Newsplaining

The American Health Care Act, AKA “The World’s Greatest Health Care Plan of 2017”
     Last week, the House of Representatives released its long awaited “repeal and replace plan,” “The World’s Greatest Health Care Plan of 2017” (this is the legitimate name of the bill that’s available for public viewing on congress.gov), for the Affordable Care Act (or as many know it, Obamacare), amid much criticism and “back-room-style” shenanigans. I say back-room-style shenanigans because according to multiple news outlets back on March 2, word had spread to members of the U.S. Senate and the press that the GOP-HOR did have a replacement plan drafted, but was keeping it hidden in several congressional basements, out of view from even members of the party.
     Kentucky Senator Rand Paul was quoted by CNBC that the treatment of the draft was equal to that of a national secret, and that healthcare should be done out in the open. Rumors were awry, venturing so far as to say that not even HOR members could take copies of the bill with them, for fear of the bill falling in the wrong hands.
     To those who called the ACA a backroom-deal done without much consideration of public input, the American Health Care Act — the GOP replacement — can already be considered of the same quality…let’s be real, it was moved from congressional basement, to congressional basement, in secret, depending on the day, and is being pushed through committee after committee, ahead of a Congressional Budget Office score.
     Nevertheless, despite my initial belief that repealing the ACA would be impossible unless the GOP was willing to commit political suicide, a plan was released, but will it pass? It depends on what congressional leaders mean by “replace Obamacare.”
     If it’s to completely overhaul the healthcare system, not so much. If it’s keeping the same protocol but fudging the accounting portion to create what pundits have called Obamacare-lite, then yes. If it means pushing legislation through congress without a CBO score and taking away health care from millions, then also yes.
     The AHCA is a 123-page bill that has dominated think-tanks, newsrooms and congressional offices for the last week, and the general consensus could be summed up in one word: “How?”
     “How” because the bill prescribes a lot without making any significant changes to tax rates, while still providing subsidies to those who can’t afford insurance. The bill also doesn’t outright “replace” the ACA, as the bill is largely done through means and reconciliation, due to the Senate not having a GOP super majority. More so, the big question is how is this going to work?
     The nonpartisan Congressional Budget Office has not yet calculated anything on the bill, but rough estimates are that ACA enrollees will be paying approximately $1,542 a year more for insurance, with that cost reaching $2,409, by 2020, when the AHCA redistributes the tax credits.
     For older individuals aged 55-64, costs would increase approximately $5,269 and approximately $6,971 by 2020 (Vox Big Idea Submitted financial Analysis).
     To give a brief breakdown of the bill’s most influential points, the biggest part of the plan, and the most unanticipated, is that Medicaid expansion continues through 2020.
     As of right now, 31 states have accepted the Medicaid expansion in the ACA, and the ACHA would allow those expansions to continue for another two years, at which time states could no longer accept new enrollees, even those who forgot to re-enroll in the program.
     Another point is that the ratio of charging older enrollees to younger enrollees goes from 3:1, to almost 5:1, meaning that older Americans would be responsible for paying five times that of a younger person (18-35).
     Another surprising point is that the AHCA keeps the subsidies of the ACA, though, redistributes who gets them, based on age, rather than income. This means anyone within an age bracket gets the same amount of money in tax credits to buy insurance, even if they make 400 percent over the poverty line. These subsidies range from $2,000, under 30, to $4,000, over 60.
     Astonishingly, the AHCA keeps ACA taxes effective for one year, though eliminates the tax on employee-provided health insurance. There is also no individual mandate, except that those who experience a lapse in coverage must pay 30 percent higher premiums to insurance companies to regain coverage.
     Does anything here sound different from what’s already law? There are still no lifetime limits, Medicaid is still expanded and subsidies are still given. This plan really is ObamaCare-lite. It is Ghostbusters 2; the only reason it’s not popular is because it comes after the ACA (Ghostbusters 1 for this metaphor).
     The bill takes away insurance from between six and 10 million people due to more burdened costs (Standard and Poor’s). Had this bill come during the George Bush Administration, congress would be crowned heroes for creating a highly volatile, yet innovative nonetheless, private insurance market place, while creating this revolutionary idea of giving subsidies to those who can’t afford insurance, and expanding Medicaid. The only issue is the ACA did it better, so much so that this looks like a step backward.
     This isn’t to say that the ACA doesn’t have its problems. It is true that it did not get everyone in the US covered, it kept premiums, deductibles and rates at normal increases until last year, when they rose astronomically; all the while creating a system that harbors disdain for those with no jobs on Medicaid, while being unable to afford reasonable healthcare while being working-poor.
     A major repeal in the AHCA is that there is no community-rating (which means all enrollees in a pool pay the same amount no matter sick or healthy) and that plans no longer must cover preventative care, or other mandates required in the ACA. Sure insurance is cheaper, but that’s only because people are only able to choose the plan that prevents them from dying while on their deathbed.
     The only winner in the plan is someone over 25 and under 35, who statistically doesn’t experience medical problems, and only needs plans in case of catastrophic incidences. The flat tax subsidy helps them even more. If the problem was too high costs, not enough great care, then the law has catered to the wrong people. But even if the law were passed, those 28-year-olds would soon find that when they reach 40, their medical costs would rise through the roof, forcing them to become complainers of too-costly coverage for poor plans.
     In reality, the only group this caters to is those who make over $250,000. With the phase out of Medicaid expansion in 2020, the tax cut on those Americans would be approximately $600 billion, according to the Atlantic.
     But it begs the question of House GOP members, that if you wanted a tax cut for the rich, why not just pass a tax cut, leaving the ACA in tact, and not facing a gauntlet in 2020, of those who lost there health insurance? Because the AHCA looks like a poorly constructed ACA that tries to help people but does not have the muscle power to do so. Not to mention, how does the government maintain the coverage of those in the Medicaid expansion through 2020? It’s not like the people disappear…
     The AHCA proposes converting the Medicaid funding to block grants given to states, that would pay the bare minimum of Medicaid costs, leaving states to make up the difference (the ACA legally bound the government to paying nearly 90 percent, in some cases, of an enrollee’s Medicaid cost).
     I have my own opinions on healthcare in the country. I believe that the ACA would not have caused premiums to rise if the GOP hadn’t gutted the individual mandate. It’s a law that all Americans behind the wheel of a car must be insured. If I am pulled over without insurance, I’m fined almost $400. If I continue to get caught, I could either see jail time or my license suspended. Why can’t we do that with health insurance?
     Speaker Paul Ryan was quoted over the weekend, that insurance couldn’t work if the healthy must pay more to subsidize the sick. It appears to me that Ryan doesn’t know that this is exactly how insurance works. Farmers in Iowa subsidize other farmers in Iowa who have bad crop yields. We pay insurance for the hope to never use it. When there’s a bad yield, a farmer takes from the pool of money that insurance has collected to help them. Next season, someone else takes it.
     If we’re getting into arguments about how Medicaid disincentivizes people from getting higher paying jobs, I ask you how many people enjoy the doctor? No one makes arrangements to spend a Sunday afternoon in a doctor’s office getting a tonsillectomy. In fact, even those with insurance barely see a doctor. It creeps people out.
     The GOP doesn’t want to do anything about student loans so anyone who worked on the floor of a car plant who was fired because of automation can’t go back to school to learn a new skill. They still have kids and a family and need to survive, so they take a low-skill job that doesn’t pay enough to cover expenses, or offer them good health insurance. No amount of pulling up on their bootstraps will get them out of that circumstance.
     No one wants to be poor, but not everyone can be rich.