For the past eight years, the single greatest unifying force in the Republican Party has been hatred of President Barack Obama. Translated into policy, that force manifested into universal opposition to the Affordable Care Act. Now, the Republican Party finds itself with control of the White House and both houses of Congress. With this perfect opportunity, they’ve finally presented their alternative “repeal and replace” health care plan. Spoiler alert: it’s a complete disaster.
What makes their proposal — alternatively “Trumpcare,” “Ryancare” or “Republicare” — so horrifically bad? First, it repeals the individual health insurance mandate, a critical component to keep costs lower under the ACA. It replaces this with a bizarre requirement that people maintain continuous insurance coverage. Under the current bill, a lapse in coverage as short as two months will be punished by a 30 percent increase on insurance premiums. Unlike the current mandate, which is paid to the government, this massive penalty must be paid directly to insurance companies.
Not only is this penalty more onerous than the mandate, it’s also less effective. Since the penalty is only paid once you sign up for insurance again, it incentivizes people to remain without coverage. And getting covered, too, will be more difficult. The Republican proposal replaces insurance subsidies with tax-credits based on age, not income. Such a change will particularly harm lower-income and older Americans, making insurance unaffordable for many of them.
Republicans argue that they’ve retained the best parts of the ACA, including keeping people on their parents health insurance until the age of 26. Yet, what good does this rule do if your parents can no longer afford insurance? In addition, a provision that allows coverage for pre-existing conditions makes little economic sense in the broader structure of the bill and could potentially trigger a death-spiral of premium increases. The scant remaining positive aspects in this bill are a mostly nonsensical attempt to preserve popular ideas. Moreover, they are outweighed by the broader plan’s complete disregard for those with the greatest need for care.
Remember that one of the most successful aspects of the ACA was its expansion of Medicaid eligibility. The Republican plan would strangle the funding for this increased enrollment, leaving the most vulnerable members of society with nowhere to turn. They argue that this Medicaid expansion is too expensive, but their proposal also cuts taxes for the rich by hundreds of billions of dollars. It’s a reverse-Robin Hood redistribution from the very poorest to the very richest.
Those are the basic policy changes. The impact? According to the nonpartisan Congressional Budget Office, the Republican health care plan will result in 24 million fewer people having health insurance within the next seven years, and 14 million fewer by 2018. Immediately, President Trump and Speaker Ryan claimed that this projection is ridiculous and inaccurate. However, if anything, these numbers are overly kind. A source from within the notoriously leaky Trump administration revealed that their internal projections of the plan show that an even higher number, 26 million, would not have insurance by 2024.
Without insurance, these individuals won’t receive the preventative care that staves off illness in the first place. Unable to pay, they will put off cancer screenings and go without essential medication. They will try to ignore health problems until it’s too late and receive care only in emergency rooms. And they will die. The true cost of this bill will be in the form of American lives; according to recent projections, more than 24,000 excess deaths every single year.
Knowing this, why would any government even think of depriving millions of people of insurance? After all, the Affordable Care Act is largely working. Contrary to doomsday projections of a “death-spiral,” the CBO and others have found that ACA insurance markets will remain stable for the foreseeable future. If the Republicans leave it alone, it will continue to save lives.
To be clear, the ACA is not perfect. A public option could help keep premiums down, and many Democrats still believe we would be better off by switching to a single-payer system. But that’s not the situation we’re in. Indeed, the Affordable Care Act was a remarkably moderate approach. In many ways, it closely modeled conservative proposals from the 1990s as well as Mitt Romney’s reform in Massachusetts. Nonetheless, Republicans still demonized the ACA. They spread lies of death panels, false accusations of a government takeover. And they knew they could. It’s easy, after all, when you’re just the opposition.
Now, it’s a little more difficult. President Trump has made promises that are impossible to keep, including that his health care policies will cover “everyone.” But ironically, for all of the uniquely terrible aspects of the Trump administration, we would be facing a similar health care proposal under virtually every conceivable Republican president. This national fraud comes directly from a Republican Party that has lied and lied and lied to the American public. It comes from a blind adherence to a failed ideology, and a partisan desire to destroy President Barack Obama’s legacy.
To President Trump, Speaker Ryan, the GOP Congress, and our very own Rep. Tom Reed (R-NY), I say this: spitefulness is not a governing strategy. You have been entrusted with the responsibility to improve the lives of 300 million Americans. As you shamelessly shirk these obligations, you may hope that Americans aren’t paying attention. Your lies, after all, got you into office, and most people aren’t glued to the arcane details of health care policy. But everyone gets sick. If you are successful in repealing the ACA, the gap between your rhetoric and the truth will be painfully filled by medical bankruptcies and funerals. Are you aware that this will happen at the same time as you run for reelection? How, exactly, do you think that’s going to end for you?
Kevin Kowalewski is a senior in the College of Arts and Sciences. He can be reached at firstname.lastname@example.org.