STARKVILLE – My wife and I are in our 50s and chase grandchildren. So, in my health insurance, do I need maternity coverage? Does my wife need prostate exam coverage?
While the answers to both questions would seem an obvious “no” – the questions are worth examining both in the halls of Congress and around family dinner tables.
The national debate over the ongoing Republican-led congressional effort to “repeal and replace” the Obama administration’s Affordable Care Act with the new American Health Care Act is – whether by design or unintended consequences – producing a discussion of difficult issues that American taxpayers should be discussing.
There is a growing realization among liberal Democrats, conservative Republicans and the less easily defined fringes to both the left and the right of our country’s major political parties that health care is a complex issue not given to easy solutions that can be explained in soundbites or bumper sticker platitudes – but that doesn’t stop folks from trying.
In the wake of Hurricane Katrina, Mississippians were quickly drawn into the home and property insurance debate that was most easily defined by the “wind versus water” controversy and arguments over how national flood insurance and the state wind pool influenced that debate. Soon, fingers began to be pointed in every direction.
The narrative emerged that residents in north Mississippi were paying higher insurance rates to subsidize their Gulf Coast neighbors living in higher risk properties along the shore. The same kinds of narratives are now emanating from the national health insurance debate.
Few have missed the recent congressional hearings in which Republican Rep. John Shimkus of Illinois asked why it was necessary in the ACA health plans for men to pay for pre-natal care. That exchange was an echo of the 2013 congressional hearing in which former Health and Human Services Secretary Kathleen Sebelius was asked by another GOP representative: “Do men not have to buy maternity coverage? To the best of your knowledge, has a man ever delivered a baby?”
The missing piece of the puzzle is that ACA was an attempt to achieve universal health care coverage. In that attempt, making the actuarial math even approach balance required that, yes, men paid for pregnancy coverage just as women helped pay for prostate exams.
Men subsidized women and vice versa. Young subsidized old. Healthy subsidized unhealthy. The plan relied on the sharing of costs without reference to gender, age, reproductive intent or ability, or health status.
And as Republican now proceed with their “repeal and replace” effort, they are drawing fire from all sides – some complaining that AHCA does away with too much of what they considered “good” about Obamacare and others complaining that AHCA is too much like ACA and doesn’t represent any significant improvement. Some even say it creates additional problems.
In Mississippi, the health care debate is even more fundamental due to our state’s poverty. Medicaid is the second largest expenditure by the state after we pay for our educational systems. For those charged with public budgeting in Mississippi, there remains a bedrock fear is that an expanded public health care program would reduce resources for every other function of state government.
Many believe the repeal of Obamacare will mean higher premiums, deductibles, and cost-sharing for Mississippians on Medicare – including reviving the so-called “donut hole” in prescription drug coverage. Similar fears center on the Medicaid program, which nationally expanded Medicaid although Mississippi chose not to participate in expansion.
Although Medicaid and Medicare are federal programs, state lawmakers have routinely avoided any actions that got between state recipients and their benefits. There’s a reason for that.
Privately, experienced state lawmakers know that any reduction in federal funds for public health care creates hard choices at the state level between public health care and public education, highways, corrections, mental health, and the rest of state government.
State impacts of federal public health care decisions are also exacerbated by prior state decisions to cut taxes substantially, which reduces available revenue to fund all facets of state government.
Sid Salter is a syndicated columnist. Contact him firstname.lastname@example.org.