The GOP's Obamacare repeal bill is out--and it's even worse than anyone expected
latimes.com
After weeks of expectations—actually, nearly seven years of expectations—House Republicans on Monday released their proposed bill to repeal the Affordable Care Act.
Elements of the proposal, which was kept under lock and key last week— have been dribbling out for a few days. The text of the full bill validates much of that reporting. On the whole, however, it’s a nastier, more consumer-unfriendly measure than even close followers could have expected.
The House GOP, in a written statement, cloaked this measure with a bodyguard of outright deceit. “What we’re proposing will deliver the control and choice individuals and families need to access health care that’s right for them,” the statement said. House Speaker Paul D. Ryan (R-Wisc.) said the measure would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance.” Curiously, the GOP statement says the bill embodies “President Trump's proposed health care reforms,” as if the President has ever advanced a coherent set of proposals.
The truth is that the GOP measure would destroy the ability of millions of Americans to access any healthcare worth the name. The Congressional Budget Office reportedly warned the Republicans that their proposals would lead to lost coverage for millions and higher costs for millions more, but the GOP is pushing ahead anyway.
Reporters and experts will be poring over the new draft for days, but here are some key elements gleaned from a first reading. Further examination undoubtedly will unearth more problems with the bill. The chances are almost nil that closer examination will find much, if anything, good about it.
The bill defunds Planned Parenthood. No federal funding can be made, either directly or indirectly, to a healthcare organization that “provides for abortions,” other than those done in cases of rape or incest or to save the life of the mother. That’s Planned Parenthood. It’s proper to note that Planned Parenthood doesn’t use federal funds to pay for abortions, as that’s already against the law. This measure shuts down funding for the organization just because it uses other funds to cover those procedures.
The bill even shuts down health insurance plans that cover abortion.According to a House Ways and Means Committee digest, the measure forbids spending federal tax subsidies on health plans that include coverage of abortion, even if the customer doesn’t get an abortion. This would dramatically shrink working Americans’ access to insurance-covered abortions, or would leads to insurers dropping abortion coverage from their plans, or both.
The individual and employer mandates are eliminated. They’re not repealed exactly, but the penalties are repealed, which amounts to the same thing. Without a requirement that individuals carry health insurance, the insurance markets are almost certain to collapse. The repeal is retroactive back to the beginning of 2016, but the real problem is in the market starting this year. Individuals would be able to drop their coverage immediately, which will wreak havoc with the market starting right now.
Essential health benefit rules are repealed. As of Dec. 31, 2019, ACA rules that required qualified health plans to provide hospitalization, maternity care, mental health services, and other benefits would be sunsetted. That’s likely to make maternity coverage, among other services, immensely expensive, if available at all.
Income-based premium subsidies would be replaced with age-based subsidies, a giveaway to the rich. As we reported last week, this scheme, which makes no practical sense, would cut subsidies to many of the people who need them the most, while awarding them to recipients who don’t need them. “People who are lower income, older, or live in high premium areas would be particularly disadvantaged,” the Kaiser Family Foundation observed after examining an earlier draft. The new draft retains those features. Means-testing of the subsidies—an idea tossed around within the GOP caucus last week to quell complaints that the change would make the rich richer—doesn’t seem to be in this draft.
The Medicaid expansion is killed. As of Dec. 31, 2019, the Medicaid expansion is repealed. Traditional Medicaid will be block-granted, a system almost certain to result in less federal funding for the joint state-federal program than it would have received, over time. The neediest and sickest Americans will increasingly be on their own, as states get less federal help to provide them with medical services.
All of Obamacare’s taxes are repealed, another boon for the rich. Everything from the tax on tanning salons and medical devices to the surcharge on high-income taxpayers will be gone. As we explained earlier, this amounts to an enormous tax cut for the wealthy—at least $346 billion over 10 years, every cent going to taxpayers earning more than $200,000 ($250,000 for couples). According to the GOP statement about the bill, it would increase the limits on tax-advantaged Health Savings Accounts — another gimme for the rich.
The tax repeal, the Brookings Institution has reported, will make it impossible to pay for any Obamacare “replacement”—which still isn’t on the horizon. It also will exacerbate the fiscal problems of Medicare, by hastening the exhaustion of the program’s trust fund by four years, to 2025. |
