The GOP and the Un-Affordable Care Act

For those of you who don’t remember, the Affordable Care act was passed about seven years ago. In that seven years, Republicans have promised to repeal it every election. Since they took over Congress, the House has voted to repeal it more than 70 times. When they took their seats at the beginning of this year, they immediately set the stage for repeal, but “suddenly” found out that people actually don’t want to lose their health insurance. Imagine that. So, they had to “pivot” (God, I hate that word!) to “Repeal and replace.” For more than a month, they have worked on a new plan (in secret, mind you – it was so secret, even most Republicans couldn’t see it as they worked on it. I kid you not. One of their biggest when’s about “Obamacare” was that it was done in secret, which was a lie, but, well now…

Yesterday, Republicans finally released a preliminary plan and, while it’s not the complete disaster many had anticipated, it does follow Republican tradition, in that it totally screws the poor, the elderly and union workers. Ironically(?), whereas Lord Donny promised a “terrific” plan, the only people who get the “terrific” are, as usual, people who can easily afford health insurance.

If you have always gotten your health insurance through your job, you won’t see many changes, at least at first. However, most of the changes that are being made are destined to make health insurance much more expensive. Not just for the poor and the working class, but for everyone. Expect double-digit healthcare inflation to return.

You can tell this proposal is a veritable turd in the health insurance punch bowl by the way they lie about it. In a statement, House Ways and Means Committee Chairman Kevin Brady said, “Our legislation transfers power from Washington back to the states. We dismantle Obamacare’s damaging taxes and mandates so states can deliver quality affordable options.”

In actually, the proposal does either of those things. States always had most of the power under the ACA, which is obvious when you consider that most red states chose to refuse Medicaid expansion money and refused to set up an exchange. Obviously, if they could do that, they weren’t exactly under the federal thumb, as it were. And the only “tax” they killed was the penalty for those who chose not to buy health insurance. That money went to pay for those who ended up in the ER, even though they refused to buy insurance. Now, hospitals will go back to having to write off those patients. They can’t deny emergency treatment, but if they don’t get paid for, say 10 percent of their ER bills, they have to bill everyone else more to make up that difference.

See, here’s the problem with the GOP’s “logic” on this. Risk needs to be spread evenly if insurance companies are to be expected to pay medical bills and also make a profit or at least not lose money. The healthiest people pay the bills for the sickest people. I mean, if I cost a health insurance company $500 a year for doctor visits and shots for me an my kids, but they’re collecting $1,000 a month in premiums from me, I am helping to make up the costs for someone who was hit by a bus and will cost the same insurance company $100,000. That’s how insurance works. I know right wingers hate the word “socialism,” but that’s what insurance is. Everyone puts money into a pool and, when someone gets sick or hurt, they take what they need to pay for getting better. Without a mandate, the people who are most likely to choose to not buy insurance are the healthiest. Those with a chronic illness are not going to opt out, it’ll be the guy who never gets sick and only sees the doctor for a checkup once in a while. That costs everyone.

(By the way, that is the reason we need a public option. Let the sickest and poorest people have an option and lessen the burden on the insurance companies.)

Another “irony(?)” is the fact that, while they eliminate the mandate, they leave the Cadillac plan tax intact, which makes one wonder about their intent to eliminate tax burdens. They are playing to the portion of their brain-dead base who suggest that it’s a violation of their freedom to “force” them to pay for health insurance. Given that the tax penalty is far less than the cost of even the cheapest health insurance, it’s impossible to claim they’re being “forced” to do anything. Instead of a mandate, the GOP plan “encourages” people to buy insurance by allowing insurance companies to charge a 30 percent penalty for those who allow coverage to lapse and then try to buy a new policy. However, to believe that will encourage people to buy and keep insurance requires everyone to believe in Republican magical thinking. People’s policies can lapse for any number of reasons that have nothing to do with their choice to not buy insurance. A working parent with a family will not allow their insurance to lapse, uses they get laid off, for example, and they can’t afford the COBRA. What happens to them?

