In 2010, the Affordable Care Act passed, and in 2011 was significantly modified by a Supreme Court decision. In 2012, the first features of Obamacare were felt and by 2014 the exchange marketplaces, tax subsidies and insurance regulations seriously changed health care availability and financing. But if one thought those were rapid changes, this year has shown that we may get whiplash from proposed further changes.
The Republican American Health Care Act (ACHA) was presented earlier this year, and pulled within two weeks. It was clear it was much too generous for the GOP Freedom Caucus. But the truth was also that this Republican replacement to Obamacare was so bad that it would not have passed the Senate even if it had garnered the 216 Republican House votes needed for passage. Only 17 percent of U.S. citizens viewed the ACHA positively, likely because it would have given a trillion dollars in tax cuts for high-income Americans, resulted in 24 million unable to get coverage, decreased Medicaid support for the elderly and poor, and greatly increased the cost for older (50-64) aged purchasers.
There have been any number of discussions on how to improve the ACA (Obamacare) without making American health care worse. Most include funding the risk-mitigation tools in the original ACA, strengthening the incentive for continued coverage, and re-examining the support for families being hit with increases in premiums so that the net cost is not increasing more rapidly than health care cost inflation. Many, including business leaders, have even resumed a push for a more centralized approach, either a “Medicare for all” single system or single payer.
I was not surprised, however, to hear earlier this week that the White House and House Speaker Paul Ryan chose a different path. It seems that they decided to give in to the far right and try to get the Freedom Caucus on board by decreasing the baseline essential benefits, by allowing pricing (underwriting) for additional factors including health history, and allowing easy waivers from other requirements of the ACA. Here is a link to a more in-depth analysis. (http://tinyurl.com/lnrqoe8)
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One doesn’t need to be a health care expert to appreciate that this proposal will be even more harmful. While allowed to buy insurance coverage, those with existing illnesses or even only at risk for illness would only have plans with scanty coverage (imagine a plan without pharmacy or chemotherapy benefits) or be prohibitively expensive.
What makes this move even more curious is that a bill needs to pass both the House and the Senate. The more benefits are dismantled and the more Trump/Ryancare 2.0 decreases the value of health insurance, the fewer “moderates” will be on board, and the further it gets away from the votes needed for Senate passage.
I am really interested to see the Congressional Budget Office assessment of this try. Hopefully Congress will listen to the CBO and the vast majority of Americans who are asking for a fix, not a repeal, and who deserve something better than Trump/Ryan Care.
John Rusche, M.D., is a former Board Certified pediatrician, health plan medical executive, and Idaho House minority leader, 2009-2016. He is currently retired in Lewiston.