Last week, after eight years of criticizing Obamacare without ever offering an alternative, and after voting to repeal Obamacare more than 60 times, congressional Republicans finally released their plan to replace Obamacare. It’s called the American Health Care Act, which seems innocent enough until you realize that it’s even worse than most people anticipated.
On Monday, the Congressional Budget Office (CBO) released a report estimating the Republican proposal’s impact. According to the report, the AHCA, or Trumpcare, would result in 24 million people losing insurance over the coming decade, including 14 million who will lose their insurance within the first year of implementation.
A large portion of those losing coverage will be millions of people currently covered by Medicaid, which Republicans plan to cut by almost a trillion dollars. But, the health bill’s primary architect, Speaker of the House Paul Ryan, feels no shame over the devastation that the bill will cause. In fact, he’s quite proud of it and in a recent radio interview with conservative talk show host Hugh Hewitt explained exactly why he’s so excited. “Let me just describe exactly what this bill does for conservatives,” he said. “This is why I’m so excited about it and this is why I think people need to see the forest through the trees. We are de-federalizing an entitlement.”
Paul Ryan is absolutely giddy about the thought of ending Medicaid, a program which, among other things, covers the birth of one out of every two babies born in the United States.
It’s not clear if the Medicaid cuts are the absolute worst part of the proposed bill; there are so many other deplorable features, it’s hard to rank them. The new plan would replace subsidies based on income with credits based on age. But, that’s not a gain for the elderly because the subsidies based on age won’t keep pace with the higher prices that insurance companies will be allowed to charge the elderly because of the removal of caps that had been put in place by Obamacare. So, in addition to low-income individuals, the elderly are another major demographic that will be hurt by Trumpcare.
According to Dr. Harry J Heiman, director of Health Policy at the Morehouse School of Medicine, “In contrast to the ACA, which put in place new mechanisms to make health insurance more accessible and affordable for low-income working Americans, Trumpcare preferentially lowers costs for middle- and upper-income people at the expense of older and poorer Americans.”
“For those concerned about health disparities, this is especially bad news as low-income, racial and ethnic minority, and rural communities will all be net losers, as will the elderly and people living with disabilities.”
Here in Georgia last month, at a “Save My Care” rally in support of Obamacare, residents who have coverage through the Affordable Care Act shared their stories. As reported by WABE, one rally participant commented:
“Since I’ve been on the ACA, I’ve gotten a mammogram, a sinus surgery that keeps me from getting sick all the time, physical therapy to help me with my scoliosis… I’m healthier than I’ve been in a long time. And now I’m looking at that getting taken away.”
if you’re young, healthy and not particularly poor, you’ll actually see some benefit from the new plan. The CBO estimates that premiums for such individuals will rise at a slightly lower rate than what has been projected for Obamacare. However, given that the proposed Trumpcare will eliminate rules regarding required minimum coverage, those lower rates will likely be for inferior coverage.
So, the young and healthy aren’t quite the biggest winners. That’s reserved for rich individuals and corporations, especially health insurance company CEOs, who will be getting around $600 million in tax breaks over 10 years.
Given the details of the bill, the disastrous decrease in coverage and the increase in cost, it’s no surprise that criticism from Democrats has been swift. However, what Paul Ryan must find more troubling is the resistance coming from many of his Republican colleagues.
Several Republican senators from states that actually took advantage of the Obamacare Medicaid expansion are concerned about the massive Medicaid cuts included in the Republican proposals. In a letter sent to their Senate Leader, Republican Sens. Rob Portman (Ohio), Shelley Moore Capito (West Virginia), Cory Gardner (Colorado) and Lisa Murkowski (Alaska) stated, “We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states.”
While these Republican senators, and others, criticize the bill for going too far in dismantling Obamacare, there is another group of Republicans in Congress who adamantly oppose the bill because, unbelievably, they feel the Republican proposal does not go far enough!
Sen. Rand Paul (Kentucky) and members of the ultra-fiscally conservative Freedom Caucus have called the Republican bill “Obamacare Lite” and have threatened to vote against it, claiming that it maintains too mainly features of Obamacare. Some members of the conservative group would like to see Medicaid phased out even faster than the current bill proposes, while many others are not happy with the fact that the Republican plan still includes a “mandate.”
The major difference between the Obamacare coverage mandate and the Republican version is that Obamacare included a tax penalty (which was then recycled back into health care), while the Trumpcare penalty will result in profits directly for the insurance companies.
But, despite the opposition coming from within his own party, Ryan has a friend in Trump, who has clearly expressed support for the proposed plan, although he has stopped short of attaching his name to it in the same way he loves to attach his name to buildings, ties and steaks. However, at some point, Trump will have to explain to voters how a plan that increases the ranks of the uninsured by 24 million can be made to fit with his promise that his plan would provide “insurance for everybody.”
To sell this nightmare of a plan to the public, Ryan and his Republican colleagues are already emphasizing the issue of choice. Their mantra is that Americans will now have the freedom to choose the plan that they want. In Ryan’s world, whether or not an individual can afford their choice is completely irrelevant.
After all, as Rep. Jason Chaffetz suggested, if folks really want health care, they may just have to choose paying for insurance over paying for an iPhone. There may, in fact, be a planet somewhere in this universe where the cost of those two items is equivalent, but not here. Sadly, when people like Chaffetz and Ryan benefit from luxury insurance fully paid for by the government, it’s easy to see how he might be confused.
Or maybe they just don’t care.