By Wayne Caswell, founding editor
UPDATE 3/24/2017 — Republicans in the U.S. House of Representatives scheduled a critical vote today but could not secure enough votes within their own party to pass the American Health Care Act. So Speaker Paul Ryan and and President Trump decided to pulled it. The bill to partially repeal Obamacare would partially fulfill a campaign promise and give tax breaks to wealthy benefactors, but it would also steal from the Medicare Trust Fund, gut Medicaid, and result in the deaths of Americans by leaving them without health care. Pulling the bill was a better option than facing angry constituents, 85% of whom were against it.
As a left-leaning consumer advocate focused more on policy than politics, I’m glad; but now Congress must find ways to shore up Obamacare insurance exchanges and work toward more effective health reform. Too many healthy people have stayed out of the private insurance market, choosing instead to pay the tax penalty. That left too many older and sicker people and caused many insurance companies to lose money with the policies they offered. The ACA mandated penalties were apparently not high enough to convince healthy people to sign up, so fixing that should be relatively easy.
It’s my hope, however, that both parties will now reach across the isle in a bipartisan way and do the hard work of making affordable healthcare available to everyone, as the President promised. The Republican rhetoric that Obamacare is collapsing is not accurate or helpful, and I worry that HHS Secretary Tom Price could make things worse with rule changes and then blame Democrats for resulting problems. But that too is not helpful.
I continue to believe we can cut our $3.5+ trillion/year healthcare costs in half, and also improve outcomes, by adopting a single-payer national healthcare system like all other advanced nations have. But that would require standing up to powerful special interests who don’t want to lose revenue and profit. It’s my view that we should migrate off of employer-provided and private health insurance and provide healthcare universally for all citizens as a right. Yes, they would pay higher income taxes but overall healthcare costs would be far lower, especially if we also abandon fee-for-service business models, ban drug companies from advertising to consumers, and focus on wellness, prevention, and more efficient delivery systems through smart uses of technologies like telehealth and medical tourism across state lines.
American Health Care Act — a Summary
I can’t avoid getting political when it comes to healthcare, and I’ve been critical of both Obamacare and the medical industry, which spends three times as much on lobbying as the military industrial complex.
Obamacare made improvements but is far from perfect, so I’m all for replacing it eventually with a single-payer system that cuts our $3.5+ Trillion/year spending in half to match what other advanced nations pay on a per capita or percent of GDP basis. Unfortunately, the Republicans’ American Health Care Act (AHCA) would just shift the financial burden to the poor, disabled, and elderly while giving a huge tax cut to the wealthy and doing more harm than good.
According to the bipartisan Government Budget Office (GBO), tens of millions of Americans would lose their insurance under the AHCA, because they’d be unable to afford it. As a result, tens of thousands of them would die needlessly.
Understanding the full impact of this Republican healthcare bill is difficult, given the mixed spin from both political parties, and the fact that most articles just describe one aspect of it or another. The purpose of today’s post is to pull it all together and include a summary page that you can print as a reference when discussing the issues with friends.
AHCA is Just Part of a Larger Republican Plan
Republicans have had seven years to “repeal & replace” Obamacare, the Affordable Care Act, and in all that time they’ve been unable to come up with a good replacement. Now that they control the Presidency and Congress, they’re trying to rush through a replacement but still haven’t gained enough support in their own party. They also face still opposition from Democrats, and from Senate rules that require a 60% vote. That means they’ll need some Democrats to help them replace Obamacare unless they enact “the nuclear option” to overcome a filibuster, which would be a risky permanent rules change.
PART 1 – Republicans can make financial changes involving taxes and budget with just a simple majority, so that’s what the AHCA is: the first step. It’s a relatively simple step, except that too many constituents have shown their disagreement and anger and applied pressure, especially on representatives facing reelection challenges in 2018. If the bill survives a House vote, it will find the Senate even more difficult, because Republicans only have a thinner majority there.
PART 2 – Health & Human Services (HHS) Secretary Tom Price can make significant changes on his own with the stroke of a pen and change how healthcare rules are interpreted, applied and administered. That’s scary given his history of using his public office to make investments in the medical industry, and then influencing policy to affect the profitability of companies he invested in. So the question is, will he now function as a physician and “first do no harm,” or will his decisions further enrich himself and his industry partners?
