Serving Northern St. Louis County, Minnesota

GOP makes mediocre Obamacare far worse


President Trump has repeatedly promised that his alternative to the Affordable Care Act, otherwise known as Obamacare, would increase access, lower costs, and provide better health care. Yet the replacement plan outlined by House Republicans last week will achieve none of these things. And that’s according to just about every health care analyst who has taken a look.

House Speaker Paul Ryan and other GOP leaders, themselves, have so little faith in their plan that they released it and tried to ram it through committees like a runaway freight train before the document could even be scored by the nonpartisan Congressional Budget Office.

It’s easy to understand why. The CBO, on Monday, concluded that 14 million Americans would lose their health insurance next year under the GOP plan, and that the number would to rise to 20 million within three years. By 2026, 24 million fewer Americans will be insured than at present, effectively putting the U.S. uninsured rate back to where it was before implementation of the ACA.

For all its faults, the Medicaid expansion and subsidies in the ACA have made insurance either free or relatively inexpensive for tens of millions of Americans.

Such provisions, however, will vanish or grow much stingier under the GOP plan. Here are just some of the ways that the Republicans take a mediocre government program and make it far worse:

‰ The plan significantly reduces the tax credits that have made it possible for millions of Americans to pay for health insurance under the ACA. The GOP plan offers credits in most cases, ranging from $2,000-$4,000 per year, depending on your age. That will increase the costs to most Americans currently helped by the ACA by thousands of dollars a year in many cases, particularly for Americans age 50-64. They won’t be able to afford the kind of coverage they can under the ACA, so the vast majority will either drop it, or buy cheaper, lower quality plans with higher deductibles and other out-of-pocket costs. This is hardly a win for most Americans.

‰ It eliminates the mandate on large businesses to provide insurance coverage to employees. There’s no way to know at this point how many businesses will choose to drop coverage as a result, but some certainly will, and in almost every case the workers who lose health coverage will be those least able to afford to buy coverage on the individual market.

‰ Rather than an individual mandate to buy insurance, the GOP plan allows insurance companies to charge you up to 30 percent more if your coverage lapses. This is the incentive to keep people buying insurance who might otherwise decide it’s too expensive. As a stick, it’s a lot heftier than the mandate, since the cost of a 30-percent hike in insurance premiums would be higher for most people than the current fine for failing to buy coverage.

‰ It changes the way Medicaid is paid for, and will put far more of the burden on the states than in the past. Indeed, the plan is expected to shift $800 billion in Medicaid costs to the states over ten years. Most won’t be able to afford that extra cost, so they’ll tighten eligibility rules and throw millions off of the program. Indeed, that’s exactly what the CBO projects. And it won’t be just poor working age folks suffering the effects. As Medicaid funding withers under the GOP plan, it will impact nursing homes, the elderly, and the disabled, which are the populations predominantly served by the program.

‰ It reverses the redistributive effect of the ACA. Because the focus of the ACA has always been on health care, many folks never recognized its positive impact on reducing income inequality in the U.S. The ACA took a tax nip from those with extremely high incomes and used the money to provide premium support to average working stiffs. This, of course, drove the GOP crazy. So their replacement plan eliminates those taxes on the wealthiest Americans, saving those in the top 0.1 percent a whopping $197,000 a year, according to estimates. It also bases the size of someone’s health care tax credit on their age, rather than income, so the plan in many cases would provide more help to wealthier people than the poor. Think of the GOP plan as Robin Hood in reverse.

‰ It will increase pressure to turn Medicare into a voucher program. Taxes assessed by the ACA have extended the fiscal solvency of Medicare until 2028, according to the latest projections put out by the program’s trustees. By eliminating those taxes, the GOP plan would put the program into insolvency as early as 2024. This is one of the reasons that AARP recently came out against the GOP plan. They recognize that creating a Medicare funding crisis is consistent with the Republican leadership’s desire to turn Medicare into a voucher program.

GOP claims

Republicans argue that their health care plan will actually work out, by making health insurance more affordable due to lower premiums. Their plan allows insurance companies to charge older customers up to five times more than younger ones. Currently, the ACA allows a variance of only three times, so this will mean higher premiums for middle-aged Americans who don’t yet qualify for Medicare.

This is one way that the GOP plan might actually lower premiums. By making them so expensive for middle-aged Americans, the GOP plan is expected to push many of them out of the insurance market—because they can’t afford it anymore. This will make the overall insurance pool younger and healthier, which should eventually translate into lower premiums, at least for younger Americans. But that will be slim comfort to the millions of middle-aged Americans, many of whom actually need health insurance, who won’t be able to afford it.

The GOP will also allow insurance companies to sell insurance policies that cover less, which will mean more out-of-pocket costs for those buying such insurance. The ACA had set minimum standards for policies, to guarantee that insurance companies weren’t selling “insurance” in name only, and Republicans correctly noted that this meant the insurance cost more.

According to the CBO, the GOP plan would reduce the deficit by about $337 billion over ten years. It does so, however, by shifting nearly a trillion dollars in costs currently borne by the federal government to the states and to hospitals and clinics, which will see a jump in their uncompensated care. And, of course, the GOP plan will leave tens of millions of Americans without health coverage, so the federal government will pay out less in insurance subsidies than it does today.

