(image from readthebill.gop)
After the failure to repeal the Affordable Care Act in the early days of the Trump Presidency, the Senate is now considering a bill that will roll back many of the protections and regulations of the ACA. The LA Times has a nice comparison article that shows the differences being proposed. Here is a key quote from the article:
“The Congressional Budget Office score on the Senate version is expected in the next several days. The CBO’s score on the House version estimated 23 million fewer people would have insurance over the next decade. The report stated the hardest hit in the long run would be lower-income, older and sicker Americans.”
One thing to note is that the Republican proposal (which has no bipartisan support and as of today lacks unanimous support among Conservatives as well) does not literally keep these millions of Americans from having healthcare. It stops providing the means for them to have such care. For the “lower-income, older and sicker Americans” this will effectively mean the same thing. They will be unable to afford the healthcare they need, and they will not receive help in receiving such care. However, many of the people who will “lose” healthcare will do so because they have opted out of purchasing it, mostly by gambling that their current health status will remain the same. In other words, these will be younger, healthier Americans who decide that the cost of such care is not worth it for them.
While some of these people will lose this gamble, most will not. From their own perspective, it will be a rational choice to make. However, from the perspective of those who need health insurance in order to cover their bills, it will create higher premiums, and likely higher deductibles. The reasons are simple. When you remove the low risk members of an insurance pool, the insurance companies do not have income to offset their expenses from payments made to less healthy customers. In order to stay in business, they must raise premiums, deductibles, or both. This is pretty simple financing.
Republicans know this, of course, but they believe that the negative liberty of allowing Americans to choose whether to insure themselves outweighs the need to keep rates lower for sicker Americans.
Politics is always a matter of trade-offs. The ACA traded liberty for security by forcing Americans to purchase healthcare or pay fines for not doing so. The new plan would trade security for liberty. In a vacuum, the values of liberty and security are roughly equal. You need a bit of both in order to have a good life. However, in a political system, these trades are made between groups, rather than being distributed equally. What does that mean, exactly?
In this case, it means that the wealthiest Americans will see a huge tax cut, just as they would have under the House’s proposed plan. The Atlantic covered this pretty well back in March. Basically, the ACA was funded in large part by higher taxes on the wealthy, especially capital gains taxes. Republicans believe that this is an unfair redistribution of wealth, where wealthier citizens are forced to finance those who are poor. That’s basically correct, too. I personally don’t see this as a problem. I think it’s part of living in a society with a social contract. However, many people disagree and do not see supporting the poor as their responsibility at all. Others do think they should help the poor, but not via government interference.
Wherever you fall on this debate over how to provide healthcare for the poor, the fact is that the proposed bill would deny healthcare to millions of Americans who have been given such care through the ACA. This removal will cause a great deal of suffering. I’ve noted before that I think there are many flaws in the ACA, especially with regard to how the marketplace works, who gets funding, how it gets distributed, etc. However, I do not think this is a good way to fix the problem.
The bill as it currently stands would freeze funding for Planned Parenthood for one year. PP is a kind of bogeyman for the GOP. They like to pain it as basically an abortion mill, even though abortions are a very small part of what Planned Parenthood does, and by law, those cannot be funded by federal funding anyway. Instead, a lot of people (especially poor women) will not be able to get needed services. These include birth control, which would help prevent the birth of more children who need healthcare and welfare services. But the Republicans have backed themselves into a corner on this issue due to strong rhetoric against the organization.
More critically, in the long run, the bill would reduce funding for Medicaid over time. This is the part that will save tax dollars. It’s also the part that will remove medical care for millions of Americans who saw Medicaid coverage expanded from the ACA. I personally know people who will lose coverage if this happens, and they are terrified. Some of them need that coverage for life saving medications. Others just want the security of knowing it is available. In both cases, the loss will produce more than just physical health issues. The added stress and anxiety will cause a ripple throughout society.
As the President noted, healthcare is very complicated. Assessing all the things this bill would or would not do can be difficult. That’s what Nancy Pelosi meant when she said that the ACA had to be passed before we would be able to determine all of its effects. Many of the effects of such legislation cannot be foreseen, and no doubt some of the more alarmist predictions will prove false as well. Still, the parts we can foresee, which include loss of coverage, looser regulations on what insurance companies must cover, and lessened protection against rising healthcare costs all seem scary enough to me!
At this point, though, Congress doesn’t have a lot of options. For years they’ve talked about how terrible the ACA is; how it is un—American and must be overturned. Now that the Republicans have all the power, they almost have to do something with it, even if they aren’t entirely sure whether their new plan will be good for healthcare in America. I just hope they slow down a bit and get it right.