Author: Ted St. Hilaire
The Republican controlled House of Representatives has, over the years, voted over sixty times to repeal the Affordable Care Act. So, it seemed that when the House Republicans unveiled its proposed repeal and replace bill, that they would finally have their way. The bill’s proponents asserted that the replacement would improve accessibility, lower insurance premiums, provide more choice in plans in that they can be tailor-made, allow purchasing insurance across State lines, that no one would lose coverage, and that it would retain coverage of existing conditions. It would eliminate the individual mandate, Medicaid expansion would, within several years, replace subsidies with tax credits, would eliminate taxes imposed by the ACA, and would eliminate the requirement to include mental health and addiction.
However, facts belied those Republican claims. First accessibility to purchase a health insurance policy depends not only on availability but also on affordability. The elimination of the Medicaid expansion would make a comprehensive health care policy unaffordable for those dependent on Medicaid assistance, hence accessibility is not improved but in fact lost for millions of Americans. Second, Insurance premiums of all kinds based on the open market never decrease; they only increase and the amount depends of market costs of goods needed to repair damage covered by the policy. Third, increased choices do not guarantee adequate coverage. Tailor-made policies can leave out coverage of specific items that a person could decide not to include due to cost of belief that the specific hazard will never happen to him/her/or their child. Fourth, there is no federal prohibition of crossing state lines for the purchase of insurance premiums. Each State has its own laws and regulations which make the inter- state buying of insurance premiums complicated and costly. Fifth, the CBO’s assessment of the Republican health care bill states that initially 14 million who are now insured will lose health care insurance and that in nine years’ time 24 million will have lost health care insurance. That will mean more uninsured than there was before the Affordable Care Act. Sixth, eliminating the individual mandate will drive up premium costs due to the decrease in policy holders and probably decrease the coverage of the policies either by what is covered or by the dollar limitations allowed. Seventh, rural and low-income populations will lose the most due to the loss of Medicaid and as they learn of the loss of the ACA they began to oppose its repeal.
The Republican apparent lock-step approach to the repeal and replacement of the ACA proved to be unfounded. For varying reasons, moderate and libertarian Republicans criticized elements of the House Bill; moderates felt it was going too far and Libertarians felt it didn’t go far enough. The “Freedom Caucus” opposed replacement; it wanted only to repeal the ACA. Democrats were universally opposed so that even if the House had approved the bill, the Senate’s approval seemed doubtful. Finally, at the last moment, the Republican leadership, realizing they lacked the votes to approve the bill, withdrew from the floor.
It may have seemed that this saga was coming to a finale; but it hasn’t. The Republican distaste for government social programs is far too strong to let this issue die. Discussion among Republican members of the House continues. The extremist “Freedom Caucus” wanted no replacement of the ACA, only its repeal. Moderates do not want their constituents to lose health insurance; they want to replace the methodology of providing it. In those red States where the ACA was implemented through Medicaid expansion, the beneficiaries learned that the ACA and Obamacare are the same thing and soon voiced their opposition to repealing and replacing Obamacare with the Republican plan.
The heath care issue will probably continue to be discussed and fought over in Congress and ‘the nation indefinitely. Medicare’s popularity does not discourage some from trying to repeal or replace or privatize it. Democrats need to stand firm in protecting federally subsidized and effective health care insurance.