The (un)Affordable Care Act

Trump promised to replace the Affordable Care Act (ACA) with something that is better, more affordable, and offers more coverage. Not so fast. Republican leaders in the House and secretary of health and human services Tom Price released a plan last week that would provide insurance that is far inferior to the status quo, shift more costs onto families, and cover far fewer people.

In a policy paper released on Thursday, House speaker Paul Ryan offered washed-up ideas for improving the country’s health care system that would, in reality, do anything but. For example, the paper calls for reducing spending on Medicaid—which now provides insurance to more than 74 million poor, disabled, and the elderly. Many millions of them would be cast out of the program. The Republican plan would also force most people who don’t get their health insurance through an employer to pay more by sharply reducing subsidies that the ACA. now provides. The proposal would allow families to store more money in health savings accounts, which may sound good at first but would primarily benefit affluent people who can afford to save more.

The paper is Ryan’s blueprint for essentially repealing and replacing "Obamacare." Unsurprisingly, he and his colleagues offered no estimates of how many people would lose coverage or a measure of how high premiums and deductibles would rise for middle-class and poor families. Yet the scant details did not prevent the Trump administration’s top health official from embracing the proposal. Tom Price, the secretary of health and human services and a former Ryan lieutenant in the House, said the president “is all in on this.”

To understand how terrible the House Republican plan is, consider its plans for Medicaid. It would roll back the ACA. provisions that helped more than 11 million people gain Medicaid coverage. Republican governors like John Kasich of Ohio and Rick Snyder of Michigan have actually praised the expansion because it has helped reduce uncompensated care at hospitals and provided addiction treatment to people suffering from the opioid epidemic. “Thank [G-d] we expanded Medicaid, because that Medicaid money is helping to rehab people,” Mr. Kasich said in January.

More so, the Republicans want to slash spending on Medicaid over all by giving states the option of a block grant or a "per capita allotment." The current program pays for the health care of everyone who is eligible. When the number of impoverished increases during recessions, the government spends more. Without the flexibility that was built into Medicaid, Congress would have to vote to give states more money when health care costs rise. Politically, that is in the “impossible dream” category, which is why most experts believe that, over time, states would cover fewer people and cut benefits.

Another part of the Republican proposal throws out the income-based Obamacare subsidies that help families buy affordable insurance. Instead, the Speaker wants to offer a flat subsidy that would be the same whether families earn $500,000 or $50,000. Residents of Minnesota would get the same support as residents of Alaska, where premiums on average are three times as high. The subsidies would vary by age to give older people more support, but the Republicans have not said how much more.

The House proposal is part of a broader attack on the ACA. Last week, the Department of Health and Human Services proposed regulatory changes to the law; one of which would permit insurers to shrink benefits and force people to pay higher deductibles on future policies. And the Internal Revenue Service said it would no longer require people to answer a question on their tax returns about whether they were covered the previous year. The question remains on the form, but filers can chose not to answer it. Under Obamacare, people must buy insurance or pay a penalty enforced by the IRS By backing off, the IRS will encourage people to forgo insurance and take a chance that it will not seek more information or penalize them. When fewer people—especially the young and healthy—buy insurance, costs go up overall because the people who do sign up tend to need more medical care.

Congress is in recess this week. If citizens can reach their representatives in congress and generally act to make their voices heard, they can send a strong message that Americans want legislation that improves health care and makes it more affordable for everyone, not the opposite.


Matthew Sporn is a Senior Editor at Sojourn Review. You can follow him on Twitter here.