Speaker Paul Ryan’s proposed “American Health Care Act” (a.k.a. RINOcare) got a bit of a makeover on Monday. Now the pig has rouge and eye shadow in addition to lipstick.
To be fair, some of the changes are good ones. Amendments that will be added to RINOcare on the floor of the House will (1) prevent any more states from expanding Medicaid; (2) allow states to impose work requirements on non-disabled Medicaid recipients; and (3) permit states to receive Medicaid as a block grant. The last one is particularly good because it gives states more flexibility to experiment with their Medicaid programs.
One other Medicaid change is a mixed bag. Currently, New York State requires counties to help pay for Medicaid via property taxes. One of the amendments will prevent New York’s government from doing that, presumably leading to some tax relief for counties in the Empire State. To make up that tax revenue, the state government in Albany will have to find more money or cut Medicaid spending. Ryan inserted this change
Ryan inserted this change to woo the votes of upstate Republicans. On the one hand, you could call it the “Empire State Extortion”– it looks a lot like Obamacare’s “Cornhusker Kickback” and “Louisiana Purchase.” On the other hand, you might call it the “Albany Asskicking,” given the fiasco that is New York’s Medicaid program.
Unfortunately, the changes also decrease whatever little RINOcare did to lower the cost of health insurance. Under the original version of the RINOcare legislation, an individual or family who used a tax credit to purchase insurance and spent less than the amount of the credit could put the remainder in a Health Savings Account (HSA). This incentivizes not only consumers to shop around for the best deal but also insurers to lower the cost of insurance since doing both allows the consumer to build up savings in the HSA.
Well, guess what? One of the amendments “strikes [the] provision allowing excess tax credits to be deposited into” HSAs. The Senate GOP will likely use that money instead to increase tax credits for older Americans. Why? Because, well, the AARP!
Now that the incentive to look for lower-cost health insurance is all but gone from RINOcare, one wonders if Republicans backing the bill can still say it will lower the cost of premiums with a straight face.