The Goldendale Sentinel - Headlines & History since 1879

By Don Thomas
Goldendale 

Waiting for GOP

 


Why are the Republicans in Congress making so little progress in formulating a replacement for the Affordable Care Act (ACA or Obamacare)? For seven years it’s been “something better and cheaper is coming soon.”

Why don’t they simply repeal the ACA? The problem with repeal is that about 20 million people would lose their insurance. That number includes poor people, those without jobs that include health insurance, and those with pre-existing conditions (PECs). With repeal people without insurance would, as before the ACA, only seek treatment in emergencies. For the uninsured, major medical problems end in bankruptcy, leading to higher medical costs for everyone else. While the Republican leadership favors repeal, the popularity of the ACA has forced them to come up with “repeal and replace.”

There are three parts in the ACA that address who gets covered and how: a requirement that those without insurance must buy insurance, people with PECs are to be covered at the same rate as everyone else, and the federal government subsidizes those that can’t afford insurance. A fourth part deals with who pays. So what is it Republicans don’t like?

How about just keeping the part of the ACA that people like (covering people with PECs at the same rate as everyone else) and dropping the unpopular requirement that everyone buy insurance? Covering people with PECs leads to slightly higher premiums for the healthy people who already have insurance in order to include those with PECs at the same premium. But with PECs covered by insurance, healthy people would no longer have any incentive to buy insurance—until they get sick or injured. No insurance company will offer that kind of insurance. Insurers will cover people with PECs, but only as part of a larger group of healthy people that share the costs.

What else have the Republicans been considering? One idea is reducing or eliminating federal subsidies—leading to many lower income people losing their insurance. Another idea is a tax credit for everyone that increases with age (older people tend to have more medical problems) but doesn’t increase for lower incomes. Since the proposed credit is smaller than current credits, the poor again suffer, but the well-off gain a windfall tax credit they don’t have under the ACA. Another proposal is to increase the incentives for putting money into Health Savings Accounts—of little help to the poor who have less spare income, but a boon to the well-off. While Republicans hate the requirement that everyone must buy insurance, they are mute on how to keep the requirement for covering people with PECs. But if PECs are covered, and healthy people are not required to buy insurance, the individual insurance Market will crash as discussed above. And if PECs are not covered and healthy people are not required to buy insurance, then once again we return to the inefficient and expensive “emergency room health care” for the uninsured and higher prices for everyone. Finally, repealing the ACA means lower taxes for the rich since the majority of the ACA’s funding comes from taxes on the wealthy.

Republican proposals do not improve on the ACA. Poor people and people with PECs will be thrown under the bus, while the rich will get lower taxes. Health care costs for everyone will rise at an accelerated rate. The President recently said; “Nobody knew health care could be so complicated.” Actually, a lot of people do know. That’s why the ACA looks the way it does—all four parts are necessary. This is not to say that the ACA can’t be improved by tweaking those parts. But the only major improvement to the ACA that might actually improve coverage and lower costs would be to include a “public option” in the individual insurance Market place. However, that choice is not under Republican consideration.

 

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