As the U.S. House of Representatives rushed to repeal the Affordable Care Act, aka Obamacare, Speaker Paul Ryan promised that the chamber he leads would create a replacement worthy of the slogan “A Better Way.”
On May 4, by a four-vote margin, the House approved the American Health Care Act.
Prior to the vote, President Donald Trump pledged to engage Congress in a “big, fat, beautiful negotiation” that would repeal Obamacare and replace it with something “really terrific.”
This week, the nonpartisan Congressional Budget Office issued a report that echoed its preliminary projections of the AHCA’s impacts.
According to the CBO, the replacement act would, if endorsed by the Senate and signed by Trump, result next year in 14 million more Americans lacking health-insurance coverage than under Obamacare (assuming it remained in place).
The number of uninsured Americans would be 23 million higher in 2026; in other words, an estimated 51 million people under 65 would lack insurance less than a decade from now.
The AHCA would result in 14 million fewer people being covered under Medicaid, the federal-state program for low-income Americans, by 2026. In states such as Florida, which has woefully underfunded its contributions to Medicaid, the program is inadequate; nevertheless, it provides a safety net for children, families and the rising number of elderly Floridians who cannot afford long-term care.
In many states, according to the CBO analysis, insurance premiums would soar — at the same time income-based subsidies declined — for Americans who are ill or have pre-existing conditions. As a practical matter, pre-existing conditions would again prevent millions of Americans from obtaining the private-sector coverage that Obamacare sought to provide.
Furthermore, the report stated, “out-of-pocket spending on maternity care and mental-health and substance-abuse services could increase by thousands of dollars.” The former would place legions of American families at risk of incurring debilitating debt if they eschewed coverage; the latter could have the same impacts on individuals and families who need mental-health care and addiction treatment, both of which are already shortchanged by insurance policies.
The House bill would save the federal budget $119 billion over a decade, no small amount, and give tax breaks to upper-income Americans who have essentially subsidized Obamacare’s premiums for people in the middle- and low-income brackets. In addition, premiums for many healthy Americans would decrease — if they bought streamlined coverage authorized by the AHCA.
The United States faces a long-term debt crisis, yes, and the rising premiums under Obamacare have been a serious concern. Indeed, the two Republican House members from our region, Vern Buchanan and Tom Rooney, cited flaws in the status quo as justification for their votes in favor of the AHCA.
But a bill that results in private- or public-sector coverage for fewer Americans is not a better way. A bill that does not offer Americans with pre-existing conditions affordable access to coverage is not “really terrific.”
As we have noted, Obamacare has flaws and has been undermined by political upheaval. But it improved what was the status quo — which should be the Senate’s goal as it pursues an alternative to the House’s AHCA.
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