The Republican plan to repeal and replace the Affordable Care Act (ACA) "will do active harm to millions of people, particularly low-income people and seniors;" includes tax breaks for wealthy insurance CEOs; and is generally "a nastier, more consumer-unfriendly proposal than even close followers could have expected."
The American Healthcare Act (AHCA), unveiled by House Republicans Monday night, dismantles (pdf) major provisions of the ACA, or Obamacare, and puts in place a system of age-based tax credits for individuals to buy insurance.
It would "end Medicaid as we know it," as per Sen. Ron Wyden (D-Ore.), converting the program in 2020 from open-ended funding to a "per capita cap" system, where states would receive a set amount from the federal government for each person eligible for the program. "In the past, analysts have usually projected that spending caps like those in the Republican plan would lead to fewer people being covered and less generous benefits," Dylan Scott wrote at STAT.
The proposal would defund Planned Parenthood and other women's healthcare providers, as Common Dreams reported, and would roll back the ACA's requirement that health insurance plans cover "essential" benefits such as maternity care and mental health services.
Furthermore, columnist Michael Hiltzik wrote at the Los Angeles Times, "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). The proposal would sharply raise the limits on contributions to tax-advantaged Health Savings Accounts—another gimme for the rich."
Not only is this giveaway a slap in the face to middle-class workers, but it "advances Paul Ryan [and the] Koch brothers' major aim of abolishing Medicare," the Bernie Sanders-inspired political group Our Revolution declared on Monday night. Indeed, the Brookings Institution think tank confirmed: "Repealing the ACA's tax on high income households and hospitals would exhaust the Medicare Trust fund by 2024."
Meanwhile, "[p]oor, older adults would face the largest crunch," the New York Times reported. "The magnitude of their tax credits shrinks, even as a separate provision in the bill allows insurers to charge older people substantially higher prices than are allowed under the Affordable Care Act."
Plain and simple, journalist David Dayen wrote Tuesday at The Nation:
Under this bill, the average American will be more likely to be uninsured, or insured with higher co-pays and deductibles, or "covered" with a plan worth as much as the plastic insurance card it's issued on.
As for government-run programs, Medicare’s trust fund will come four years closer to depletion, and Medicaid will shed millions of people over time through a per capita cap, which is just as bad as a block grant, an inflexible funding outlay that fails to shift upward in times of need. Even if you get healthcare through an employer, the bill creates incentives for companies to throw people off insurance, sticking you in the aforementioned hazardous individual market.
President Donald Trump called the plan "wonderful" in a tweet Tuesday morning.
But healthcare expert Andy Slavitt, who ran Medicare, Medicaid, and the ACA under former President Barack Obama, noted as part of his multi-part analysis that the AHCA "violates all" of Trump's campaign trail commitments, in that it covers fewer people, takes away critical protections afforded under Obamacare, and raises premiums and deductibles.
An analysis presented last month by Physicians for a National Health Program argued that in fact, the only way for Trump to meet his campaign promises would be to enact a single-payer, Medicare-for-All system.
According to The Hill, "House Republicans plan to take up the legislation at a breakneck pace, with two committees—Energy and Commerce and Ways and Means—scheduled to hold votes on Wednesday. A vote in the full House is expected to soon follow, within weeks."
Such a vote would likely come in the continued absence of a Congressional Budget Office "score" for the proposal, making it impossible for the public or lawmakers to know the human or financial costs of the legislation.
"The fact that House leaders plan to plow forward with a markup of this bill without the typical Congressional Budget Office analysis of its costs and impact tips their hand: They know they cannot afford to tell the truth," columnist Isaiah J. Poole wrote on Monday. "Their plan will hurt people who count on our country's important healthcare programs while giving a tax break to the rich. As sound health care policy, it just won't add up."