U.S. Sen. Bill Cassidy laid out his criteria last week for supporting the Senate’s healthcare bill, the Better Care Reconciliation Act, telling The Advocate: “I will study the bill to determine whether it fulfills President Trump’s campaign promises to lower premiums, maintain coverage and protect those with preexisting conditions without mandates.” The bill plainly fails that test.  Average marketplace premiums are projected to rise 105 percent in Louisiana, 22 million people are projected to lose coverage, and there’s a  loophole in the bill that exposes people with pre-existing medical conditions to higher costs.

There’s also a new penalty in the bill that requires people to wait six months before obtaining coverage if their insurance lapses for more than two months.

Last week Cassidy gave a Senate floor speech in which he decried the political partisanship that has overtaken the healthcare debate on Capitol Hill and the need to keep “the patient as the focus.” While few would dispute that sentiment, several other points raised by Sen. Cassidy require further evaluation.

Cassidy claims that Medicaid expansion is unsustainable for Louisiana.

In fact, expansion – which provides coverage for more than 433,000 Louisianans – is actually saving our state money. The state’s cost share will increase from 5 percent to 10 percent by 2020, and the projected cost to Louisiana under current law will be just over $400 million by 2024. When fees from insurers, which will cover more than half the state’s costs, and cost savings are taken into account, Louisiana’s Medicaid expansion is sustainable beyond 2020. Alternatively, with the enhanced federal match eliminated under the Senate bill, the Medicaid expansion would cost the state a total of $1.3 billion annually by 2024, an amount that would make it virtually impossible for the state to sustain.

Sen. Cassidy said health reform must offer relief to “Brian in Covington,” who is struggling with $1,700 a month premiums for his family’s health insurance. He pointed out that Brian is cutting through the “political noise” and asking for a solution to help the middle class afford health insurance.  So, would the Senate’s bill bring down Brian’s premiums?

Because he pays a premium of $1,700 per month, we know that Brian earns more than four times the federal poverty line, which is the cutoff for receiving federal subsidies under the current law (under the Senate bill, the cutoff would be reduced to 350 percent of the poverty line). If Brian and his partner are 40 years old, his premiums would stay almost exactly the same under the Senate bill, according to Congressional Budget Office (CBO) projections. If they are 60 years old, however, Brian would see a substantial increase in premiums. That’s because the bill eliminates the mandate that people buy insurance or face a penalty, which means fewer young and healthy people will likely enroll. That, in turn, makes the “risk pool” smaller and pushes up costs for those who remain. Also, Brian’s premiums will go up because the BCRA increases the “age tax,” by allowing insurers to charge him five times more than a younger person, compared to just three times more under the ACA.  Overall, the Kaiser Family Foundation estimates that average monthly after-tax-credit marketplace premiums would be 105 percent higher in Louisiana compared to current law.

Sen. Cassidy said any healthcare bill must meet the “Jimmy Kimmel test” – which the senator defines as Brian and his family having adequate coverage to pay for needed care in case of a terrible illness (Kimmel himself defines the test as “No family should be denied medical care, emergency or otherwise, because they can’t afford it.”) In another interview Cassidy said the Senate bill “begins to address the Jimmy Kimmel test,” but that was before the Congressional Budget Office report was released.  So now that we have more information, does the Senate bill satisfy the Kimmel test?

The CBO makes clear that the waiver process established in the Senate bill could leave people with pre-existing conditions without adequate coverage to pay for the care they need, saying:

“States would be allowed to meet fewer criteria to waive the ACA’s requirement establishing essential health benefits and many other requirements related to subsidies and the marketplaces…People who used services or benefits no longer included in the essential health benefits would experience substantial increases in supplemental premiums or out-of-pocket spending on health care, or would choose to forgo the services.”

So in addition to paying the same or higher for premiums, Brian could face much higher out-of-pocket costs – and even medical bankruptcy – if he or a family member became seriously ill.

The Senate bill also fails the Jimmy Kimmel test because it would leave Louisianans with pre-existing conditions who rely on Medicaid at risk of losing insurance altogether. At least 30 percent of Medicaid expansion enrollees have a pre-existing condition, like the rest of the state’s adult population. The Senate bill would phase out the expansion, leaving the vast majority of enrollees uninsured and lacking the access to care that comes with having coverage.  

Before he saw the actual text of the Senate bill, Sen. Cassidy said it would be more kind than the House-passed American Health Care Act. He predicted it would lower premiums, and would be “cognizant” of pre-existing conditions. Now that the Senate bill is public and has been reviewed by the  CBO, it’s safe to say it has not lived up to the senator’s expectations.

-Jeanie Donovan