Cassidy Lays Out His Vision for Health Care Reform
WASHINGTON, DC – With Congress debating how to repeal and replace the Affordable Care Act, U.S. Senator and veteran physician Bill Cassidy (LA) appeared before a breakfast meeting of The Ripon Society yesterday morning to lay out his vision for health care reform and his view of the reform legislation that is currently being considered in the House.
“I’m a pragmatic guy,” Cassidy stated. “I’m a doctor. If someone is bleeding, you do what you have to do. If someone falls on the ground, you do what you have to do. And you don’t debate whether or not they have a right to health care. You do what you have to do. Frankly, that’s what society has decided. Wherever we go in the philosophical debate as to whether or not we have established a right to health care, functionally, Congress has established a right to health care.
“I say that because just think of what I’m about to list. We have Medicare and Medicaid. We have Tricare. We have the VA. We have the Indian Health Service. We have 340-B, which subsidizes health care for others. I can keep going down the list. If you’re totally uninsured, and you walk into an emergency room, EMTALA laws say that you have to be treated. If you need to be hospitalized, you will be hospitalized. And when you’re hospitalized, it may cost $100,000. If you have no money and you cannot get on Medicaid, society will pay.
“Functionally, we’ve established that there is a right to health care – period. I say that as a physician who worked in a hospital for the uninsured for 25 to 30 years. As long as the doors of that emergency room were open, we saw the COPD patients, the diabetic, the hypertensive, the heart failure, the car wreck, the burn patient, the schizophrenic, the drug overdose – we treated them all. By the way, we didn’t treat them for free … society pays for that care.”
Cassidy was elected to the Senate in 2014 after serving three terms in the U.S. House. He has spent nearly three decades providing care for uninsured and underinsured patients in Louisiana’s charity hospital system. He is also the co-founder of the Greater Baton Rouge Community Clinic, which provides free dental and health care to the working uninsured.
In addition to talking about how this own experience as a doctor has shaped his approach to health care reform, Cassidy also talked about President Trump’s approach to the issue and the goals that Trump set forth as a candidate last year. These goals, he noted, included providing coverage for all Americans, including those with preexisting conditions. The goals also included lowering the cost of coverage – a problem, Cassidy indicated, that he has heard plenty about.
“The American people are sick of paying higher premiums,” the Louisiana lawmaker declared. “If I could channel the American people you would see steam blowing out of my ears, because the Obamacare law has raised their premiums.”
To that end, Cassidy said there are three basic ways to lower premiums.
“One, you’ve got to lower the cost of care,” he stated. “Two, you have to improve competition or lower the cost of insurance, independently lowering the cost of care. And the third way you can do it is by changing the regulatory environment.”
“So how do you lower the cost of care? One thing I’ve advocated for in legislation I’ve advanced is price transparency. We have opaqueness now, where some people know the price, but the consumer does not. And that consumer can either be the patient, or the consumer can be the employer paying 80% of the employee’s coverage. But the people who are paying do not know the cost.”
According to Cassidy, another way to lower the cost of premiums is to encourage competition among insurance companies.
“If there’s only one insurance company in a county, that insurance company is going to set the price. That’s just market economics. If there are two, you have a little competition. And three, even more so. If you look where Obamacare has been said to be successful, it’s in urban areas, and California and New York. In New York, I think they have 10 different insurance companies competing for people’s business. That really works. If you look at rural counties in Louisiana, you’re often down to one. An occasional county is down to zero, unless they give them whatever they want in terms of premium increases, at which point they attract one back.
“So as we again look at the bill that I advanced with five other Senators, we give tax credits to the individual, allowing her to choose her insurance plan. What we hope to do is to reignite competition. There will be some insurance broker out there who would say, ‘Listen, I could put together a provider network. I would have these pre-funded health saving accounts that I could be the fiduciary agent for, and make money managing the money.’ There are banks, insurance brokers, and other institutions that would like that. It invites competition back in. I’m not sure the House plan does that, because the plan gives the money directly to an insurance company. That means the current players play, but you don’t invite new players in. That’s not a fiscally conservative kind of pro-market approach.”
Cassidy expressed concern with one other provision recently added to the House GOP health care proposal – the provision that would give states the option to require people to work in order to receive Medicaid benefits.
“I think the work requirement kind of conflates health care economics with that of, say, food stamps,” the Louisiana physician stated. “Implicit in a work requirement is that a healthy young man is freeloading when he gets coverage. The reality is that the sick 58 year-old guy is freeloading on the healthy young man as I offload my excess cost of care to the healthy young man. So if we put in a work requirement and take out all those young healthy people, there goes your premium. Because the only folks in the pool now are guys like me – with arthritis, and a couple knee surgeries, and at risk of a heart attack. So I take a little bit of issue with this enthusiasm for a work requirement, because I think it works against your actuarial pool.”
Cassidy concluded his remarks by returning to the basic importance of health care reform and the promise that was made to the American people during last year’s campaign.
“We have to fulfill Trump’s pledge in a fiscally conservative way that lowers premiums,” he said. “I think that the fiscally conservative way to manage this is to recognize that Congress has created a right to health care, that we’re going to pay it for one way or another, and that it’s better to give someone coverage so their diabetes is managed as an out-patient, as opposed to not being managed and they end up in the emergency room episodically and hospitalized.
“So we want to give them coverage that’s fiscally conservative, and we’re going to lower the costs of care. We’re going to lower premiums by lowering the cost of care, increasing competition, expanding our actuarial pools, and then rely upon the Administration to decrease the regulatory burden. I’m not sure the House bill is going to achieve that. I don’t see anything that actually lowers the regulatory environment, increases competition among insurance companies, or expands the actuarial pool. It certainly decreases the amount of subsidies the working poor receive to purchase their insurance, which in turn, I think, will worsen the actuarial pools. Only the sick will buy in. But that’s the debate before the House right now.”
To view the remarks of Senator Cassidy before The Ripon Society’s breakfast discussion yesterday morning, please click on the link below:
The Ripon Society is a public policy organization that was founded in 1962 and takes its name from the town where the Republican Party was born in 1854 – Ripon, Wisconsin. One of the main goals of The Ripon Society is to promote the ideas and principles that have made America great and contributed to the GOP’s success. These ideas include keeping our nation secure, keeping taxes low and having a federal government that is smaller, smarter and more accountable to the people.