Even many more moderate Republicans recognize this is false economy. Anyone can cut the deficit by forcing federal costs onto others, and by forcing millions of Americans off of health insurance. And that’s one reason the plan faces an uphill fight in the more moderate Senate.

For the White House, the plan is a political loser. It bears no resemblance to the “fantastic” insurance plan that will cover everyone that President Trump assured voters he’d deliver. As usual, Trump over-promised and under-delivered— at least when it comes to average Americans. The fabulously wealthy get a glorious tax cut under this plan, but for millions of Americans, including many who voted for Trump, it’s back to the bad old days of no health insurance, and a federal government that is happy to ignore the problem.

For Trump, it’s one big broken promise.


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Interesting that GOP and WH saying CBO scoring shouldn't be taken seriously but hasn't mentioned WH analysts, OMB, estimated even higher number of Americans losing their health insurance, 26 million. Standard and Poor's and Brookings gave GOP/Ryan plan very poor grade. Consumer's Union gave it an F. Most healthcare organizations against it, incl, AMA, American Hospital Assn, MN Hospital Assn, Kaiser, AARP.

Block grants just shift costs to the states which is a common conservative tactic to get rid of government programs that majority of Americans approve of and need. Block grants forces states to make hard choices who gets hurt with less oversight. Historical data shows that instituting block grants decreases Medicaid funding over time.

There's a lot of news coverage on how the GOP/Ryan no care plan hurts the working poor but this plan negatively affects healthcare insurance coverage for all of us who are not wealthy.

People seem to forget that Medicaid pays for a lot of Americans in nursing homes and Medicaid block grants would create humanitarian and economical crises around the country. How many Americans would be able to take in or pay for their disabled and/or elderly family members care?

We don't get enough funding to adequately treat mental illnesses or opioid/drug addictions right now which are huge issues in rural/small town counties. St. Louis Co has one of the highest number of opioid overdoses in MN. There would be even less funding under AHCA.

Giving big surtax cuts to the wealthy means higher premiums for the rest of us including Medicare premiums. Hundreds of billions of dollars cut from our health care coverage to give right back to the wealthiest of us. Most people I know in their 50's are just waiting to get on Medicare because of their current high premiums and deductibles on their private market plans or their employer provided plans. The GOP plan would allow some companies to forgo providing health insurance to their employees. It might be wise for them and current Medicare recipients who have been putting off a medical procedure to schedule it sooner because no matter how low the odds of this repeal of getting passed in the Senate or even the House are, I have no doubt they will keep chipping away at our insurance coverage.

It's not just people becoming uninsured. It's our hospitals, clinics and health care jobs that will lose out.

13 members of the RSC met with Trump to discuss AHCA recently including Medicaid work requirements and block grants. One of them, AL Republican Rep Aderholt, released a statement after. Aderholt had concerns about treatment of older, poorer Americans as in his state. Aderholt said Trump listened to the fact that a 64 year old making $26,500 a year would see insurance premiums go up from $1,700 to $14,600 per year. "The president looked me in the eye and said, 'These are my people and I will not let them down. We will fix this for them'. I also asked the president point blank if this House bill was the one he supported. He told me he supports it 'one thousand percent' ". Then Aderholt said after getting "Trump's word that these concerns would be addressed, I changed my vote to yes". What?!?!? How does that make any sense? Just trust Trump? Seriously?

Tucker Carlson interviewed Trump last week.

Carlson: This bill has a tax cut for investors primarily benefiting those who make over $250,000 a year, who have already done quite well in the last ten years. A Bloomberg analysis showed middle class and working counties who voted for you would do far less well under this bill.

Trump: Oh, I know, I know.

Carlson: Maybe this isn't consistent with your message.

Trump: A lot of things aren't consistent.

He's not even denying his his health care proposal will punish his own supporters. Just trust he will "fix" it later.

Tom Price said "Nobody will be worse off financially". He also said children's vaccinations should be up to the states. That would work out well...not.

Paul Ryan said, "I can't answer that question" if there will be coverage losses. "It's up to people. People are going to do what they want to do with their lives because we believe in individual freedom in this country."

Chris Wallace, Fox News, pressed Ryan on that which surprised me: "You said this is what freedom looks like. What people are saying is this isn't freedom, this isn't people voluntarily deciding not to have health insurance. It's that your plan makes it unaffordable for people."

Check out excellent Ezra Klein youtube: "The more you need, the less you get".

Now comes Trump budget wish list, nickel and diming Americans some more, cutting or eliminating funding to basic programs which help people who need them and cost peanuts, Meals on Wheels, after school programs feeding children, heating assistance, health care to retired coal miners, PBS, veteran housing, etc, etc.

Budge director Mulvaney said about Meals on Wheels which feeds seniors probably the only regular meal they get a day, "Can we ask the taxpayer to pay for this?" Reporter Jim Acosta asked Mulvaney if it is also a hard-hearted budget. "No, I think this is one of the most compassionate things we can do". Acosta asked incredulously: "To cut programs that help the elderly and kids?" Mulvaney: "We're not going to ask you for your hard earned money anymore unless we can guarantee the money is actually being used in a proper function."

Huh? The cruelty of these kind of "priorities" is staggering. Turning the richest country on earth into a third world country looks like a deliberate goal not just gross ignorance.

Monday, March 20, 2017