The center of the domestic policy conversation in the U.S. has been centered on one piece of legislation lately – The American Healthcare Act, or as some (like I) prefer to call it – RyanCare. The GOP’s first full attempt at repealing and replacing Obamacare (The Affordable Care Act) is the brainchild of Speaker of the House Paul Ryan, and Ryan is insisting that the ACHA ought to be passed through Congress as soon as possible.
Earlier this week, the CBO (Congressional Budget Office), a non-partisan office, released the statistics that the ACHA would likely bring about. I’m here to discuss those outcomes, and why they might arise.
For those unfamiliar, the ACHA is a bill that has received a lot of bipartisan backlash. The Freedom Caucus, a group of hardcore conservative congressmen that used to include Vice President Mike Pence, has dubbed the bill “ObamaCare Light”. They think the bill is a reworking of Obama’s signature policy, just simply without the mandate that all citizens must be insured.
Democrats on the other hand, have largely refused to get behind any health care reforms that repeal the Affordable Care Act. This is strictly a partisan move, as Clinton campaigned on fixing the legislation herself.
Many are awaiting the word of the President himself, but Trump has remained relatively quiet on the issue (by his standards). He has held a copious amount of meetings, with insurance execs, doctors, congress groups, etc., and has tweeted support of both Ryan and GOP-opponent to the bill, Rand Paul.
Ultimately, whichever bill ends up reaching the Oval Office will be one Trump supports and strong-arms through congress. However, it will need to please a majority of the Freedom Caucus, Speaker Ryan and the “establishment”, and the more independent GOP Senators like libertarian Rand Paul, moderate Susan Collins, and brash conservative Tom Cotton- all senators that have publicly criticized Ryan’s ACHA harshly.
Now to the meat of the bill. The CBO projects a few things – I’ll list them first, and explain after.
-14 million fewer insured by 2018, and 24 million fewer by 2026.
–> It is also enormously important to note that the CBO’s number does not necessarily take into account those who might use the ACHA’s tax benefits to buy healthcare options that they cannot under Obamacare.
-Healthcare premiums to rise in the short term (2018), but to drop by a noticeable margin by 2026 as the marketplace develops
-$880 billion in savings to the federal government, which is a hefty national debt reducing measure
-Significantly less federal funding for Medicaid, with an effort for state-wide reform and investment
–> Obamacare expanded Medicaid, so this is a rollback, but an unpopular one
-Older, sicker people paying more for their healthcare
–> Younger, healthier people paying less for healthcare
-Those making over $75,000 will be paying, on average, less for healthcare
The GOP seems to be in disarray with how they want to “sell” this bill to the public. Ryan praised the fewer insured number, saying (and I paraphrase) “If you don’t make people buy something they don’t want to buy, they won’t buy it anymore. This is a good thing”. Again, as I previously mentioned, it’s important to note that the CBO’s number doesn’t account at all for those who could potentially use the ACHA’s tax benefits to buy healthcare options that they couldn’t under Obamacare.
Health and Human Services Secretary Tom Price, a supporter of this bill that Paul Ryan calls a “3 Step Plan” which includes administrative changes by Price, called the CBO numbers unreliable. The CBO infamously overestimated how many citizens would participate in the Obamacare exchange initially, a mistake that led to much higher premiums than anticipated. This “death spiral” as the GOP calls it has led to fewer and fewer participants and insurers being in the Obamacare marketplace, which is leading to higher and higher prices each year.
From what we can tell, the White House is following along with Price- criticizing the amount thought to lose coverage. Of course though, that whopping $880 billion number is true to them- why would they want to criticize the numbers that help?
The main philosophical argument against Obamacare is the individual mandate- the part of the legislation that requires people to either buy healthcare or pay a fine. Many don’t think that the federal government should be dictating what consumers purchase, but should rather build a marketplace which encourages people to purchase the plans which work best for them.
Also, many think that older, sicker people paying more than their younger counterparts do is fair because they use more healthcare. That is a fact. Should healthcare be a consumption priced good? That is another philosophical argument.
Trump campaigned on opening insurers to be able to market across state lines, a move which would allow for more “low-cost low-coverage” insurance options. According to Ryan, this step would fall into “Phase 3” of the ACHA’s 3-Step Process. However, Senator Cotton has firmly stated he wants this bill to be a one-and-done piece of legislation.
The urgency from the GOP congressional camp likely comes with mounting fear of not fulfilling their number one campaign promise- the repeal of Obamacare. Midterm elections promise to be a whopping battle of ideologies, and the GOP wants to prove it can govern effectively when in full control of Washington like it is until 2019.
In the end, any meaningful healthcare reform will likely do a few things. It will decrease federal funding for Medicaid (poor and elderly state healthcare) and call on states to put more into their funds. It will likely withhold all federal funding from Planned Parenthood if the group refuses to restrict abortion access. It will almost assuredly see a short term increase in premiums before the system adjusts and lowers costs long-term, which will happen. It will save the federal government money somewhere, and it will shift the costs onto a new group of consumers.