Kominski weighs in on Senate health bill vote on CNN

[ Posted on August 1st, 2017 by Center Communications | No Comments » ]

cnn_GFKcloseupOn July 27, the night the latest Senate health care bill was voted down, Center Director Gerald Kominski discussed on a CNN International broadcast the bill’s rocky path, whether the Affordable Care Act works, and if a universal health care bill is on the horizon.

Kominski was part of an expert panel that included Politico reporter David Siders, Democratic strategists Caroline Heldman and Mathew Littman, Republican consultant John Thomas, California Republican National Committee’s Shawn Steel and anchors John Vause and Isa Soares.

See video excerpt at http://www.cnn.com/videos/world/2017/07/28/exp-does-the-affordable-care-act-work.cnn.

Some of Kominski’s comments from the broadcast:

John Vause: Gerald, how badly is Obamacare failing in reality? Republicans say it’s a death spiral. The Democrats say, no, it’s not. It can be fixed. Where does it stand?

Gerald Kominski: In my opinion, it’s working fairly well. Not perfectly. It’s not in a death spiral, but getting worse because of the rhetoric. It becomes a self-fulfilling prophecy when the president is tweeting ‘Let’s let it fail.’ This is not inspiring confidence in the markets and inspiring confidence in insurers and people who will be buying insurance in the exchanges later this year in open enrollment.

Vause: Speaker Ryan didn’t do a lot to put those concerns to rest either in the statements he put out. Gerald, the inability for the Republicans to get even the most minor reform to health care through the Senate and through the House, does this in a way move them closer to a single payer bill?

Kominski: It might. We couldn’t move closer and there is a lot of popular support for universal coverage in this country. Whether or not Medicare-for-all is the right way to do it or not, is an open question. There are many ways that countries around the world provide universal access to care. There are competitive models in a number of countries. But the key is that everyone has access, the government is providing the financing and we don’t rely markets when markets don’t exist. Obamacare is not failing because there’s a lack of competition. There is a lack of competition in a number of areas of the country prior to Obamacare. In the large group market, which serves about 160 million Americans, there are markets through the South and the rural areas where there are one or two insurers. That’s not competition. And Obamacare didn’t create those conditions.

Vause: Gerald, given the divisions (in the party), it’s seems an impossible task. How do they get that compromise?

Kominski: If this bill had gone forward, I don’t know how you reconcile the differences between the Senate Republicans and the House Republicans. I never saw a path where they could successfully resolve their internal differences. But I’ll also add I think that one of things that’s most shocking to me about this process to date is not that Democrats weren’t invited, but that that the major stakeholders in the health care system were completely shut out of this — doctors, hospitals, insurers, patient groups — everyone was excluded.

And as a result, we’ve seen the full-page ad in the New York Times saying ‘We’re against this because we’ve haven’t been involved, nobody’s consulted us about the health care system. We’re the ones who have been providing the health care — maybe you should consult with us.’

Vause: The skinny bill didn’t make it through. And let’s say it had, in its current form, as enacted in the House, what were Americans looking at? What was in this bill?

Kominski: There was very little in the bill. So the skinny bill was to repeal mandates and the provided benefits.

Vause: The things that make Obamacare work.

Kominski: Yes. The two features that have been popular and there has been consistent opposition to the individual mandate. Democratic polling has shown that supporters of Obamacare don’t like the individual mandate. It’s problematic. But there are ways of doing that differently. Democrats could work to change that requirement as well. But you need to have a penalty for people sitting on the sidelines and they will sit on the sidelines until they get sick.

Vause: Is the ACA still n trouble? it’s still the law of the land

Kominski: It is still the law of the land and it is in trouble. in the following sense: it has been destabilized this year because of everything that’s taken place for the first seven months. And we’ll have an open enrollment season that opes in November.

The president still has some authority to disrupt this market. There’s something known as cost-sharing reductions. If they stop, these markets will be more destabilized. If the government stops enforcing the individual mandate and lets that be widely know that destabilizes the market. It almost accomplishes what the republicans were trying to do with these bills.

This open enrollment season is going to be very challenging.

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