False narrative that past Cassidy bills resemble Obamacare

Being that Republican Senate candidate Rep. Bill Cassidy actually has practiced medicine for a quarter century or so with a high volume of Medicaid patients, as compared to his opponent Democrat Sen. Mary Landrieu who has been in elected office almost from the day she graduated college, it’s not surprising that during his short stint in the Louisiana Legislature he authored a pair bills dealing with health care provision. But to make any attempt to equate those two to the Patient Protection and Affordable Care Act (“Obamacare”) that he now campaigns against demonstrates a distinct lack of understanding both about the many flaws of Obamacare and therefore why Cassidy opposes it.

In 2007, Cassidy introduced SB 307, which would have created a health care exchange run by the state, designed for participating entities to buy and sell health insurance. Its operation would be funded through own revenues (presumably a fee attached to policies sold this way) and primarily was aimed at Medicaid recipients; in those days, the state operated Medicaid as a fee-for-service arrangement where providers performed whatever actual and presumed needed services in any way they wanted then billed the state, no questions asked.

In 2008, he introduced SB 535, which would have changed from optional to a requirement that employers of fewer than 50 offer specified mental health insurance benefits, and would add on more if and when the state offered a tax credit equal to the premium increase, if an employer offered health insurance. Neither bill was passed into law.

Neither bill also resembles much Obamacare’s onerous and counterproductive provisions. First, in the bills the only mandatory aspect was the 50 or fewer requirement for mental health benefits if the employer offered insurance. Individuals were not required to have insurance and to enter a health exchange if they did not purchase it another way or face fines. What makes Obamacare particularly noxious (besides being bad policy authorized through bad jurisprudence) is it forces people to buy something or penalizes them, violating their liberty. Nothing in Cassidy’s bills argued for that: it did not require individuals to have insurance, nor for employers to have to provide it.

Second, SB 307 was designed realistically to be self-sustaining. Obamacare will cost taxpayers a currently estimated $1.8 trillion extra over the next decade when realistically appraised. Nor did SB 307 include provisions that would have the effect of raising premium prices on average.

Finally, SB 307 was aimed primarily at the state’s Medicaid program as it then existed, where it directed the state to find ways to put its Medicaid population into an exchange, using a premium support plan if found effective. And, in large degree, that’s what happened since with the introduction of the Bayou Health program that has transferred about three-quarters of Medicaid clients into its managed capitation regime that in essence includes premium support: the state provides funds to buy insurance from any of five plan providers, and the administrators take it from there. This resulted in $135 million of savings last year. By contrast, Obamacare simply wished to expand the Medicaid population without cost savings reforms, which Louisiana correctly rejected.

So, contrary to some media assertions, there’s not much similar between these bills and Obamacare, and thus little that Cassidy or other Republicans would wish to repeal that he endorsed in some fashion previously. Unlike Obamacare, Cassidy’s bills never forced employers to offer a defined set of benefits and coverage, except for the mental health ones for small employers already offering insurance, never forced people to have insurance or to pay a penalty, never mandated universal coverage set at community rates (that is, insurers could not price actual risk into rates), and did not raise costs to taxpayers and probably would have passed on just a small increase to those who voluntarily used the exchange.

Republicans generally, and apparently Cassidy as well, argue against Obamacare precisely because it raises costs on Americans while reducing choices, empowering government at the expense of the people. Rather than understand and accept this, proponents of Obamacare often try to make out a straw man that opponents criticize it only because Democrats enacted “health care reform” first. This inaccurately drives any implication that Cassidy opposes something he once supported, and is used as a tactic to re-elect Landrieu.