Thread by @charles_gaba

MICHIGAN: John James tries explaining his position on healthcare policy again. It does not go well. acasignups.net/20/10/19/michi…

A lot of people have seen this clip of @JohnJamesMI (who's running for the U.S. Senate for the 2nd time) blurting out "I'm not a politician!" in response to being asked what he plans on replacing the #ACA with if it's struck down, as he has called for...

https://twitter.com/elenakuhn/status/1317852142867283970

...however, that clip was cut off pretty abruptly, so I watched the entire segment to see if his *full* response was any better.

Short answer: It's *even worse* when you watch the whole thing in context.

James claims Sen. Stabenow lied 2 yrs ago when she said he'd vote to remove protections for those w/pre-existing conditions...except there's only 1 federal law which has those protections, the #ACA, which he supported striking down *in full* at the time w/out a replacement plan.

James NOW says we must *keep* the part of the #ACA which protects coverage of pre-existing conditions...except that's the very part of the ACA which the Trump Admin & plaintiffs in the case are most focused on having struck down. They want it *all* gone, but that most of all.

James calls for a "patient-centered", "market-based" system. The former has no meaning whatsoever. The latter is *exactly what we had BEFORE the ACA*. The best way to make health insurance "market-based" is to...remove protections for coverage of pre-existing conditions.

James then rattles off several of his "ideas" for replacing the ACA:
--"Association Plans"
--"Tax Reform"
--"Tort Reform"
--"Regulatory Reform"
--"Selling Across State Lines"

There's so much dust on these you'd need a DustBuster® to clean them off.

"Association Plans" were already allowed to a limited extent under the ACA, and have been expanded under Trump. Guess what? They have a long history of fraud & incompetence. James wants to *reduce* regulation, which would make this problem *worse*:
modernhealthcare.com/article/201806…

"Selling Across State Lines" is an old GOP chestnut. The idea is that someone from Michigan should be able to buy the same dirt-cheap policy available in Mississippi.

Yeah, there's a couple of kind of important problems with this:
acasignups.net/19/03/08/updat…

Problem #1: While there are some "multi-state plans" available, an inexpensive Mississippi-based insurance policy doesn't do a Michigander much good unless he wants to drive 1,000 miles every time he needs to visit an in-network doctor.

This unveils Problem #2: In order to make such a system practical, the MS-based insurance carrier would have to also arrange for a bunch of doctors/hospitals in *Michigan* to be in their network...which operate under Michigan regulations. This is a major hassle.

As it happens, the #ACA ALREADY ALLOWS FOR CARRIERS TO SELL ACROSS STATE LINES via interstate compacts....and in fact, 5 states have already enacted such compacts (GA, KY, ME, RI & WY)...

...except that due to Problems #1 & 2, *not a single insurance carrier has expressed any interest in doing so*.

Instead, they simply set up subsidiary carriers in other states, which I presume is why there's "BCBS of Oregon" operating in Washington State, for instance.

That brings me to "Tort Reform", which the GOP has been obsessed with since at least the 1980's. In healthcare, it generally refers to restricting medical malpractice awards and making it more difficult to sue doctors/hospitals.

The idea is that this would reduce doctor/hospital overhead, which would lower healthcare costs, which would lead to lower premiums/deductibles/etc for health insurance.

Again, there's some problems with this logic, especially re. the actual question of pre-existing conditions.

First of all, the TOTAL cost of medical malpractice--including insurance premiums, settlements, legal expenses, etc--is only around 2.4% of all healthcare spending nationally (this is from 2008, but it's my understanding that it's an even smaller % today)
ncbi.nlm.nih.gov/pmc/articles/P…

This means that even if you outright BANNED the ability to sue doctors/hospitals for malpractice altogether nationally, you'd only shave 2.4% *at most* off of total spending...assuming they passed 100% of the savings along to the consumer, which is...unlikely.

More to the point, however, TORT REFORM HAS NOTHING TO DO WITH MANDATING COVERAGE OF PRE-EXISTING CONDITIONS.

The tortured logic James is presumably using is:

Reduce provider overhead > reduced rates > reduced carrier overhead > carriers being more willing to take on risk (?)

The first three steps above take an incredible amount of naivety. The fourth requires an incredible leap of logic.

At the *very* most, insurance carriers *might* see their overhead go down ~2% or so. This could lead to slightly lower premiums (maybe), but that'd be about it.

James then praises himself for providing healthcare coverage for his employees...which he's only required to do because of the #ACA (to be fair, I'm willing to assume that his company already did so pre-ACA as well).

James then attacks @GaryPeters as a "hypocrite" for not being enrolled in an #ACA exchange plan (Peters is in a plan he's entitled to as a former MI state Senator).

This is just stupid. The ACA requires you to be enrolled in an ACA-*compliant* plan, not an ACA *exchange* plan.

You know who else isn't enrolled in an ACA *exchange* plan specifically?
Everyone enrolled in employer-based coverage.
Everyone enrolled in Medicare.
Everyone enrolled in Medicaid.
Everyone enrolled in CHIP.
Everyone enrolled in TriCare or the VA.

All of those are ACA-compliant.

Only around 10 million people or so are enrolled in ACA-*exchange* plans specifically. As long as Peters is enrolled in a plan *at least as comprehensive* as the ACA requires, what's the problem? ACA exchange plans are targeted towards people not in those other categories.

Oh yes, then, after comparing health insurance to "decorating your house", @JohnJamesMI issues THIS jaw-dropper:

Yes, that's right: JOHN JAMES, WHO OPPOSES HAVING THE RIGHT TO HAVE AN ABORTION EVEN IN CASES OF RAPE OR INCEST, says that "medical decision choices should be up to you, not the federal government".
elle.com/culture/career…

FINALLY, James makes the most bald-faced lie of all: He claims *Democrats* aren't trying to fix the parts of the #ACA which don't work...when House Dems JUST PASSED #HR1425, the ACA 2.0 bill, which repairs, protects and dramatically strengthens the law.
acasignups.net/20/06/30/victo…

The short version of all this is HELP RE-ELECT @GARYPETERS by donating to his campaign (as well as other Michigan Dems) today: secure.actblue.com/donate/miforbi…