TrumpCare: The Good, The Bad, The Ugly

This week the House GOP released details of its long awaited ObamaCare repeal and replace bill to much praise from the White House. Trump promised that this first step toward health care reform would be followed by additional upgrades to our system that would fulfill the many, often contradictory, campaign promises he made about ridding the US of ObamaCare. No fan of many aspects of ObamaCare, I was curious about what the GOP had planned as a repeal and replace bill. And, I have to say: there are provisions of the AHCA bill that I like. And, there are many provisions that I hate. I’ll try to be as specific as possible here about it all.

The House GOP’s AHCA would immediately dump ObamaCare’s health insurance mandate. I have long thought the mandate was an unnecessary and overly burdensome aspect of the ACA. I will remind you that Obama himself was against the mandate in 2007 when Clinton made it central to her policy on health care reform. The mandate does not take into account the fact that even with ObamaCare subsidies some people still do not want or can not afford insurance. And, the idea of the government fining people or locking them up over a lack of health insurance is ridiculous. So, I am glad to see the mandate go. The GOP’s bill would also preserve two provisions of ObamaCare that I like very much- pre-existing conditions and the ability for young people to stay on their parents’ health insurance until they are 26. The GOP bill also continues Medicaid expansion until 2020- a reversal from previous drafts of the bill that ended Medicaid expansion immediately. So, that is what I like about the bill. Now, let’s talk about the less prudent provisions.

First, making no one happy it appears, the GOP bill would replace ObamaCare’s subsidies with refundable tax credits, the size of which have not been disclosed yet. Depending on the size of the credit, Americans could see their share of health insurance premiums go up. That is not wise for a country already at crisis level with health care costs. Probably the best aspect of ObamaCare was the subsidies, which Obama supported since the 2007 primary. Making health insurance as affordable as possible should be a high priority for anyone seeking to ameliorate our system. It seems the GOP has missed this point. Under ObamaCare the poorest Americans got the most help via subsidy. Under TrumpCare everyone making under $75,000 will receive the same sized tax credit. The GOP plan will also take age into account, making it more expensive for older, sicker Americans to buy health insurance and less expensive for younger, healthier Americans to buy coverage. It seems the GOP’s goal there is to get healthier, young Americans to buy coverage and make it harder for those that really need health insurance to buy coverage. This is a huge giveaway to the insurance industry as younger, healthy Americans are less expensive to cover than older, sicker Americans who need more care.

The AHCA will also allow insurers to charge older Americans more for health insurance, which was restricted under ObamaCare. This seems like a cruel and particularly unusual aspect of the bill. Older Americans are most in need of coverage. And, I get that they are more expensive to insure, but allowing insurance companies to charge them more and giving them a smaller tax credit than the subsidy they have been receiving must be a sick joke. I hope the AARP rallies against this bill based on that aspect alone. That provision lacks compassion toward older Americans and penalizes them at a point when they are most vulnerable. I believe that a nation is judged by how they treat their most vulnerable citizens. And, the GOP has failed the test by making health insurance unaffordable for older Americans.

There is no doubt that TrumpCare will cover less people than ObamaCare, an immediate red flag. And, in order to keep the health insurance risk pool as diverse as ObamaCare made it with the mandate, the GOP has made it cheaper for young Americans to buy care and more expensive for older Americans to buy care- a risky scheme. While there are some provisions of the AHCA that I support, largely this bill seems unwise and doomed to fail. It may not even pass. Assuming no Democratic defectors, the GOP can only afford to lose 21 votes in the House and two in the Senate. Given the conservative reaction to this bill, I can not imagine it will pass without major upgrades. What is clear is that the GOP has heard the loud message Americans have been sending them at town halls and on Twitter- many people like their health insurance coverage and do not want to lose it. The GOP offered ObamaCare Lite to appease the nation, but may end up not making anyone happy with this haphazard and confusing bill.

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