As medicine for our health care system, it’s worse than a placebo. It will do active harm to millions of people, particularly low-income people and seniors. It cuts taxes for the wealthy and corporations and dangles paltry tax credits to working people. It leaves consumers facing higher health care prices and will force many of them to forgo needed care.
This is the toxic prescription that the Trump administration and the Republican Congress wants to give the American public in place of the Affordable Care Act.
The House Republican plan was injected into the political debate Monday evening, while the country was still recovering from President Trump’s latest Twitter seizure. With much of the media preoccupied with Trump’s other democracy-destroying antics, the extreme nature of what the House Republicans have proposed has yet to hit home. But when it does, expect more of the condemnation of the Republicans’ “repeal and replace” wrecking ball that we saw when members of Congress were in their home districts during the February congressional recess. People’s Action was a leader in those town hall confrontations and protests, and now that the details confirm the worst fears of working people, the poor and the elderly, People’s Action affiliates will intensify its resistance.
A key feature of the Republican plan is the replacement of the premium subsidies that were available through the Affordable Care Act health care exchanges with a tax credit that ranges for individuals from $2,000 to $4,000 a year, based on age. The tax credits would go toward policies purchased on the open market that would be very different from what’s offered on the exchanges. Those policies would be much less regulated, so they would cover less and be free to charge more. Meanwhile, some $600 million in taxes, largely on the health care industry and wealthy Americans, that were raised to cover the cost of the Affordable Care Act subsidies would be eliminated.
Also gone are the health care penalties that were designed to encourage healthy people to buy insurance, so that their presence in the insurance pool would make insurance more affordable for everyone.
Providers would also be more free to discriminate based on age: A 55-year-old could end up paying five times more than a 25-year-old for the same insurance coverage.
Of course, a market-based system would charge more for older people who would likely need more care than for younger people who would likely use less care. But that also means that if the free market has its way, the people who need the most care are the least likely to get it. That’s called market failure, and the Affordable Care Act was designed, as much as a political system hobbled by big-money interests would allow, to ameliorate that.
One of the most pernicious features of the House Republican plan is what it would do to Medicaid. Instead of a program that budgets to allow each poor and low-income person to get the care they need, the program will impose firm funding caps for each state. The bill has short-term concessions for states that opted for Medicaid expansion under the Affordable Care Act, but over time even those states would hit constraints on what they can spend on health care for those in poverty and the working poor. The changes are designed to force states to make choices about who gets health care and who doesn’t. They are integral to a plan that creates, as Iowa pig farmer and Main Street Alliance member Chris Petersen put it in a town-hall meeting with Sen. Chuck Grassley in February, “one big death panel in this country.”
Also pernicious is its singling out of Planned Parenthood for cuts in federal aid for women’s health care program. No other organization is explicitly singled out for punishment by being barred from federal funding. Yet this bill would deny women access to a primary source for vital women’s health services.
The fact that House leaders plan to plow forward with a markup of this bill without the typical Congressional Budget Office analysis of its costs and impact tips their hand: They know they cannot afford to tell the truth. Their plan will hurt people who count on our country’s important health care programs while giving a tax break to the rich. As sound health care policy, it just won’t add up.
In an op-ed in The Hill, LeeAnn Hall, co-director of People’s Action, warns that because of proposals like these lawmakers will have to “get ready for plenty of opposition — and not just in the expected places.
“The GOP’s radical plans for health care, and Medicaid in particular, would reach deep into communities that Republican electeds represent, creating chaos not just for patients, but for hospitals, clinics, small businesses, and local and regional economies.”
President Trump recently laughably complained that “nobody knew that health care could be so complicated.” The truth is, it doesn’t have to be. If we began with the premise that access to quality health care should be as fundamental as access to air and water, we can begin to imagine a system that is far simpler and less costly. It is costly only because the behavior of the profiteers who dominate America’s health care system make it so.
Moving to the kind of simpler, less costly health care system already prevalent in much of the industrialized world will take America some time. In the meantime, we cannot go backward into something that would be even worse than the dark days before the Affordable Care Act became law. This Republican health care plan – hatched in cooperation with extremists in the Trump administration like uber-right-wing Freedom Caucus alumnus Mick Mulvaney, who is now in charge of the Office of Management and Budget – is dangerous to our health and needs to be pulled off the shelf.