Senate Republicans have announced that they are delaying a vote on their health care plan by at least a week. The news comes after several Senators had second thoughts because a report from the Congressional Budget Office suggested that under the GOP plan 22 million people would not have health insurance.
The U.S. Bishops cited the 22 million figure as “simply unacceptable” in a press release attacking the GOP plan. The brief USCCB statement came from Bishop Frank Dewane of the Diocese of Venice, who heads the conference’s “Domestic Justice and Humane Development Committee.”
The focus of Bishop Dewane’s statement is on CBO’s coverage estimates. According to the scorekeeper’s report, 22 million Americans will lose health insurance coverage under BCRA. Understandably, such a decimation of basic health insurance coverage would create a public policy crisis and the bishops are right to be sensitive to it.
But what Bishop Dewane might not realize, the CBO has a horrible record of estimating coverage changes under health care legislation — as health policy experts like Avik Roy, Doug Badger, and Grace-Marie Turner have all pointed out. As President Trump cited last night, the CBO originally thought 30 million Americans would gain coverage by now under Obamacare, when the actual number is 22 million–a full 8 million short.
Additionally, Avik Roy points out that CBO came up with nearly identical coverage numbers for Obamacare repeal with no replace (24 million new uninsured), Obamacare repeal with the House version of replace (23 million uninsured), and Obamacare repeal with the Senate version of replace (22 million uninsured).
In other words, the CBO would have us believe spending over $600 billion in a decade to buy people insurance results in the same coverage numbers as spending $0 on people.
That’s absurd. And it should cause any CBO coverage numbers to be dismissed, without irony, as fake news.
The reason these coverage numbers keep coming out the way they do is because the CBO is staffed by health policy experts hired by Democrat-appointed CBO directors during the run-up to Obamacare. They in turn developed a coverage model highly dependent on the much-hated individual mandate and which assumes that most states will expand their Medicaid populations.
In fact, fully 15 of the 22 million new uninsured arise under the CBO’s model solely due to the repeal of the individual mandate–meaning people are choosing voluntarily to not buy a product when the government stops forcing them to.
Having a better command of facts like these could help the Bishops craft statements that illuminate the debate, rather than needlessly inflame it.
So what should an informed Catholic think about the bill?
The first answer is that this is an area, almost by definition, of prudential judgment. A Catholic lay healthcare expert in good conscience can be for single payer health care, HSAs for all, or almost anything in between. More politically liberal Catholics seem to think they have a monopoly on turning Catholic social doctrine into law, but that’s simply not true. There is a wide range of ways to, in good conscience, live out the social teachings of the Church in the area of public policy. The Church–and especially the clergy, to avoid the hated moniker of “clericalism”–should really respect the freedom of the expert laity to do so.
Another consideration is the status quo. Obamacare is absolutely failing for millions of people. According to the Department of Health and Human Services, some 1200 counties in the United States will have one or zero health insurance providers in their individual markets in 2018. That’s 40 percent of the counties in the whole country. These are people who need access to much better and more robust health insurance markets than they have today.
Then there are the poor. There are 3 million Americans who live below the poverty line, but who do not qualify for Medicaid in their state. Obamacare does nothing for them, as the tax credit starts above the poverty line level. In other words, the Americans who most need help purchasing health insurance get no help at all.
Even for those who can get health insurance, it is increasingly unaffordable for families (especially families who are generous and open to the gift of life). In Virginia’s northern suburbs, the least expensive plan for a typical family of four has premiums of $12,000 and a deductible of over $8000. This plan is being dropped in 2018, and any new insurance plan is likely to have even higher premiums and deductibles. This is simply not affordable for families who don’t make multiple six-figure salaries.
Where’s the solidarity with these people? Shouldn’t the USCCB be focused on the people hurting today under Obamacare, and not the obviously flawed projection numbers of government bean counters? What about the Catholic families who live in one of the 1200 counties with zero or one insurance company? What about the Catholic families living below the poverty line and given no help with their health insurance costs? What about the Catholic families who can’t afford coverage after paying the bills and raising all the kids they vowed on their wedding day that they would accept lovingly from God?
BCRA is not a perfect bill, but it addresses all of these areas. It stabilizes insurance in the short term, bringing back multiple providers to these 1200 counties and stopping that number from growing. It for the first time extends health insurance subsidies–generous ones–to families living below the poverty line. It sets up a system where states can better tailor their individual markets and lower premiums for families. It gives states resources to establish mechanisms like chronically ill pools and reinsurance to further lower costs. It for the first time puts Medicaid on a sustainable fiscal path while turning over administration of the program to the states.
The theme of BCRA, actually, is the dual Catholic social justice goals of subsidiarity and solidarity. Means are provided to help states cover poor and working class people, but states are also given more latitude and responsibilities in this regard. States are the appropriate innovators here, and have the best and closest interaction with people who most need the help.
The alternative to passing BCRA is a continuation of the failures we have seen in Obamacare, and that will continue to hurt millions of families. More counties will become health insurance deserts. The poor will continue to have neither Medicaid nor subsidies in many states. The Catholic child-rearing middle class will get more and more priced out of having insurance at all.
It’s time that Bishop Dewane and the USCCB took a more nuanced view of this issue. The facts are there.