Republicans have been trying to undo Obamacare since before the bill even became law when President Barrack Obama signed it on March 23, 2010. House Republicans passed literally dozens of bills to repeal it. They fought it in the courts. They insisted, repeatedly, that Obamacare was a disaster and that they had a better plan.
With Donald Trump’s unlikely victory last November, Republicans were suddenly put in a spot. They had the power to repeal Obamacare. Trump would go along. But for that to happen, they would need to, after all these years, actually produce a viable replacement plan.
On Monday, Republicans delivered — if you can call it that.
The repeal-and-replace legislation unveiled by House Republicans is such a hot mess that it’s already attracting fierce criticism from all sides. Libertarians are deriding it as Obamacare Lite. Democrats are warning that it would force Americans to pay more for less health care coverage. Conservatives worry about the impact on the deficit.
And, commendably, even Sen. Shelley Moore Capito, R-W.Va., joined by three other Republican senators, came out in opposition to the plan because it doesn’t do enough to protect those who gained coverage under Obamacare’s Medicaid expansion.
The four senators sent a letter to Senate Majority Leader Mitch McConnell warning that the proposal “does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states.”
That’s a good sign that Capito will give more than lip service to her many unrealistic promises about replacing Obamacare, though it doesn’t make up for the fact that her promises cannot be kept, at least if Obamacare is repealed rather than repaired. She has promised a “replacement vehicle that’s going to be better for everybody.” The House Republican plan certainly is not that.
That plan would remove Obamacare’s subsidies for the poor and elderly, replacing them with refundable tax credits that increase with age. The effect of this will be to shift subsidies from low-income Americans to the middle- and upper-class. The bill would also allow insurers to charge older, sicker enrollees more.
The Medicaid expansion that so many working Americans now count on for coverage would start to disappear after 2020, and Medicaid itself would shift to a block-grant system that would inevitably result in lower payments to states.
The package also falls far short of President Trump’s promises for an Obamacare replacement — which isn’t a huge surprise since A) he promised his plan would cover literally everyone with lower costs and lower deductibles and B) he just figured out that health care policy is “an unbelievably complex subject,” claiming that “nobody knew health care could be so complicated.”
Nevertheless, after the White House issued a bland, non-endorsement of a statement on Monday, Trump himself followed up with an effusive tweet referring to it as “our wonderful new Healthcare Bill.” Though he followed that up with a vague tweet referring to “phase 2 & 3 of healthcare rollout” — a tweet apparently responding to a Fox and Friends segment he was watching — promising features not currently included in the House proposal.
Congressional Republicans, by the way, have given no indication that there will be further phases to their healthcare plan. It is best and safest to assume that this plan is the best Republicans could come up with. And it is awful.
By all accounts, it will increase the deficit, decrease the number of Americans covered, increase deductibles and out-of-pocket costs, decrease the standards for coverage, destabilize the individual marketplace, and, just for fun, defund Planned Parenthood — cutting millions of women off from affordable reproductive health care.
The bill will not improve health care access, health care coverage or lower health care costs. It will cut many taxes for the wealthy, and shift subsidies from the poor and sick to the healthy and wealthy. And it will shift Medicaid expenses either onto the state or onto hospitals who end up providing care for those no longer adequately covered.
As Peter Suderman writes for the libertarian website Reason.com, “In general, it’s not clear what problems this particular bill would actually solve.”
The bill won’t fix Obamacare’s problems, it will exacerbate them. It won’t restore the health of the individual marketplace. By eliminating penalties for the individual mandate, replacing them with a 30 percent premium surcharge for people who allow their coverage to lapse, the plan will encourage healthy people not to get coverage until they already sick — even as it keeps Obamacare’s provision requiring coverage of pre-existing conditions. This will destroy the individual marketplace.
The bill has no real cost-containment measures while jettisoning Obamacare measures that have already proven successful in decreasing health care inflation.
Vox’s Ezra Klein had a good take-down of the bill in which he asks some important questions, “But the biggest problem this bill has is that it’s not clear why it exists. What does it make better? What is it even trying to achieve? Democrats wanted to cover more people and reduce long-term costs, and they had an argument for how their bill did both. As far as I can tell, Republicans have neither. At best, you can say this bill makes every obvious health care metric a bit worse, but at least it cuts taxes on rich people? Is that really a winning argument in American politics?”
This bill should, and likely will, go down in flames — especially if Senate Republicans like Capito stay firm to those principles they retain.
Radmacher is former editorial page editor of The Charleston Gazette and The Roanoke Times. This Land is a weekly column produced by Appalachian Mountain Advocates.