Statehouse Report
July 13, 2017

By Thornton Kirby, special to Statehouse Report  |

As CEO of the South Carolina Hospital Association, my friends and neighbors often come to me with questions about how the country’s health care system works.  The dynamics surrounding the cost of care and access are so complex that it’s easy to understand why so many Americans are confused about healthcare reform.

Watching Congress debate changes to our health insurance markets – and seeing the public’s reaction to those proposals – has led me back to two key observations about how we expect our country to work.  First, each of us expects to be treated fairly and equitably.  And second, although our country’s values are rooted in the protection of individual rights, I think most of us agree that we’re collectively better off when we recognize that we’re all in this together.

Since 2010, health care reform has divided our country, in part because of its uneven treatment of those two themes.  The Affordable Care Act (ACA) provided coverage to about one-third of those who previously lacked insurance, but was accomplished partly through the individual mandate, which forced Americans to sign up for a health plan.  Bringing everyone together into a common insurance pool has helped us share risk and guarantee coverage for those with pre-existing conditions.  The trade-off has been an infringement on individual liberty.

While the ACA improved access to health care for millions of Americans, it also amplified existing inequities in how states are treated by the federal government.  Unfortunately, the Better Care Reconciliation Act (BCRA) proposed in the U.S. Senate not only fails to fix this problem – it essentially locks it in forever.  States like Massachusetts and New York spend about twice as much money per Medicaid enrollee as South Carolina.  By capping allowable increases in Medicaid spending, BCRA would let northeastern states keep benefitting from more federal funding than states like ours.

This is further exacerbated by the fact that some states expanded Medicaid under the ACA and tapped in to billions of dollars to improve health coverage, while others like South Carolina rejected expansion.  Even though BCRA would phase-out the Medicaid expansion over several years, expansion states would still collect billions more during that period, while non-expansion states would receive token allocations.  There’s something inherently unfair about this – especially since this punishes the states that opposed Obamacare.

The nonpartisan Congressional Budget Office estimated that the BCRA would cost 22 million Americans their health insurance over the next decade because many of these people will drop their policies, since BCRA would eliminate the individual mandate.  This ignores some important realities about our country’s insurance markets.

First, many of those who would “choose” to go without coverage under BCRA would do so because they would no longer be able to afford insurance. Premiums for working-class adults aged 50 to 64 would be roughly doubled, even as the coverage provided by these policies would be watered-down by the new law’s standards.  That’s not a real choice.

Second, when it comes to health insurance pools, we really are “all in this together.”  The way that BCRA seeks to bring more young, healthy Americans into the market is to allow insurers to charge older adults a rate that is five times as high for the same policy.  Twentysomethings will find coverage as their parents – who typically need it more – lose theirs because they can no longer afford it.  This will lead more people to access treatment through emergency rooms, which are federally required to stabilize anyone, regardless of their ability to pay.  In turn, healthcare providers must pass the costs of treating the uninsured by raising the prices that the insured must pay.  Society can’t avoid the cost of treating the uninsured by ignoring them.

The BCRA is currently in the U.S. Senate and could be voted on any day now, which would cost more than a quarter-million South Carolinians their health insurance and take billions of dollars out of our economy.  If we want a health care system that treats us individually or treats South Carolina fairly and equitably, then BCRA fails to meet this standard.  If you expect better than this, there’s still time to let U.S. Sens. Lindsey Graham and Tim Scott know.

Thornton Kirby is President and CEO of the South Carolina Hospital Association.

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