With the release of the American Health Care Act, House Republicans have pulled off an impressive feat: managing to alienate virtually everybody with a stake in health care. If you liked the Affordable Care Act, you will, unsurprisingly, hate this bill. We’ll get into the details later (the bill is in two parts; the Energy and Commerce Committee text is here, the Ways and Means Committee text here; summaries in plain English here and here), but in short, the subsidies for insurance coverage are stingier, the coverage itself is worse, and the penalty for non-coverage is actually higher.
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 health care through an employer, the bill creates incentives for companies to throw people off insurance, sticking you in the aforementioned hazardous individual market.
If you didn’t like the ACA, whether from the left or the right, there’s nothing really here for you either. That’s because the basic structure of Obama’s 2010 law has been retained.
“Writing checks to individuals to purchase insurance is, in principle, Obamacare,” concluded the Republican Study Committee, a conservative faction in the House that opposes the bill. They are correct. The AHCA gives refundable tax credits to every American (up to a certain income threshold) to buy insurance. The size of the tax credits are pathetic, but fixing that is one Democratic budget-reconciliation bill away. Because Republicans aren’t even bothering with Democratic votes on this legislation, and progressing through the clumsy reconciliation process, they’re only muting the ACA rather than obliterating it. For example, the individual mandate and employer mandate would still exist; their penalties would be set to $0, which is simple to change back. The tax credits could be dialed up as well.
In fact, if you’re a rock-ribbed conservative who can’t stand federal social spending, the AHCA isn’t for you. The bill tries to buy its way out of one of the biggest conundrums with repeal: how to handle states that refused to expand Medicaid, which would then lose out on a block grant set to current spending levels. These non-expansion states, which took such a principled stand in denying government money for years, get a $10 billion handout for “safety net funding,” and two extra years of grants to state hospitals that treat poor patients.