Another thing that makes this proposal a turd is the virtual elimination of premium subsidies. First, they eliminate the limits, in a way. Instead of “four times the federal poverty level,” they put in a flat $75,000 limit for individuals and $150,000 for families. That sounds like a lot, but it’s tricky because there is no provision for an inflation adjustment. This could make it just like the 1996 “welfare reform” plan, in which states got block grants out of a total amount of $16.4 billion. That was a lot in 1996, but in 20 years, that amount has never changed, even though the cost of almost everything has more than double. That is not a good thing, especially if health care inflation returns. In any case, the tax credits aren’t enough to pay for a decent health insurance plan, as they start at $2,000 for people under 30, and gradually rising to a whopping $4,000 by the time they reach the age of 60. That will only pay for catastrophic insurance most places. With Catastrphic insurance, the deductible is enormously high. Say it’s $20,000. That means that, if the bill comes to $21,000, the $1,000 will be paid, but the patient will have to pay the other $20,000. Now, what are the odds that someone who opts for the cheapest plan they can find will have $20,000 lying around. Not only that, but based on the reaction on the part of teabaggers, they strongly object to any tax credit for someone who is not paying taxes, which means, in the final bill, the only people who are likely to see the tax credit are those whose income taxes top $2,000-4,000. Again, screw the poor, even those who voted for Trump.

Oh, yeah; and you know what Brady said about giving more power to the states? Well, the tax credits won’t be available for any insurance policy that covers abortion. You know, because states need to have all the power, unless federal Republicans want it for themselves. And that means any POLICY that includes abortion coverage, not just if you have an abortion under such a policy. Any abortion coverage, even if it’s medically necessary, will not get a tax credit. Even if the policy is being purchased by a man.

The good news in all of this is, this proposal is dead in the water, as written. There are no numbers, meaning no budget numbers like costs and economic impact. Whereas it is tradition to have the CBO score a bill to determine its economic and budgetary impact, that wasn’t done with this bill. When there are no numbers, it isn’t eligible for reconciliation as it stands. And once it is scored, the result will not be good for anyone. It WILL explode the deficit again, which the teabaggers won’t like, and Lord Donny will absolutely hate. It also keeps most of the regulatory aspects of the ACA intact and at least five Republican Senators are already on record as being opposed, deriding it as “Obamacare Lite.”

Without reconciliation, the bill would need 60 Senators to pass, which won’t happen. Not only that, but it will be very difficult to get 218 votes in the House on this piece of shit. Some Republicans will object because they think health insurance companies should be able to do what they want, without restrictions. This bill sucks for everyone. Not only will it make health insurance unaffordable for about 7-8 million of the poorest and sickest Americans, which should piss us off, but it also retains all of the regulatory structure that we love, but the far right hates. If this is all they could come up with in seven years, they have validated everything we have said about them.

Get on the phone with your congresscritter, especially if they’re Republican, and tell them you don’t want them to vote yes on this crap. Higher costs and larger numbers of uninsured are a recipe for disaster. We only need a few Republicans to vote against it to kill it. And this bill needs to die…

About Milt Shook

A writer with more than 45 years in the political game (and let's face it, it is a game). I am a liberal because facts have a liberal bias, and I really like facts. If you like facts, you'll like this blog. If not, you'll have a hard time.


The GOP and the Un-Affordable Care Act — 5 Comments

  1. This “bill” is crap, plain and simple.

    I don’t know what the hell Paul Ryan was thinking, but if he thinks that this will go down well with his constituents he’s got another thought coming. The reaming he got from his town hall meeting will be tame compared to what will happen to him when his constituents confront him.

    This thing is so toxic that the conservative groups Club For Growth, the Heritage Foundation, and Freedomworks are against it.

    Seriously GOP–what the HELL were you thinking?

    Oh, and if anyone comes in gleeful that if the ACA is wiped out it will finally mean that we will get single-payer….please go and do something anatomically impossible with yourself.

    • The only constituents Ryan cares about are the very wealthy; he doesn’t acknowledge anyone else.

  2. Yesterday, Republicans finally released a preliminary plan and, while it’s not the complete disaster many had anticipated,

    If it isn’t a complete disaster I don’t know what one would actually look like.

    I haven’t read the text but I was listening to some professor on NPR about it this morning. To me one of the biggest tells is that most (all?) of what they propose won’t take effect until after the mid-term elections. That makes it pretty nakedly obvious that the Republicans think a) this won’t be very popular, and b) the delay will shield them from that enough to allow them to win their next election.

    • They left most of the regulatory stuff intact, is what I meant. A complete disaster would include taking Away all protections too. I doubt this will pass, so if we do our jobs right, this won’t be around by the midterms

  3. At some point in time Americans need to wake up and understand how healthcare can be provided to all people. Many nations understand how to do it and we need to understand it too. Using sovereign money or seigniorage if you prefer that word, the government can pay for healthcare for all to the limits of the healthcare resources in the nation. This process will place a large quantity of dollars into the economy which can then, after they are spent, be redeemed / destroyed by taxes to prevent inflation. It is that simple and the only limitation and most important issue is the resources to provide needed health care to all.