The fate of the GOP’s health reform plan right now hinges on Sen. John McCain’s recovery from a blood clot surgery. It’s also the perfect reminder of just how critical insurance can be — and how much protection from health emergencies Americans stand to lose with the Better Care Act, the Senate Republicans’ plan to dismantle Obamacare.
According to a press release from McCain’s office, the senator had a craniotomy to remove a blood clot from above his left eye on Friday, July 14, at the Mayo Clinic in Phoenix, Arizona. He’s now “recovering comfortably at home.”
This weekend, Senate Majority Leader Mitch McConnell announced that he’d delay the vote on the contentious Better Care Act until the Arizona Republican had returned to the Hill and could vote to start debate on the bill. (McConnell needs all the supportive votes he can get.)
There are at least four deeply ironic things about McCain’s health scare:
1) As Vox’s Dylan Scott explained, nothing less than a health emergency has thrown the GOP’s health reform plan into disarray.
2) The senator’s blood clot was discovered during a routine physical, which is exactly the type of preventive service Obamacare expanded and the Better Care Act could curtail.
3) The craniotomy sounds like an emergency surgery (though McCain’s office would not confirm that and sent me to their press release). Obamacare required insurance plans sold in the individual market, the fully insured small-group market, and through Medicaid to cover a list of 10 “essential health benefits”, including emergency services like this. The Better Care Act would allow health insurers to once again sell skimpier insurance that might not have such comprehensive benefits.
4) Life-saving surgeries like these would also be out of reach for more people if the GOP plan were to pass, since it’s expected to leave millions more Americans without insurance compared to Obamacare.
To find out just how much the procedure would cost someone without insurance, we looked to CMS, which publishes Medicare payments for more than 3,000 hospitals for inpatient procedures.
At the Mayo Clinic in Phoenix (line 1598 of this spreadsheet), the most recent data (2014) suggests the average Medicare charge for a craniotomy was $76,119, while average payments ranged from $25,932 to $33,958.
For help interpreting these costs, I called up Jeanne Pinder, the founder and CEO of clearhealthcosts.com. She said this kind of variation is completely normal in the US, and that an uninsured American would be “very fortunate” to pay that Medicare amount for the bill. So they could be on the hook for more than $76,000. (We asked Mayo Clinic to confirm the average cost of the procedure and haven’t heard back. McCain’s office referred us to their press release.)
Obamacare made health insurance plans more robust by requiring insurers to cover a basic array of services for people, including emergency services. Obamacare also helped expand access to insurance through Medicaid, the government health insurance program for the poor, as well as through the individual marketplace. The GOP’s Better Care plan would loosen some of those requirements for basic insurance coverage and roll back the Medicaid expansion, which is expected to leave more people on the hook for their hospital bills and fewer people with health insurance.
That means that if McCain happened to be one of his uninsured or under-insured constituents, he could be paying some $76,000 — more than the average annual household income in America.
*Caveat about the price estimate: Finding the precise price of a procedure in America can be an exercise in futility: Different hospitals charge different patients different prices on different days. We decided to go with the Medicare rate, though, since this is often used as a benchmark by experts for the cost of a procedure and it’s what the government considers reasonable to pay for a service. But a hospital could apply tens or hundreds of billing codes for a complicated episode of care like the one McCain received, so the cost of the craniotomy alone is really just a ballpark.