Health care expert translates Hugin Republican-Speak into truth that he would fall in line with Trump, GOP to repeal ACA, protections for pre-existing conditions & gut Medicaid
New Brunswick, NJ – In a scathing op-ed for the Record, health care policy expert Andrew Sprung called out Bob Hugin, a “prominent supporter of President Trump and an aspiring member of a Republican-controlled Senate” for misleading voters with “Republican-speak” on health care that amounts to same policies pushed by Trump and Republican leaders that would repeal the Affordable Act and gut Medicaid.
Sprung underscores that several health care goals touted by Hugin are Republican-speak for gutting Medicaid, imposing new work requirements, raising premiums and reducing coverage.
Opinion: Three healthcare questions for Bob Hugin
By Andrew Sprung
Special to The North Jersey Record
Bob Hugin, the former Celgene CEO seeking to take Bob Menendez’s New Jersey Senate seat, talks a moderate game on healthcare. He doesn’t trash-talk the Affordable Care Act, and he touts “value-based payment” and preventive care — pious goals to which politicians in both parties pay tribute.
Hugin is also a prominent supporter of President Trump and an aspiring member of a Republican-controlled Senate. Republicans’ recent failed bills and stated goals — such as repeal of the ACA and massive cuts to Medicaid — cut against Hugin’s assertions that healthcare should be affordable and accessible to everyone.
Hugin focused on healthcare in a Sept. 26 roundtable in Glen Ridge and in an October 7 op-ed. Below, some followup questions.
- “I cannot envision any changes to our health system today that would not protect people with pre-existing conditions.”
Almost all Republicans now running for office say this. But a lawsuit filed by 20 Republican attorneys general and governors seeks to have the entire ACA declared unconstitutional, while the Trump administration has asked that only the ACA’s protections for preexisting conditions be struck down.
Republican senators recently introduced a bill purporting to enshrine equal access to insurance for people with pre-existing conditions — but also allowing insurers to exclude an applicant’s pre-existing condition from coverage. In the House, Greg Walden’s bill, the “Pre-existing Conditions Protection Act,” allows insurers to charge more to people with pre-existing conditions. Does Hugin support these bills?
- Re Medicaid: “Giving states flexibility to be innovative and deliver more choice at a better value will enable them to provide better care while also being cost effective to the taxpayer.”
In Republican-speak, “state flexibility” in Medicaid means converting federal Medicaid funding to block grants or imposing “per capita” caps on it.
At present, federal Medicaid funding is determined by a “match rate” — the feds’ share of each state’s Medicaid spending (ranging from 50% to 74%), which the feds must pay for all qualifying enrollees.
Block grants and per capita caps would set a fixed amount to be paid each state, or a fixed amount per person, with a yearly inflation adjustment designed to lag behind real cost growth.
In 2017, Republican ACA repeal bills that passed the House and nearly passed the Senate imposed per capita caps on Medicaid. The Congressional Budget Office estimated that the Senate repeal bill would cut Medicaid spending by 35% over 20 years — a $2.1 trillion cut by one estimate.
Medicaid covers 75 million Americans, including 38% of the nation’s children and 62% of nursing home residents. Capping or block-granting the federal contribution would force relentless cutbacks on states. Does Mr. Hugin favor these measures?
“State flexibility” is also now code for imposing work requirements on certain Medicaid enrollees — which the Trump administration, breaking with long tradition, has recently encouraged states to implement. These requirements, — for example, that “able-bodied” enrollees work 80 hours per month and report their hours online — are designed to throw people off the rolls. In fact the vast majority of Medicaid enrollees who are able to work and are subject to states’ implemented or pending work requirements do work or have good reasons for not doing so. There is evidence, too, that Medicaid enrollment makes people more able and more likely to work. To date, 14 states have approved or pending proposals to impose work requirements. Does Mr. Hugin approve these measures?
In an October 24 debate, Mr. Hugin said that he would not change Medicaid. How does that square with calling for more flexibility for states?
- Hugin “said he’d eliminate what he called the [ACA’s] biggest faults — such as making the sickest patients and the working poor shoulder too much cost.”
ACA cost-sharing does not vary according to health. As for the “working poor,” the ACA subsidizes premiums for those earning up to four times the Federal Poverty Level — $100,400 for a family of four in 2019. Subsidized solo enrollees pay an average of $89 per month, with the government kicking in $550.
For those who do not qualify for subsidies, coverage is indeed very expensive — in large part because of Republican sabotage in 2018 and prior. Would Hugin subsidize plans more heavily, and to higher incomes, than does the ACA?
Hugin says he’d “introduce legislation to cap co-pays at $50 per prescription and limit monthly out-of-pocket expenses.” By how much? The ACA imposes a maximum annual per person out-of-pocket limit of $7,350 in 2018. For those with incomes below 200% of the poverty level, the limit is $2,450 if they select silver plans.
Lower limits would require either raising premiums or improving subsidies. If that’s Hugin’s intent, he’d better switch parties. Republican ACA repeal bills would have sharply raised premiums and out-of-pocket costs.
Hugin has not said that he won’t support ACA repeal bills that Republicans are certain to introduce if they retain control of Congress. He has not spoken out against the $1.5 trillion in Medicaid cuts and $537 billion in cuts to Medicare over 10 years included in the 2019 Republican House budget, or against capping federal Medicaid spending generally. By making vague promises to preserve protections for people with pre-existing conditions, and to seek to create new subsidies that are out of keeping with Republican past behavior and current plans, he’s creating an impression of moderation in a party that will brook none.
Andrew Sprung is a health care policy writer who blogs at xpostfactoid and healthinsurance.org. He also co-chairs the healthcare committee at BlueWaveNJ. Follow him on Twitter: @xpostfactoid
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