage. In many cases, these people would end up uninsured, paying substantially more for insurance than they now do, or purchasing insurance that provides inadequate coverage and has high cost-sharing. The bill also would sharply increase costs for many low-income elderly individuals...

In other words, as Rep. Grayson said, it amounts to..."Don't get sick."

To read more, go to the progressive labor and reform blog, Working In These Times.

Art Levine co-hosts the Blog Talk radio show, "The D'Antoni and Levine Show," with Huffington Post blogger Tom D'Antoni, bi-monthly on Thursdays at 5:30 p.m. This week's guest is Nomi Prins, a Demos fellow and author of It Takes a Pillage, exposing the waste, greed and cronyism driving the economic meltdown and bailouts.

UPDATE: See Wanda Sykes take on GOP scare-mongering over "death panels":