The Republicans have finally revealed their “repeal and replace” plan for the wholly-misnamed Affordable Care Act:
by Tami Luhby March 7, 2017: 9:52 AM ET
Republican lawmakers have long vowed that they can make health care more affordable and accessible. Americans will now see if Congress can keep that promise.
The House finally revealed its plan to repeal and replace major portions of the Affordable Care Act on Monday. While the bill will likely change a lot before it lands on President Trump’s desk, it’s already possible to see whom the winners and losers in the individual market and Medicaid could be.
Titled the American Health Care Act, the legislation calls for providing refundable tax credits based on a person’s age and income. It keeps the Obamacare protections for those with pre-existing conditions, but it allows insurers to levy a 30% surcharge for a year on the premiums of those who let their coverage lapse. It lifts the taxes that Obamacare had imposed on the wealthy, insurers and prescription drug manufacturers. And it loosens one of the law’s strict insurance reforms so that carriers can offer a wider array of policies that pick up less of the tab for getting care.
The bill also eliminates the enhanced federal match for Medicaid expansion starting in 2020 and revamps the funding for the entire Medicaid program.
The most glaring weakness of the GOP bill is that it will likely leave millions uninsured, experts said. Republican lawmakers have repeatedly skirted that question, but reviews of preliminary drafts by the Congressional Budget Office confirmed the problem, sources said.
“With Medicaid reductions and smaller tax credits, this bill would clearly result in fewer people insured than under the ACA,” said Larry Levitt, senior vice president at the Kaiser Family Foundation. “The House GOP proposal seeks to reduce what the federal government spends on health care, and that inevitably means more people uninsured.”
Experts remain divided over the impact on the individual market. Some say insurers would flee or jack up their rates if millions of people drop out. Others contend that the Republican bill would stabilize the market and premiums because the reforms would give insurers more flexibility and entice more younger enrollees to sign up for coverage.
“If we let the ACA continue on its current trajectory, people really will lose coverage,” said Doug Badger, senior fellow at the Galen Institute, a free-market, health-care think tank.
There’s plenty more at the link, but, as I’ve said many times before, there are only three options:
- The government guarantees access to health care through some form of single-payer plan, such as extending Medicare to cover everybody;
- The government guaranteed access to health care via the private insurance system, which is how the current Affordable Care Act works and how the Republican proposal would work; or
- The government does not guarantee access to health care, which would mean that some people would not have it, other than through emergency room visits.
It was always easy for the Republicans to pass repeals of the ACA as long as Barack Obama was in office, because they knew the repeals would be vetoed, or, prior to 2015, the repeal bills would never pass the Senate. Now they are stuck: they have their ‘repeal and replace’ promise, often made, that they have to keep, but they don’t want any responsibility for the replace part.
The Democrats now want to ‘fix’ the ACA, but the Republicans want no part of that. ‘Repeal and replace’ has been the GOP mantra on this, but while Hillary Clinton will probably win the presidency, and the Democrats have a chance to take control of the Senate, the Republicans are almost certain to retain control of the House of Representatives, and all that they have to do is pass nothing, and the ACA doesn’t get ‘fixed.’ Given that it is really irretrievably broken, fixing it is highly unlikely to work.
There are only two practical options remaining:
- Some sort of single-payer system, which is what the Democrats really wanted all along; or
- Nothing, a return to the when the government did not guarantee access to health care.
I have already said that I prefer the second option; I do not want the government providing health care for people who cannot or will not pay for insurance themselves. Alas! The Editor is one of the few people who will actually say that, in public, and stand behind his statement. The Republicans have pretty much conceded the principle that the government will guarantee access to health care; the ‘repeal and replace’ theme does include the replace part, and accepting that principle means that the only debate is over how to best provide that access.
Eventually, we will have single-payer. Oh, it will be messy getting there, and the system will probably be as rotten and graft-ridden as the one Sachi ab Hugh described for her family in Japan. We will see the same cost-cutting measures that shocked so many people1 when the Veterans’ Administration Hospitals stories broke because that is what governments have to do under single-payer systems, control and cut costs. We won’t like the healthcare that we’ll get, but it will be all that we’ll have.
I turned out to have been very wrong about the outcome of the election, but I wasn’t exactly the only person who was surprised. But what the Republicans have come up with to ‘replace’ Obaminablecare is little more than tweaking the program, trying to find a way to provide guaranteed access to health care without going to single-payer. They have agreed with the principle that the government is responsible for this, and are now scrambling to find a way to placate their base by having it different enough from the ACA that they can call it something other than Obamacare.
And I’ve often wondered: if the GOP hadn’t hung the name Obamacare on the ACA, for political purposes — purposes which did, in fact, work — could they have lived with the legislation enough to simply offer whatever fixes could be made,2 and work with the President they hated enough to perhaps make it less of a failure, but leaving it a program for which President Obama would continue to get the credit.
I’ll be plain and clear about this: I am opposed to the principle that the government should guarantee access to health care, and I am fully aware that not guaranteeing such means that some people will not get it. More, I am opposed even knowing that such opposition would mean that some people who cannot or will not pay for their health care would suffer more and die earlier; I am completely honest about that, especially to myself.
But if the government is going to guarantee health care, some form of single-payer plan is the most logical way to do so. It evens out regulations between states, it (should) simplify paperwork, and it (should) lower administrative costs for doctors, hospitals and other health care providers. It would mean much higher taxes, but those (should) be offset by the elimination of health insurance premiums.3 Businesses would find it a real boon, no longer having to maintain private health insurance for their employees, thus both lowering costs and leveling the playing field in competition with businesses which do not offer insurance. Of course, that’s far too simple, because businesses would see their taxes increased, since the government loves to hide taxes from the public by pretending that they are taxing those wicked ol’ corporations instead.
Going to single-payer would be a huge mess, but it is one which would straighten itself out eventually. Sticking with some form of reliance on the private insurance system will never get straightened out; there will always be complications as insurers try to find profit margins.
I very much dislike the notion that the government is going to guarantee access to health care, but if it is going to happen, we ought to do so in the most efficient way possible.
- They did not shock the Editor in the slightest, because the appointment-delaying techniques used by the VA were virtually identical to what Canada and the United Kingdom do to cut costs themselves. ↩
- This statement does not mean that I believe the ACA can be fixed; I do not. ↩
- At least, it would mean the elimination of premiums for those who now pay such premiums. ↩