House Speaker Paul Ryan (R-WI) swears that he has unity among the GOP Congress and executive branch for the proposed health care plan, but reality shows a different picture. Dictator Donald Trump (DDT) said that he will have his own plan in two weeks although tonight’s speech gave the feeling that he agreed in someways with the GOP program. GOP Sens. Rand Paul (KY), Ted Cruz (TX), and Mike Lee (UT) want only a full repeal of Obamacare, and Paul called GOP plans “Obamacare lite.” The three senators met with House Freedom Caucus Chairman Mark Meadows (R-NC) and Republican Study Committee Chairman Mark Walker (R-NC) who also vigorously opposed colleagues’ plans, especially on the tax credits. Members of Freedom Caucus and the Republican Study Committee had met with the far-right Heritage Foundation in early February and agreed that the solution was the 2015 repeal bill without any replacement plans. Meadows and Walker announced that they could not recommend votes for the proposed bill without “substantial changes.”
Republicans from the DDT on down have consistently promised the people of the United States a better deal for health care than the Affordable Care Act (ACA), and after years of meaningless repeals, the rubber is hitting the road. What are their plans? Drop coverage, raise prices, and take out every advantage of the health insurance now on the books. And drop all the taxes the raise funds for the ACA.
The replacement as of late February:
Replace subsidies with tax credits based on age instead of income. Under age 30, the credit would be $2,000 and double for those over 60. Wealthy elders, such as Bill Gates worth $83 billion, would get twice as much as poor young people. The ACA tax credit was adjusted by income, age, and the average price of insurance in a person’s market. An example of the importance of the ACA system is Alaska, where people receive double the tax credits as those in the rest of the country because of its scarcity of coverage in a frontier population. Other problematic areas are the rural counties and states in the interior and western frontier, DDT land.
Replace the existing Medicaid expansion in 2020 with capped state payments based on the number of Medicaid enrollees. The current plan provides for eligibility expansion for people who make up to 138 percent of the federal poverty line. The elimination of federal funds would damage the abilities of states to cope with populations in health crises, such as coal miners in Kentucky and West Virginia; deal with natural catastrophes and outbreaks such as 9/11 and Hurricane Katrina; and combat human-caused disasters such as the HIV outbreak in southern Indiana after Republicans, including then Gov. Mike Pence refused a clean needle exchange. The GOP plan would also jeopardize coverage for 11 million people who have gained it under the ACA.
Democratic governors and the GOP governors who accepted the expansion are opposed to this measure. The Republican governors who didn’t take the expansion are afraid they’ll get less under the plan than the states that did—and they may be right. At any rate, the plan will cost states billions of dollars that they don’t have.
Provide $100 billion in “state innovation grants” for extremely expensive enrollees. The intent is to cover some of the “pre-existing condition” population without the protections as in the Affordable Care Act.
Leave decisions about mandatory or essential benefits to the states. They could eliminate insurance for such health needs as mental health services, annual exams, prenatal and maternity care, pediatric care, and birth control.
Cap the tax exemption for employer sponsored insurance at the 90th percentile of current premiums and tax amounts above that benefit. This sounds like a good idea until you figure that employees will just pass their costs on to their employees without giving them a wage increase.
Allow insurers to charge older customers up to five times as much as their younger counterparts, an increase from the existing three times as much in premiums.
Assess penalties for people who let their coverage lapse and then decide to enroll with a 30-percent boost in premiums for a year. People who cannot afford to keep paying premiums if they suffer sudden hardship would be punished by this part of the bill. This would also allow people to not buy health insurance and then have no money for health care no matter what happens.
Defund Planned Parenthood to make more women get pregnant.
Allow people to decide if they want health insurance.
On Last Week Tonight, comedian John Oliver broke down an explanation of the GOP plan into four categories: refundable tax credits, high risk pools, block grants, and health savings accounts. None of these ideas will actually work, Oliver argues, breaking them down in financial terms—they all share the same “thong problem.” His view of the GOP’s plan—and pitfalls—is well worth watching.
Missing from the Republican plan is the provision that health care insurance remain “affordable.” The plan benefits people with good health and wealth as well as penalizing areas with disasters or emerging health problems. Rural areas would suffer more because this population relies more heavily on public insurance than people in cities.
Former House Speaker John Boehner (R-OH) doubts that the GOP can manage a full repeal and replace of Obamacare. He predicts a few fixes to the existing ACA, not a bad idea if the fixes help people:
“In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a health care proposal should look like. Not once. And all this happy talk that went on in November and December and January about repeal, repeal, repeal—yeah, we’ll do replace, replace—I started laughing, because if you pass repeal without replace, first, anything that happens is your fault. You broke it.”
Basically, “GOPcare” supports the “coastal elites” over Middle America that voted for Dictator Donald Trump. Until faced with reality, DDT claimed that his health care would be far better than the existing program. His meeting with governors and insurance CEOs provided insight into his confusion. “Nobody knew that health care could be so complicated.” Actually almost everyone except the current president understood the complexity of health care.
DDT’s current solution is to allow Obamacare to “implode” and then blame the Democrats and President Obama. As DDT continues to declare the ACA a “failed disaster,” popularity for the program is steadily increasing. A poll in mid-February shows that 54 percent of people surveyed approve of the law while only 43 percent disapprove. And of those who disapprove of the ACA, one-fourth of them want the current law to be changed while only 17 percent want to completely get rid of ACA.
A common Republican claim is that “Obamacare” shackles people to government, and repeal of the health care plan will make them free. Almost 242 years ago, Patrick Henry said some version of “Give me liberty or give me death.” That is the choice that Republicans are pushing onto many people into the United States. The “freedom” of no health care will definitely give many of them death—but legislators aren’t talking about their own death. They’re the ones who already have health care and are wealthy enough that they always have. Almost 30 million people count on the ACA, and that doesn’t include the young people under 26 on their parents’ policies and the people on Medicare who have some benefits from the ACA. These are the people who will suffer from the congressional decision to give them “freedom.”