A generational walk through the health care debate

By Tom Baxter

He’s a young, healthy guy with an independent streak, who may decide he doesn’t need health insurance when the government mandate goes away. She’s a 60-ish cancer survivor who depends on an Affordable Care Act subsidy for her continued medical care. You’ll be hearing a lot about them as the debate over the American Health Care Act unfolds.

To hear House Speaker Paul Ryan tell it, the young guy is the reason there won’t be as many people covered under his plan as there are under the Affordable Care Act.

“The one thing I’m certain will happen is CBO will say, ‘Well, gosh, not as many people will get coverage.’ You know why? Because this isn’t a government mandate,” Ryan said Sunday on “Face the Nation.” If fewer people end up covered, by this logic, it’s because fewer will choose to do so.

Critics of the bill, who at the moment are diverse and numerous, think that the new ranks of the uninsured will look a lot more like the second stock character, the one who’s older and less financially independent.

While Ryan was supplying his John Galt alibi for the bad numbers he expected from the Congressional Budget Office estimate (which turned out to be even worse than expected), Health and Human Services Secretary Tom Price was on “Meet the Press” making a no-alibi guarantee.

“I firmly believe that nobody will be worse off financially in the process that we’re going through,” Price said.

It tells you all you need to know about the treacherous twists and uneasy alliances involved in the Republican health care overhaul that Breitbart News posted Price’s comments under the headline “Upcoming Lie of the Year?” To say the least, there has been great unease about this bill from the right, with U.S. Sen. Tom Cotton of Arkansas warning House Republicans not to “walk the plank” for a bill the Senate wouldn’t pass anyway.

This is a bill which is being discussed as an ObamaCare repeal and replace bill, even though it retains some of the more popular features of ObamaCare. It isn’t being discussed as a Medicaid replacement bill, although that aspect of the bill could be much more far reaching. The bill not only phases out the Medicaid expansions which became such a battleground under ObamaCare, but it converts the entire program into block grants to the states by 2020.

Let’s go back to the 60-ish woman, who happens to be the mother of the young, independent guy. (Go figure.) Her 87-year-old mother is in a nursing home. She paid with her own funds when she got to the home a few years ago, but that money was used up eventually. Now, like nearly two thirds of all nursing home residents, Medicaid pays for her costs.

Therein lies one of the great complicating factors for this conservative restructuring as it marches forward. Medicaid as it is portrayed in the news is the last-stop alternative for the very poor to receive medical attention. That much is true, but the elderly and disabled — that is, the residents of nursing homes — account for half the money Medicaid spends, even though they are only six percent of the total enrollees in the program. So a bill that so radically affects Medicaid has a negative impact which climbs much farther up into the middle class than might seem at first. And it’s not insignificant, politically, that the nursing homes, which have honed their lobbying skills in the nation’s state legislatures, would feel the impact also.

When the impact on Medicaid is combined with other aspects of the bill, such as the provision which raises the amount insurers can charge older customers from three times that of young people to five times, the impact on older Americans is, if anything, greater than it has already been portrayed. It has long been predicted that politics would eventually begin to break down along generational lines; this bill could be the first great rumble.

Utah Congressman Jason Chaffetz struck the most ironic note in the repeal-and-replace rollout when he suggested on CNN that many Americans will have to choose between buying “that new iPhone that they just love” and insuring themselves. Leave aside the comparative costs of iPhones and health care policies, this is a misreading of one of the fundamental realities of American life.

In America, even a lot of homeless people have cell phones, because cell phones have become the main tool for maneuvering through daily life. You don’t need health care insurance until you’re sick… and then?

“It’s not our job to make people do what they don’t want to do,” Ryan said Sunday. Bet that young guy has a slick iPhone.

Tom Baxter has written about politics and the South for more than four decades. He was national editor and chief political correspondent at the Atlanta Journal-Constitution, and later edited The Southern Political Report, an online publication, for four years. Tom was the consultant for the 2008 election night coverage sponsored jointly by Current TV, Digg and Twitter, and a 2011 fellow at the Robert J. Dole Institute of Politics at the University of Kansas. He has written about the impact of Georgia’s and Alabama's immigration laws in reports for the Center for American Progress. Tom and his wife, Lili, have three adult children and seven grandchildren.

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