For the past six years, Republicans have had it easy. Instead of trying to fix how health care is paid for, they’ve just lobbed rocks – voting to repeal the Affordable Care Act some 50 times. With a certain presidential veto awaiting, there was no risk.
Now the cast is on the other foot, so to speak. Finally, the Republicans can fix this flawed, inequitable, onerous, falling-apart system they long ago dubbed Obamacare.
Except maybe they can’t. What they’ve come up with is more unworkable than what they’re trying to replace. Obamacare is becoming “Don’t Care.”
Instead of adding Americans to insurance rolls – as President Donald Trump famously promised – perhaps 10 million will lose their insurance. Instead of keeping older Americans secure through Medicare, the Republican plan will eventually diminish funding for this lifeline program.
For those with pre-existing conditions, the “Don’t Care” plan would herd them into “high-risk” pools where their premiums could be heavily subsidized by the government. The question is how much subsidy would be required and how high would their premiums rise?
Most analysts say premiums and deductibles under “Don’t Care” will surely go up. Absent a mandate, many won’t sign up. Hospitals will once again be on the hook for treating patients who can’t pay, and they’ll pass along unreimbursed costs to paying customers.
Medical savings accounts, which have existed for some time, will be nice for those who have means to save. But many young Californians barely earn enough to pay the rent; they aren’t saving enough for retirement, their kids’ education, or even a set of new tires. Expecting them to save for health care isn’t rational. And if nothing is done about the rising cost of prescription drugs, Americans will face a triple whammy – less coverage, higher hospitalization costs and more expensive meds.
Perhaps unexpected is that many Republican don’t like it, either. Sen. Rand Paul, R-Ky., called it Obamacare Lite. The conservative Federalist’s headline was, “The GOP Repeal Plan Sucks.” Sen. Mike Lee of Utah said his party “took a step in the wrong direction,” adding it was “exactly the type of backroom dealing and rushed process we criticized the Democrats for.”
Is that where those tax decreases for the wealthy were created?
There are some things in the Republican plan to like. The “metal plans” (gold, bronze, silver) will be replaced with a greater array of choices within plans (adding costs as you add features). Kids will still be able to stay on parents’ plans until age 26, and insurers won’t be able deny coverage based on pre-existing conditions – two features from Obamacare. But on balance, this is hardly an improvement. Not even close.
Republicans have offered a plan that will cost more and deliver less care.
How much less? We’re not yet sure, since the bill didn’t go to the Congressional Budget Office before being introduced. But some say it will leave California on the hook for $15 billion to $20 billion in Medi-Cal costs each year even as up to 3 million Californians lose their insurance.
We’ve heard the complaints – many valid – about Obamacare. Premiums are rising. Rural residents are left without any real choices. So yes, we want Obamacare fixed – not replaced with “Don’t Care.”