Congressional Republicans took their first break from Washington under the new Trump Administration. And those, like Sen. Tom Cotton, R.-Ark., who actually tried to hear out constituents in town halls got caught in an angry backlash. Voters let their lawmakers know they were furious about GOP plans to repeal and replace the Affordable Care Act, aka Obamacare.
The electorate’s rising anger led to reports that the GOP, even in its hard-core House majority, might be jammed up in its long-pledged vow to immediately unwind Obamacare, especially how it added health insurance coverage for tens of millions of Americans, notably through an expansion of the Medicaid program. John Boehner, the former GOP House speaker, flatly proclaimed that his party would leave most of the ACA undisturbed.
Partisans press on with plan with new taxes
But GOP leaders, including President Trump, pressed on, seemingly undeterred. The president launched yet another counterfactual assault on the ACA at a national meeting of conservatives, while other Republicans—notably House Speaker Paul Ryan and Tom Price, the newly installed head of the Health and Human Services Department—made their positions ever clearer in a “leaked” draft of Trumpcare, the prospective replacement for the ACA.
Although there were a few wrinkles in it, Trumpcare consists mostly of retread Republican plans, many of which have been shown by research and evidence to potentially lead to lower costs for some—but with much less coverage for many.
Ryan and Price hadn’t been explicit about it before. But the latest, leaked draft of Trumpcare contains a new twist that Republicans, when they hope to repeal the ACA’s funding mechanisms, will aim to replace some of the money needed to support their health care plans by imposing new taxes on Americans who get their health insurance through their employers.
Companies and workers both have benefited from favorable taxation on employer provided insurance. But if the coverage becomes too luxe, so-called Cadillac plans, advocates—including some in the Obama Administration—have argued these should be subject to taxes, both for fairness’ sake and to encourage policy-holders to be more conscious of and to curtail their spending on medical services.
But even the Obama Administration ran into a political buzz saw when it tried to tax employer-provided health care benefits, because many of these have become a real and symbolic part of many middle-class Americans’ compensation. Many workers clung to their health insurance as a consolation prize during long years when tough economic times meant they weren’t getting pay raises.
Ripping young and old
Republicans also may find Trumpcare, underwritten with these new taxes, an even harder sell because their plans so clearly favor the wealthy and now will zing the old and young. They plan to replace Obamacare subsidies for health insurance coverage with tax credits. Those would only amount to $2,000 annually for those younger than 30 — sums that won’t go far in paying for coverage and that don’t really kick in until and if a younger policy-holder goes to file for income taxes. Meantime, those Americans older than 60 would get roughly twice the tax credit. That $4,000 also wouldn’t be available for a while to them and it wouldn’t go far in paying for insurance with substantive benefits, analysts say.
As I’ve written, the GOP proposals also will veer from the ACA’s income-adjusted support for health coverage, favoring, instead, assistance based only on age. That means Warren Buffet could qualify for the same tax credit as a pensioner subsisting solely on Social Security. But the GOP, to try to bring as many younger, healthier people into insurance markets, also is leaning toward allowing insurers to charge seniors more for their coverage, which some analysts say will open the door to huge premium spikes for Americans 50 and older, who might end up paying as much as $17,000 annually for health insurance.
Speculation has risen that one reason the GOP keeps circulating drafts of Trumpcare, and party leaders haven’t, in their zeal and haste to repeal the ACA, provided a more final bill, is because it then would be subject to independent economic analysis, for example by the nonpartisan Congressional Budget Office.
Take it with a grain of salt: the left-leaning, Democratic-oriented Center for Progress notes that many current GOP health care proposals reprise a push a few years back by then House Majority Leader Eric Cantor to develop an ACA repeal and alternative. Under that GOP plan, which also included slashes to Medicaid, millionaires would have gotten a tax cut of more than $50,000, while the nation’s .1 percent—those earning more than $3.7 million—would have gotten a tax reduction of more than $197,000. Meantime, the center says 38 million Americans would face new taxes on their employer-provided health insurance.
Let’s not neglect the GOP assault on Medicaid. I’ve written how reductions in this program would slam millions of Americans with loved ones who have chronic health conditions, or mental or physical disabilities. It also would leave a huge hole for the sick and elderly, as millions of Americans outlive their finances and require Medicaid assistance for nursing home care and Medicare help for medical services. The GOP also has plans, which already are drawing significant and growing fire, to attack Medicare under the banner of fiscal reform.
Republicans are adamant about making big Medicaid cuts, though their latest Trumpcare proposals would let the 32 states that expanded the program under the ACA continue to benefit—albeit with a lot less money from Uncle Sam. The program also would no longer have federal funding guarantees, going, instead, to block grants that could vary in amount each year. The 19 states that declined to expand Medicaid—sadly, to the detriment of the health of their own—also will get new federal Medicaid help.
I know the ins and outs of health care policy and finance can be hard-sledding for most of us. I see in my practice how patients injured while seeking medical services struggle in lawsuits not only for justice but also to ensure they will have the long-term financial support they will need. The partisans may find it easy to take ideological positions, free from fact and reality, as they make proposals about health care that affects us all. Obamacare is decidedly imperfect.
But in a nation where more of us are “contingent workers” participating and innovating in a “gig economy”—where we are free-lancers, part-timers, creatives, artists, musicians, consultants, and others not tied to companies with many employees—the ACA has offered more health coverage and freedom than many could have imagined before. For the many deemed by autocratic insurers to have pre-existing conditions that barred health coverage or to those who have chronic conditions like cancer or who have survived it and other terrible conditions, it is a living nightmare for the uninformed to dismantle the ACA without offering a concrete substitute for a program that is growing in public support by the instant.
Repeal? Replace? Repair? ACA? Obamacare? Trumpcare? Health care is not a frill, it is not a political plaything. In a nation where 17.5 percent of the GDP is comprised of it, health care for all Americans is a right. And we need to fight for the best of it.