The quick summary of our analysis of the Graham-Cassidy healthcare bill on independent workers is:
- Low and moderate income independent workers would likely be worse off due to the reductions in medicaid and elimination of subsidies provided by the ACA (Obamacare).
- Older independent workers (aged 50+) would likely be worse off due to potential changes in how insurance companies can charge older Americans.
- Those with preexisting conditions could be much worse off due to reduced protections related to preexisting conditions.
- Those who develop new healthcare problems could be much worse off due to reduced protections related to preexisting conditions.
- Young, healthy, relatively high earning independents are potentially better off.
- The number of independent workers and self-employed will likely decline due to problems getting health insurance as an independent worker.
This last issue is a big one for independent workers. One of the best features of Obamacare is it detaches health insurance from jobs, making health insurance portable. This greatly reduces health insurance related job lock, allowing more people to become self-employed and start small businesses.
It's likely under Graham-Cassidy the availability and portability of health insurance available to independent will be reduced, at least in some states and likely many states.
It's also likely that some states will allow insurance companies to charge more for preexisting conditions and also charge older independent worker more than allowed under Obamacare.
Combined, we think these changes will increase health insurance job lock and reduce the number of people who choose to become self-employed or start small businesses.
Because of these reasons, we think the Graham-Cassidy bill is bad for independent workers and the independent workforce.
Despite our negative view of the bill, there are parts of it we like. We think providing more flexibility to the states - a major objective of the bill - is a good idea.
But the bill seems at best half-baked, rushed and lacking specifics. For example, the reason we say "likely" and "could" above because the bill lacks the specifics required to analyze its impact on independent workers in a definitive way.
As hard as it is to believe, there's not even enough specific information to understand the bill's impact at a broad level on healthcare or health insurance.
John McCain summed up the lack of information nicely when he said last week:
“Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.”
Republican Senator Joni Ernst's response last week to a question about the impact of medicaid cuts is also telling:
“Well, I’d have to see the numbers ..."
In other words, she doesn't know. Nor will she know prior to the vote, which is planned for this week, because no new numbers will be available by then.
Normally the Congressional Budget Office (CBO) does an analysis of the impact of new bills. This isn't happening for the Graham-Cassidy bill because the Senate isn't giving the CBO enough time or information to do a detailed analysis prior to the vote.
Several groups outside of government have released analyses of the impact. All the groups who have done this have stressed their studies are speculative due to a lack of information around the bill's potential impacts.
Avalere Health's analysis shows that Medicaid funding to the states would be reduced by $713 billion over the next 10 years.
The Brookings Institution's analysis found the bill would reduce the number of people with insurance coverage by around 21 million.
The Kaiser Family Foundation's analysis shows the impacts of the bill on a state by state basis. Their analysis shows thirty-five states plus the District of Columbia would face a loss of funding and almost all states face a potential loss of federal funds for their traditional Medicaid programs.
All of these studies are quite negative on the bill.
We tried to find a positive analysis of the bill from a non-partisan source, but failed. This is because we've been unable find a non-partisan healthcare related group in favor of this bill.
The insurance industry, hospitals, consumer activists, the AARP advocacy group and organizations such as the American Medical Association, American Heart Association and American Cancer Society all oppose the bill.
Despite widespread opposition and a lack of understanding what the impact on the healthcare system would be, Republicans hope to pass this bill this week.
The reason is politics.
Passing this bill has become a political exercise with few on either side caring about what's actually in the bill. Republican Senator Chuck Grassley went as far to say:
“I could maybe give you 10 reasons why this bill shouldn’t be considered. … But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.
For those more interested in the substance of the Graham-Cassidy bill than our Senators appear to be, see the Kaiser Family Foundation's analysis.