The GOP has fallen short of its promise to repeal and replace the Affordable Care Act (ACA) with a better plan.
ACA, also nicknamed Obamacare, aimed to make health insurance affordable and decrease the number of uninsured Americans. Some of the act’s provisions include expanding Medicaid, mandating that everyone buy insurance or pay a fine, introducing competitive marketplaces to sell coverage, ruling that businesses with over fifty workers provide employee health benefits, and insuring that those with pre-existing conditions would not be denied insurance. Over the few years that it has been in place, the plan has been plagued with its fair share of issues. Many doctors still refused to take Medicaid patients, people paid the cost of the fines in lieu of actually purchasing insurance, patients were unable to find the right providers within narrow networks, out-of-pocket costs increased substantially, and employers hired more part-time rather than full-time workers to avoid having to supply health benefits. The other problems were lack of options in insurance, failing co-ops, burdened state and national budgets, and so on (Bandler, 2017).
However, Obamacare also had numerous successes. ACA has increased coverage for at least 17 million people, and although the metrics and exact numbers are disputable, this is still a significant portion of the population (Gottlieb, 2015). The plan helped the sickest gain insurance by ruling that insurance companies couldn’t refuse coverage to those pre-existing conditions. It also expanded Medicaid to cover 11 million more people, allowed those under 26 years of age to stay on their parents’ insurance plans, mandated that employers with over fifty employees provide health insurance, and created a healthcare market which in theory was supposed to foster competition to encourage low prices (BBC 2016, Luhby 2017). Although how many people actually gained insurance is still a matter of debate, it cannot be denied that millions more have some type of coverage, and many lives have been saved. Numerous stories have emerged of people being saved from unexpected and costly afflictions, such as cancer (Cohn 2017). Despite being a highly controversial and flawed plan, ACA really has benefitted the most vulnerable in terms of aiding the poorest, the sickest, and the oldest.
However, Republicans have promised to repeal and replace Obamacare since its inception. Because members of the GOP initially supported the Affordable Care Act, many speculate the repeal partisan differences primarily motivated the repeal. Nevertheless, Republicans vowed to allow U.S. citizens to pick benefits they needed rather than pay for benefits they didn’t want, as well as decrease ACA funding. However, at the same time, they vowed to replace the Affordable Care Act with a plan that was better and offered health insurance to all (Sanger-Katz 2017).
Paul Ryan’s plan “A Better Way”, introduced this past February, does not come close to fulfilling these grandiose promises. The new plan will retain the most popular aspects of Obamacare: limit on out-of-pocket costs, the ability of those under 26 years of age to stay on a family plan, and protection for those with pre-existing conditions (Luhby, 2017). What’s different is that the plan dissolves ACA’s individual and employer mandates, lowers Medicaid funding, and replaces income-based tax subsidies with tax credits based on age.
There are a number of arguments that have been brought up against “A Better Way”, even from GOP members (Rubin 2017). With the age-based tax credits, the elderly would receive more tax credits than those who are younger, which makes sense since the older tend to fall ill more often. However, this disproportionate funding may hurt younger patients. The plan also incentivizes healthcare savings accounts rather than subsidizing costs; the issue with this is that only those with money to spare will create these accounts. As a result, Democrats have accused Republicans of cost-shifting: the richest who are able to put the most money in these accounts get the most benefit from the new plan.
Another large problem is that the plan will decrease the amount of money states receive from the federal government for Medicaid spending through as-of-yet unspecified block grants or per capita blocks, which in turn will force states to cut the number of people currently on Medicaid. The plan’s creators hope that increased competition through insurance sales and health care savings accounts will lower costs for payees and benefit many. However, the non-partisan Congressional Budget Office recently released a statement claiming that 24 million Americans would be left uninsured by 2026 as a result of this plan, either because there would be no mandate making it necessary for individuals to purchase coverage or because of decreased funding. Although the GOP claims these numbers are inflated, millions will undoubtedly lose coverage (Kelly, 2017).
The GOP’s proposed system seems inherently biased against the most vulnerable and the poorest. It does solve the root of the problem. Reducing healthcare costs requires long-term planning. For the government to reduce spending on healthcare, preventative care and overall health must improve first. One cannot cut spending and force states to cover a fraction of the previous beneficiaries. Universal health insurance and improved health outcomes unfortunately still remain part of a faraway dream rather than a close reality.
Aaron Bandler, “11 Biggest Problems with Obamacare,” Daily Wire, January 5, 2017, accessed February 15, 2017, http://www.dailywire.com/news/12146/11-biggest-problems-obamacare-aaron-bandler#.
Gottlieb, Scott, “How Many People has Obamacare Really Insured?” Forbes, March 14, 2015, accessed March 11, 2017. https://www.forbes.com/sites/scottgottlieb/2015/05/14/how-many-people-has-obamacare-really-insured/#6440576c788a.
Jennifer Rubin, “Paul Ryan’s Obamacare Replacement Will Be a Tough Sell,” Chicago Tribune, February 17, 2017, accessed February 17, 2017, http://www.chicagotribune.com/news/opinion/commentary/ct-paul-ryan-obamacare-replacement-20170217-story.html.
Jonathan Cohn, “This is What Obamacare Critics Simply Won’t Admit or Understand,” Huffington Post, February 18, 2017, accessed February 18, 2017, http://www.huffingtonpost.com/entry/obamacare-what-went-right-critics_us_58a725dce4b045cd34c11b4c.
Luhby, Tami, “What’s likely to change in the GOP bill to replace Obamacare,” CNN Money, March 19, 2017, accessed March 19, 2017, http://money.cnn.com/2017/03/19/news/economy/gop-obamacare-repeal-bill/.
Margot Sanger-Katz, “Republican Health Proposal Would Direct Money from Poor to Rich,” New York Times, February 16, 2017, accessed February 17, 2017, https://www.nytimes.com/2017/02/16/upshot/republican-health-proposal-would-redirect-money-from-poor-to-rich.html?_r=1.
“Why is Obamacare so Controversial?”, BBC, November 11, 2016, accessed February 17, 2017, http://www.bbc.com/news/world-us-canada-24370967.
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