If you are one of the thousands of Mainers who buy their health insurance on the Obamacare exchange, you may have gotten something like this in the mail this week:
“This letter provides you with two important notices: 1) Notice of Harvard Pilgrim’s proposed (39.7 percent) rate increase for 2018, and: 2) Notice of Harvard Pilgrim’s possible withdrawal from the individual HMO market in Maine.”
The reasons for both, the letter goes on to explain, are health care costs, especially for pharmaceuticals, which continue to rise faster than inflation. And it says “developments in the implementation of the federal Affordable Care Act will have the effect of further raising individual-market product costs in 2018.”
That’s a nice way of saying, “We can’t afford to stay in this business if our partner in Washington keeps trying to kill us.”
Because that is what’s happening. While the 13 Republican senators in a health care working group debate in secret about how many millions of people they have to dump off Medicaid to get Ted Cruz’s vote, the Trump administration is doing whatever it can to exploit cracks in the system by pumping them full of uncertainty.
And every time an insurance company drops out of an exchange somewhere, a crocodile-tear news release goes out from the administration, bemoaning the fact that the system is failing and needs radical reform. Never mind that the reforms they have in mind would make things worse and move millions of Americans from flawed coverage to no coverage at all.
All the attention now is on the U.S. Senate, and really just the Republican working group. Democrats can’t do anything but complain because they are locked out of the process, so the millions of Americans who were able to get health insurance under the ACA are left hoping that Sen. Susan Collins and two other moderate Republicans might be able to stop a runaway train.
It’s important to remember that what we are seeing is not a battle of ideas being waged in Washington, but one of political calculation. The House-passed American Health Care Act, which would cost 23 million Americans their coverage, is not some utopian ideal dreamed up by a free-market think tank. It was a bill designed to get 216 Republican votes, and it just barely did.
And in the Senate, negotiators are not pursuing the best way to cover the most people for the least amount of money, they are looking for at least 50 out of a possible 52 Republican votes so they can ram a bill through with a tie-breaking vote from Vice President Mike Pence if necessary.
The goal here is not to reform health care, it’s to deliver on campaign promises that were made in four straight elections. The partisan’s main job isn’t to govern, but to win.
So while the Senate careens toward a vote on a mystery bill that is likely to preserve the worst parts of the hideously unpopular House bill, its authors are trying to change the subject.
Instead of talking about how they plan to dump more of the cost of caring for people in nursing homes onto state governments, or about phasing out Medicaid expansion, thus leaving millions with no coverage at all, Republican lawmakers prefer talking about Obamacare.
In a 49-second video released Tuesday, a lineup of Senate Republican leaders say some version of “Obamacare is unsustainable” seven times. If you wonder what they plan to replace it with, you’re out of luck. They didn’t mention that once.
Meanwhile, the Trump administration is doing whatever it can to make insurance companies nervous. It started by sending mixed signals about whether it would continue to enforce the individual mandate that requires everyone to buy health insurance or pay a fine. Adding more healthy people to the insurance pool was the trade-off that insurance companies needed when they were forced to cover people with pre-existing conditions. If only sick people buy insurance, the markets really would collapse.
And the administration has sown doubt about whether it will continue to pay cost-sharing reduction subsidies, which partially cover out-of-pocket costs for 7 million low-income people who buy insurance on the exchanges. Insurance companies will have a hard time pricing their plans without knowing how much the government is going to kick in.
No wonder companies like Harvard Pilgrim are thinking about getting into a safer line of work.
Figuring out why it might be good politics to put millions of people’s lives in danger by threatening their access to health care is a question for the experts.
But don’t ask whether Republicans are intentionally creating chaos in the health insurance markets in order to gain political advantage, because the answer is obvious.
It came in the mail to thousands of Mainers this week, and they probably won’t be the last to get the message.
Greg Kesich is the editorial page editor. He can be contacted at:
Twitter: gregkesich
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