The Affordable Care Act, aka Obamacare, has flaws. That much is clear. But its replacement, the American Health Care Act, would have further broken the nation’s health care system.
Instead of fixing and improving Obamacare so it continues to be sustainable going forward, Republicans led by House Speaker Paul Ryan wasted time and clout with a proposal that put politics ahead of people. No wonder it failed.
Interestingly, the GOP plan was attacked from the right and left, albeit for different reasons. And it is worth noting that the AHCA lacked support of key physician and hospital groups, including the American Hospital Association, Catholic Health Association of the United States and Association of American Medical Colleges.
In the end, not even President Donald Trump — who never misses an opportunity to tout his prowess as a deal-closer — could sway enough GOP House votes to pass the plan, despite throwing sweeteners and threats of political payback at Republican holdouts. Instead, Trump agreed with Ryan to pull the bill, knowing it was doomed.
That is a huge setback for Trump, as it was the first test of his ability to push through Congress a key plank of his agenda – repealing and replacing Obamacare. The failure also leaves Ryan in a weakened position with House GOP members and the president.
The spotlight on the AHCA heightened public awareness – and approval — of Obamacare, which is providing health care coverage for 20 million people who lacked health insurance prior to its passage. That includes 1.3 million Texans who gained coverage.
Consider that only 20 percent of Americans said Republicans in Congress should repeal all of the ACA, while 50 percent said to repeal parts of it and 27 percent said don’t repeal any of it, according to results of a Quinnipiac University national poll released last week.
Those sentiments are evident in the many letters we received from readers supporting Obamacare.
By contrast, Ryan’s AHCA was a disaster, with just 17-percent approval among Americans. It’s no wonder, as AHCA would have stranded millions of Americans without health insurance either because they could not afford coverage or because they would choose not to buy it.
AHCA was further damaged by concessions Ryan was forced to make on the fly that eliminated popular Obamacare requirements for covering maternity and mental health care and prescription drugs. Support for AHCA began unraveling earlier this month when the nonpartisan Congressional Budget Office released its figures that showed:
• An estimated 14 million people would be left without coverage by next year. That would increase to 21 million in 2020 and 24 million in 2026.
• Average premiums would increase at first, then decrease starting in 2020. But premiums would differ for various groups because insurers would be allowed to charge five times more for older enrollees than younger ones — rather than three times more, as under Obamacare.
On the positive side, the Congressional Budget Office estimated that the AHCA would reduce federal deficits by $337 billion over the coming decade. But that savings would have quickly evaporated as costs shifted to local taxpayers to pay the tab for uninsured people crowding emergency rooms or clinics.
The working poor and seniors would have been hit hardest under the AHCA, which would have rationed Medicaid through a block grant program to the states. Obamacare’s subsidies to defray deductibles or other costs would also have been wiped out. And ACA’s income-related tax credits would have been replaced by AHCA’s age-based tax credits. Those factors worked to make the AHCA’s insurance more expensive for older, sicker and lower-income people – the folks most in need of health care coverage.
Consider how the AHCA would have affected Central Texans:
• Under Obamacare, a 60-year-old resident of Travis, Williamson, Hays or Bastrop counties who earned $30,000 a year generally received a tax credit or subsidy of $6,730 to pay an insurance premium totaling $9,210. So the out-of-pocket expenses for that person was $2,480, according to figures from the Kaiser Family Foundation.
By contrast, a similarly situated 60-year-old resident of those counties would pay considerably more under the AHCA. After tax credits totaling $4,000, that person would pay a premium of $8,380 on a policy that would rise to $12,380.
In the end, Ryan’s plan was killed by hard-line conservatives, who thought it did not reflect their vision of a free-market health care system, and moderate Republicans, who thought it went too far in dismantling the safety net for working families.
We urge both parties to turn their attention to repairing Obamacare, whose out-of-pocket costs for premiums rose by double digits for many Americans. There’s also a problem in the lack of choice many Americans have in insurers.
Health coverage can determine whether someone survives a car wreck or catastrophic illness without going bankrupt because of uncovered expenses — and whether a grandmother or disabled person can receive the services and care they need under Medicaid.
Even with its flaws, Obamacare continues to provide most Americans — regardless of income — a way to care for themselves and loved ones without mortgaging the family home. Tragically, Ryan and his band of Republicans opted to make a political decision when the moment and issue required a moral one.