Written by Steven Spear, Jr.
After seven years of promising the repeal of the Affordable Care Act (ACA), Republicans finally have chance to do it. They have control of the White House and a majority in the Senate and the House. This should be easy. But it is harder than anyone thought. As President Trump said, “It’s an unbelievably complex subject. Nobody knew that healthcare could be so complicated.”
Instead of improving on the failures of the ACA, the Republican plan is to start over. They are going to dismantle the healthcare law and take us back to pre-ACA days. This is what has happened so far—
In early March, six weeks after Trump’s inauguration, Speaker of the House Paul Ryan unveiled the American Healthcare Act. The bill went through the committee process and was scheduled for a vote 3 weeks after its introduction for a grand total of 9 weeks of consideration. (For comparison, the ACA was introduced 32 weeks after Obama’s inauguration and went through the committee process and was scheduled for a vote 3 weeks for a grand total of 35 weeks of consideration.) After Republican congressman faced intense pressure from their constituents, many opposed this bill, and Ryan withdrew the bill only a few hours before the scheduled vote.
With amendments that allow insurers to charge higher premiums to older enrollees and people with pre-existing conditions, the AHCA was re-introduced in late April and passed in early May.
In late June, Senate Majority Leader Mitch McConnell released his version the Better Care Reconciliation Act of 2017. Five Republican Senators have publicly stated that they will not support this bill—the bill will fail if only three Republican Senators vote against it. McConnell is pushing for the bill to be amended and passed before Congress goes into recess next week.
- “The creation a Pension and State Stability Fund that helps states to lower premiums by reducing the costs to insurers of people with high health care expenditures;
- “The repeal of a surtax on net investment income;
- “Average premiums would be 20% lower because of waivers that—
- allow states to modify the requirements governing essential health benefits (EHBs), which set minimum standards for insurance benefits
- allow insurers to set community-rating premiums on the basis of an individual’s health status if the person had not demonstrated continuous coverage.”
The waivers are the most damaging part of these bills. Using the first waiver would cause enrollees to pay lower premiums, but the insurance would likely not cover major medical services. Using the second waiver would cause healthier enrollees to leave the high cost plans with community-rating premiums. With healthy enrollees leaving, premiums would increase and eventually people who are less healthy and with pre-existing conditions would be priced out of the plans.
Here are some of the differences:
Table A: Comparisons between the Affordable Care Act (ACA), American Healthcare Act 2017 (AHCA), and Better Care Reconciliation Act of 2017 (BCRA). Unless otherwise noted, all estimated numbers are in billions and through 2026.
|Numbered of Uninsured (in millions)||28||49||51|
|Total Cuts to Medicaid||N/A||834||772|
|Total Reduction in the Deficit||N/A||119||321|
Table B: Comparisons between total annual premium payments for a single individual making $26,500 a year under the Affordable Care Act (ACA), American Healthcare Act 2017 (AHCA), and the Better Care Reconciliation Act (BCRA).
|21 years old||$1,700||1,250||2,200|
|40 years old||1,700||2,100||3,300|
|64 years old||1,700||13,600||6,500|
The real problem in the U.S. healthcare system is the cost. According to the World Bank, healthcare costs were 17.1% of U.S. GDP in 2014. The next major country was France at 11.5%. The U.S. spends nearly fifty percent more than France on healthcare, but the two countries have similar outcomes. If we can understand the cost drivers of U.S. healthcare, it will help the government control its spending, and those without insurance will be more able to pay for unexpected medical costs.
So what happens next? Do we raise taxes? Do we cut benefits? Do we leave this to private insurance companies? Do we create a national health service? Until we can have an honest conversation about these hard trade-offs, we will see healthcare continually debated in the realm of political theatre for decades to come.
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