Since the Democrats foisted the Affordable Care Act on America in 2010, through questionable legislative tactics, Republicans have seen huge gains at every level of government. The House went red in 2010, the Senate in 2014, and the White House last year. State legislatures and governorships have also seen huge swings towards the right. Is cause and effect in play?
I think the answer is a clear yes. I believe Americans feel like the country is spiraling out of control and Obamacare is the poster child for this sentiment. A 2000+ page bill that then Speaker Nancy Pelosi said we’d have to pass in order to know what was in it. The law motivates businesses to hire fewer people and cut hours of those they already employ. It adds complexity to filing tax returns and involves the IRS in healthcare. People did not get to keep their healthcare plans or sometimes even their doctors as they had been promised. Costs did not go down, they skyrocketed. And then there were the additional taxes you had to pay if you didn’t have government mandated coverage. There is nothing affordable or caring about this mess.
And so people voiced their outrage at the ballot box. At long last the barriers to repealing Obamacare have all come down. Republicans control the House, Senate and Presidency. A month and a half in the GOP offers us their solution in the form of the American Health Care Act. It is not what I was hoping for.
The AHCA does away with Obamacare’s individual mandate. There will no longer be a tax levied on people without insurance. Instead it charges a 30% premium penalty, to be paid to insurance companies, on anyone who goes 63 days or longer without coverage. I ran the numbers on my own policy. A 30% penalty for me would be $1749. My penalty under Obamacare would be $695, and I could avoid some of that if I had coverage for part of the year. So my penalty would be over 2 ½ times higher under the new plan. And I wouldn’t even have the satisfaction of knowing that it was going to the treasury where it might offset some of the health care subsidies since it goes to the insurance company.
There is some logic to this. Under both the ACA and the AHCA insurance companies are forced to insure pre-existing conditions. If everyone let their insurance lapse until they got sick it would undermine the basic math of insurance. No business can succeed if they are receiving hundreds of dollars in premiums and sending out thousands of dollars in payments. But looking at the other side of the equation it makes no sense. If you do not have insurance for 63 days, and you are healthy and don’t particularly feel like you need it, having to pay a 30% penalty is going to motivate you to put off that purchase for as long as possible. And, obviously, a 30% penalty will make it virtually impossible to buy insurance if you let it lapse because you can’t afford it.
The AHCA eliminates the subsidies Obamacare paid to people who bought their insurance through the exchange. Instead it creates refundable tax credits. That is like saying I’m going to take away your cat and give you a kitten. Like the subsidies, this is a huge new entitlement program. These credits will be available to people who have “eligible health coverage.” Which means, in addition to spending money we don’t have (we are, after all, almost $20 trillion in debt), the government will continue to require reporting from its citizens on their health care choices.
I don’t see anything in the bill that gets to the root of the problem with healthcare in the U.S. It is still a complex system of government entanglement with insurance companies. It does nothing to increase transparency or competition between healthcare providers. It provides little or no relief to anyone trying to navigate the process of obtaining or providing medical care. It doesn’t even allow insurance to be sold across state lines, which was the only healthcare specific Donald Trump campaigned on in his presidential bid.
I had hoped for better. I guess I’m naïve. I suppose a tip of the hat is owed the GOP because their bill is only 123 pages long instead of over 2000. And six of those pages are devoted to the huge problem of high dollar lottery winners trying to stay on Medicaid. So way to go!
If you are also disappointed in this Republican offering I urge you to call your representative and senators to oppose it. They are simple calls, only take about 15 seconds. Congressional leadership is trying to rush this abomination through so act now!