The American Health Care Act Must Be Rewritten

On Monday, the non-partisan Congressional Budget Office (CBO) released it’s evaluation of the legislation Republicans have put forward to replace the Affordable Care Act. The American Health Care Act (AHCA) was introduced in the House of Representatives only last week and has been racing it’s way through legislative hurtles in an attempt to outrun much of the harsh scrutiny it has received from both the left and the right. If readers haven’t caught up on this legislation, Vox has a good explainer piece on it.

The eagerly awaited CBO score has sent some pretty well felt shockwaves through Congress—as it reveals deep disparities between what Congressional Republicans have been saying about their plans, and what this legislation will actually do.  

In a quick rundown, the CBO revealed that the Republican healthcare plan would cause at least 14 million people to lose their health insurance in the first year of it’s enactment. That number would then rise to at least 24 million if the plan stayed in place until 2026. The evaluation also noted that the AHCA could cripple Medicaid by cutting $880 billion from the program in the next ten years. This action would lead to a massive increase in the uninsured rate of the poorest Americans who have relied on Medicaid expansion through the ACA. 

Although the CBO did have some good news for Republicans—such as the fact that the legislation would likely reduce the federal deficit thanks to decreased entitlement spending—defenders of the bill and public figures in the Trump administration have been harshly attacking the non-partisan Office. Health and Human Services Secretary Tom Price said, “We disagree strenuously with the report that was put out.” Meanwhile, Mick Mulvaney, Director of the White House Office of Management and Budget (OMB), called the plan “absurd.” These attempts to discredit the CBO come at an awkward time for the White House, considering the OMB released a report Monday citing that 26 million would lose their insurance—a higher estimate than the CBO score.

With all of the information that has come out flatly refuting President Trump’s original promise that everyone would be insured under the Republican replacement plan, only one course of action has become clear: Republicans must return to the drawing table and rewrite their healthcare legislation. In fact, Republicans have a moral responsibility to rewrite this legislation.

Despite all of the Ayn Rand style political philosophizing to which House Speaker and chief defender of the AHCA Paul Ryan ascribes, Republicans must write healthcare reform in reality as it exists today. Under the Affordable Care Act, roughly 30 million people have gained health insurance. This fact must be an absolute baseline when considering how the government will once again upend 18% of the US economy—for Republicans to flatly ignore the fact that the vast majority of these people will lose the insurance which they have gained is dangerous, and irresponsible governance. 

The number one goal for any new legislation put forward by the GOP needs to be the preservation of as much of that health coverage as possible. It is true that some people will be left behind, as they were with the Affordable Care Act, and it is frankly impossible to write legislation on this grand of a scale which will encompass everyone, however the American Health Care Act doesn’t even attempt to preserve this coverage. 

The chief defense that Republicans have given for the drastic lose in insured rates is that under their plan, healthcare markets will be expanded and Americans will be given more access to healthcare. However, the provisions to do this are not even present in the legislation. Instead, there have been vague proposals of a “three-step plan”—wherein regulatory reform and another piece of legislation (which must be passed by a majority of the Senate, not through 51 vote reconciliation), will be passed to round out insurance markets. Until these additional steps are fully revealed, what we have to work with the legislation that is on the table. 

The legislation does not include any promises made by Republicans about healthcare in the run up to this bill’s unveiling. For instance, the often cited Republican ‘fix all’ proposal of allowing insurance companies to sell across state lines is nowhere to be found in any of these proposals. If the Republicans feel this is such a solid idea to improve health coverage, then why not attempt to sell it to Democrats and win their votes?  The bill also breaks President Trump’s campaign promise to “save Medicare, Medicaid and Social Security without cuts.” The AHCA ends the Medicaid expansion in 2020, and cuts $880 billion from the program.  There are also no provisions on perhaps the one place of agreement between some Republicans and Democrats: more aggressive drug price negotiation. None of these provisions are good for the American people, none of them have been drafted with the intent of preserving the current level of health coverage while fixing the problems that the insurance markets still have. 

What the bill does do however, is provide a massive tax cut for top earners in the country to the tune of nearly $200,000 a year while at the same time prioritizing the wrong people for health coverage with a weak system of enforcement. The bill prioritizes those who are young, relatively healthy, and have a high income—the people who need government subsidized healthcare the least—hurting older and sicker people who rely on the increased subsidies from the ACA. This reversal seems intended as a flip from the ACA—where too few young people were signing up because they were without need of insurance, which drove up costs for older enrollees. Except the AHCA misses the point of that problem entirely. The reason young people don’t sign up for subsided insurance is because they don’t believe they need it. This in turn drives up costs for people using the insurance because the insurance companies are being hit with lots of healthcare charges, with little income. This is why the ACA mandate was created (by Republicans) —so that everyone would have insurance at one time, and so that the insurance markets would be funded. 

The AHCA solution for this problem is to allow insurance companies to charge a 30% rate hike to anyone who lacks coverage for 60 days—the theory being that if people know they will be charged more later, they will buy coverage now. However, it’s much more likely that the opposite happens: younger more healthy people will simple stay off of the insurance market now that they’re not being hit with a tax penalty. Sicker people will remain on the market being hit with the same premium hikes that existed under the ACA. Then if a younger person were to ever need insurance, they would be faced with paying 30% more than they would have originally, and that steep price increase would continue for up to a year of coverage. This would mostly result in an outright shunning of insurance markets all together—except in times of catastrophic need. 

The provisions of the American Health Care Act are incredibly troubling plans that don’t solve any of the problems that they set out to address. They create a more burdensome system for many while not solving any of the actual systematic issues that exist under the Affordable Care Act. Ezra Klein from Vox makes a good point in saying, “It’s not clear what this bill is trying to achieve…what it makes better.” The bill, by almost all estimates will not make anything better—and it would certainly not do more good than simply fixing the problems present in the existing law. 

All of this is coupled with the fact that the bill is simply a legislative mess which has been rushed through congress faster than almost any other major piece of legislation on record. Which was read and marked up with zero amendments by two major House committees only two days after it was introduced. The bill was also was actively spurred on to be passed ahead of any budget evaluation—so much so that amending legislators were flying blind when working on the bill. It becomes painfully clear that the only responsible course of action for Republicans is for them to stop, take a breath, and rewrite this legislation. They have a moral duty to the American people to get this right; we are talking about peoples lives. There can hopefully be responsible Republican healthcare, but it is not this bill. And it will not come until Republicans are able to moderate their views and legislate with the preservation of American’s health first and foremost in their minds. 


Zachary Sizemore is the Managing Editor at Sojourn Review. You can follow him on Twitter here.