Paul Ryan's Sickening Obamacare Replacement

After six years, and more than 60 votes to repeal health care reform, Paul Ryan and House Republicans have come up with a GOP alternative to Obamacare that's guaranteed to make millions of Americans sick.

One week ago, Speaker Paul Ryan and House Republicans released their replacement plan for Obamacare. Well, sort of. Republicans have voted more than 60 times to repeal health care reform without offering a real replacement. They've had more than six years since the passage of the Affordable Care Act (ACA) to come up with a detailed, comprehensive alternative that can match the ACA's accomplishments. Instead, Republicans have offered an amalgam of the same old ideas they've been batting around for years -- including some that have already failed -- with some extra twists to make them even worse.

The 37-page document, titled "A Better Way: Our Vision For A Confident America," is short on details, and fails to answer one very important question: How much will it cost?

There's no legislation attached to the Republican plan either. That's probably more by design than chance. As House Minority Leader Nancy Pelosi pointed out, "It's not a bill. It isn't scored." At a roundtable with reporters, Pelosi said, "Maybe when they ever decide to write legislation, they'll get a score on how much it's going to cost, how many people will lose coverage, and we can make a judgement about it." Writing legislation would require Republicans to supply important details, like how many people their plan will cover, and how much it will cost. That's something Republicans are unlikely to do, because their plan will cover far fewer people, and at considerable cost to American families.

• Still relying on repeal. No Republican "alternative" to health care reform would be complete if it wasn't build on the foundation of repeal. That alone makes the GOP plan a non-starter. President Obama would veto any repeal that made it to his desk. No matter who's in the White House next, Republicans don't have and won't have the votes in the Senate to repeal the ACA. Even if Republicans had the votes, repeal would be a disaster. Unwinding the complex insurance system entangled with the law would be a bureaucratic nightmare. Not to mention that repeal would cause 20 million Americans to lose coverage.
• A taxing proposal. The Ryan/Republican plan replaces Obamacare's subsidies with a monthly tax credit that households could use towards insurance. The Republican plan offers no detail on the size of the tax credits. However, the value of the tax credit would be adjusted based on age rather than income. That means the wealthy, who could afford coverage without help, would receive the same tax credit as low-income Americans, while low-income households would get less help. For working- and middle-class households, the Ryan/Republican plan's tax credit would be offset by what amounts to a tax increase. The Ryan/Republican plan would tax workers' health benefits, shifting the tax burden on generous employer-based coverage from employers to employees. This is based on the conservative belief that employer-sponsored coverage is too generous, working Americans have had it too good for too long, and benefits need to be reduced. The real world consequences are a tax increase and lower pay for American workers.
• Repeating history on pre-existing conditions. On paper, the Ryan/Republican plan embraces Obamacare's ban on discriminating against those with pre-existing conditions, but it's a hollow embrace. The GOP plan puts Americans with pre-existing conditions -- 25 to 29 percent of those who were "medically uninsurable" before Obamacare -- right back into high-risk pools. But we already know that high-risk pools don't work. Around since the 1970s, high risk pools existed in 35 states before Obamacare. They were underfunded and thus excluded many who needed coverage. Premiums were twice the market rate, and as much as 25 percent of household income.High risk pools have to be incredibly well funded to work. According to the Department of Health and Human Services, 50 to 129 million Americans have some type of pre-existing condition. Conservative health policy scholar James Capretta estimated that it would take $15-20 billion a year to adequately cover 4 million with pre-existing conditions. Republican plan doesn't say how much would be spent on high-risk pools, but just this year Republicans opposed spending even $4 billion for a one-time high-risk stop-gap solution. There's no way Republicans would approve the taxes to adequately fund high-risk pools.
• Merciless Medicaid cuts. The Ryan/Republican plan cynically points to Obamacare's "failure" to cover millions of Americans who have "fallen into a coverage gap between their state's Medicaid eligibility and the eligibility for Obamacare subsidies." Of course, that "coverage gap" was created by conservatives' attempts to overturn the law in the courts, which led to the Supreme Court's ruling that states could opt out of the Medicaid expansion. Republican governors formed their own "death panel," refusing the Medicaid expansion and denying coverage to millions of Americans who couldn't afford it without the expansion.The Ryan/Republican plan eliminates the Medicaid expansion, and allots states a one-time fixed amount for their Medicaid programs, not to be adjusted for cost of living or economic downturns. It allows states to "charge enforceable premiums for limited benefit Medicaid packages, and "enact waiting lists and cap enrollment" for certain groups of Medicaid beneficiaries. Like previous Republican proposals, it replaces the expansion with "block granting a fixed amount" to states, empowering Republican-governed states to "profoundly reshape the Medicaid program," effectively ending Medicaid as we know it.

The rest of the Ryan/Republican plan to replace Obamacare is simply the same ideas conservatives have been half-heartedly kicking around since health care reform passed.

• "Tort reform" masquerades here as "medical liability reform," but it still limits the amount of money injured people can receive in a malpractice lawsuit. The Ryan/Republican plan still cites "frivolous lawsuits" as a major contributor to rising health care costs, though studies found that only four to seven percent of the injured ever file suits, and that "medical liability" limits failed to cut health care costs in states like Texas and Ohio.
• Republicans still want to let insurance companies sell insurance across state lines, only here its couched as freeing consumers to "purchase coverage across state lines." When the Supreme Court allowed the credit card industry to do the same by "exporting" their home states' interest caps, companies suddenly found new homes in states with low-to-no interest caps. It took Congress 31 years to stop that. The Ryan/Republican plan currently has no provisions to prevent insurance companies from doing the same.
• Republicans still want to turn Medicare into a voucher program, and call it a "premium support system" that gives seniors a choice of private plans competing alongside traditional Medicare. The Ryan/Republican plan would also raise the Medicare eligibility age from 65 to 67, for anyone born in 1960 or later.

Republicans still want to repeal Obamacare for the same reason that the majority of Americans oppose repeal. It's working.

• According to the Centers for Medicare and Medicaid, the cumulative forecast for health care spending for 2014-19 is now $2.6 trillion less than it was in 2010.
• Expanding Medicaid has improved patients' insurance coverage, financial outlook, and quality of life. A study released by the Department of Health and Human Services found that 78 percent of new Medicaid recipients said they wouldn't be able to get regular care without the program. Additionally, unmet health care needs for low-income Americans dropped to 45 percent, from over 55 percent before the expansion.
• The percentage of uninsured Americans has plummeted to six points below where it was when Obamacare went into effect. The two groups who experience the biggest drop in the uninsured rate are African-Americans (down 9.5 percent) and Latinos (down 10.4 percent).
• Studies suggest that diabetes, one of the nations costliest and most serious chronic diseases, is getting diagnosed and treated more in states that have expanded Medicaid.Newly identified cases of diabetes rose by 23 percent in states that expanded Medicaid, compared to only 0.4 percent in states that did not expand Medicaid.
• States that expanded Medicaid saw a $5 billion decline in unpaid hospital bills -- twice as much as those that did not.

Despite its imperfections, health care reform is working. Most Americans want to improve upon its imperfections, and not repeal the law and reverse its benefits. If it's to be replaced, a Gallup poll conducted in May of this year found that 58 percent of Americans favor replacing the ACA with a federally funded program that provides insurance to all Americans. That's a far cry from what Paul Ryan and House Republican's propose: a hodgepodge of old, stale, failed ideas that guarantee millions of Americans will go back to being sick and uninsured.