The Affordable Care Act, aka Obamacare, has flaws. That much is clear.
Instead of fixing and improving it so Obamacare continues to be sustainable going forward, Republicans led by House Speaker Paul Ryan are proposing to replace it with a measure that would further break the nation’s health care system.
Interestingly, the GOP plan has been attacked from the right and left, albeit for different reasons. And the nation’s physician and hospital sectors — including the American Hospital Association, Catholic Health Association of the United States and Association of American Medical Colleges — all are publicly opposing Ryan’s American Health Care Act (AHCA).
If it succeeds – and that is a big if, given the lack of enthusiasm in the U.S. Senate — it will be because of politics and not substance. President Donald Trump, like the deal-closer he boasts of being, is engaged in a full-scale sales job that involves swaying GOP holdouts with sweeteners or threats of political payback.
At its best, Obamacare is providing health care coverage for 20 million more people who lacked health insurance before it took effect seven years ago. That includes 1.3 million more Texans who gained coverage.
That is a huge deal in a state infamous for being No. 1 in the nation for the percentage of people without health insurance. Though the Affordable Care Act did not cover all, it raised the level of Americans with health insurance to its highest mark in history.
Ryan’s AHCA would fall far short of that accomplishment, stranding millions of Americans without health insurance either because they could not afford coverage or because they would choose not to buy it.
The nonpartisan Congressional Budget Office and staff of the Joint Committee on Taxation estimate that under Ryan’s AHCA:
• An estimated 14 million fewer people would be without coverage by next year. That would increase to 21 million in 2010 and 24 million in 2026. Much of those losses in coverage are because of the repeal of the mandate for individuals to buy insurance and cuts to Medicaid.
• Average premiums would increase at first but 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 estimates that the AHCA would reduce federal deficits by $337 billion over the coming decade. But that savings would quickly evaporate as costs shift to local taxpayers, who would be left to pay the tab for uninsured people crowding emergency rooms or clinics.
The working poor and seniors would be hit hardest under the AHCA, which would administer Medicaid as a block grant program to the states. Obamacare’s subsidies to defray deductibles or other costs would be eliminated. And ACA’s income-related tax credits would be replaced by AHCA’s age-based tax credits. All of those factors work 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 the impact to 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/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.
• Under Obamacare, a 60-year-old earning $50,000 generally would pay $5,100 in out-of-pocket expenses after tax credits; while under AHCA that same person generally would pay $8,380 after tax credits.
Another bizarre thing about Ryan’s plan is that it doesn’t solve the problems many Republicans point to in Obamacare, such as eliminating government-mandated health benefits. Some conservatives see Ryan’s measure more as a repair to Obamacare rather than the free-market replacement they envision.
And with so many revisions made on the fly, it isn’t clear if the AHCA would cover maternity or mental health care or pre-existing conditions, which are required under Obamacare.
As the health care battle plays out in Washington, we urge both parties to treat health insurance as a human issue – and not a political football.
Health coverage can determine whether someone survives a catastrophic illness or a family is bankrupted because of uncovered expenses — and whether a grandmother or disabled person can receive the services and care they need under Medicaid.
Too many Americans suffered such consequences prior to Obamacare. That should never again be their fate because they lack health insurance.
Even with its flaws, Obamacare continues to provide most Americans, regardless of income, a way to care for themselves and family members without mortgaging the family home. It provides a sense of security in knowing that they can weather health emergencies, such as a car wreck or long-term illness.
Tragically, Ryan and his band of Republicans are opting to make a political decision when the moment and issue requires a moral one.