PART 3 – There are many parts of Obamacare that can’t be easily undone without 60% vote, and that needs help from Democrats. These include:
- Insurance competition across state lines
- ACA Insurance 80/20 rule requiring 80% of premiums to be applied to medical care
- Replace preexisting conditions requirement with state administered High-risk Pools
- Annual & lifetime insurance caps
- Stay on parents’ plan until age 26
- ACA promotion of innovative business models such as Accountable Care Organizations, Patient-Centered Medical Homes, EMR Meaningful Use incentives
And you thought the Town Halls were feisty
I met Dr. Michael Burgess, my Congressional Representative who chairs the House Energy and Commerce subcommittee related to health care, and I shared my disappointment with the direction that he and other Republicans are taking health care. I also attended his Town Hall meeting, similar events and protests around Texas, and even did a road trip to Austin with dozens of others to voice our concerns during a Capital Day sponsored by Cover Texas Now. But as feisty as many of those rallies and town halls were, none compared to Elizabeth Warren as she addressed Republicans preparing to vote on the American Health Care Act.
Summary of the American Health Care Act
Over the last five years, I’ve posted well over 100 consumer articles on healthcare policy. Here are some of my Favorites and most relevant to today’s article:
- US Healthcare System has Cancer. Can Trump Fix it?
- Escape Fire: The Fight to Rescue America’s Healthcare (documentary film)
- Transforming Our Flawed Healthcare System
- Influencing Healthcare Policy – Lobbying, Incentives & Insurance
- Health Care Reform – Progress and Next Steps (by President Obama)
- Let the Health Care Reform Debates Begin, Again
- Why Republicans Want to Repeal Obamacare
- Healthcare as Public Utility
- Universal Healthcare Opposition
- Chipping Away at Healthcare Special Interests Yet?
- HEALTH or SICK Care?
- Disrupting Healthcare with Functional Medicine 2.0
- Corporate Behavior and Rising Health Care Costs
- Wealth Inequality, Healthcare and the Economy
Hundreds of mainstream press articles covered different aspects of the American Health Care Act, and in many cases I commented. Here are some of the best:
- Obamacare: The Republican Waterloo (The Atlantic – exceptionally well-written historical perspective of health reform)
- On health reform, Donald Trump followed Republican leaders into a ditch (Vox on how it all happened)
- How health care works around the world (CNN, great charts)
- Republicans are Losing the Healthcare War to “Win” a Battle (RealClearMarkets)
- The GOP’s Obamacare repeal plan is out – and it’s even worse than anyone expected (Chicago Tribune)
- Why Even Some Republicans Are Rejecting the Replacement Bill (NY Times)
- “It won’t work.” Obamacare’s toughest critics are panning the GOP replacement bill. (Vox)
- CBO: Republican bill raises premiums for older, poor Americans by more than 750% (Vox)
- White House analysis of Obamacare repeal sees even deeper insurance losses than CBO (Politico: 26M v. 24M)
- Who Wins and Who Loses Under Republicans’ Health Care Plan (NY Times, great charts)
- What the GOP health plan really means for taxes (Washington Post)
- Here’s the secret payoff to health insurance CEOs buried in the GOP Obamacare repeal bill (LA Times)
- Why It Matters How We Define ‘Insurance’ (WSJ)
- What the Republican Obamacare replacement plan means for the sickest Americans (Vox)
- Republicans lied about healthcare for years, and they’re about to get the punishment they deserve (Business Insider)
- Why can’t Republicans give straight answers about their health care bill? Because the truth is ugly (Salon)
- The real reason Republicans are ramming through a health care bill that no one wants (Quartz)
- The new Republican health-care plan is awe-inspiringly awful (Washington Post)
- House leadership Obamacare repeal bill is Republican declaration of class warfare (Salon)
- Paul Ryan’s Health Care Plan Doesn’t Really Eliminate The Individual Mandate (Huffington Post)
- Why the Obamacare repeal bill will have an even tougher time in the Senate (Vox)
- Tom Price, Dr. Personal Enrichment (NY Times)
- Texas Braces for Medicaid Cuts under GOP Health Plan (NPR)
- How Lower Premiums Could Mean Higher Health-Care Costs (Bloomberg)
- Obama health law’s “essential benefits” may be in jeopardy (Associated Press)
- Abortion rate declines to historic low, with Obamacare a likely contributor (LA Times)
- The AHCA’s war on women: There’s nothing “pro-life” about the Republican health care bill (Salon)
- Could the [non-group] individual insurance market collapse in some states? (Salon)
- U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare (LA Times)
- Obamacare repeal guts crucial public health funds (Washington Post)
- 20% cut to NIH budget would leave Americans more vulnerable to cancer and other diseases, experts warn (LA Times)
- The American Health Care Act would lead to more smoking, disease and tobacco industry profits. (Salon)