Math is hard. That’s why the Congressional Budget Office (CBO) exists.
Its 230-member staff is tasked with rating proposed legislation to determine its economic impact on America and Americans. The new HHS Secretary, Tom Price, and the rest of the House GOP chose the current CBO director two years ago, so you’d think they’d have some respect for his work. But when the CBO released its report on the GOP’s American Health Care Act (AHCA) last Monday, its findings were much worse than most observers were expecting. Spoiler alert, the conclusion of the CBO, and many others who have looked in depth at the Republican proposal, is that the plan Speaker Paul Ryan has presented would make American’s health care much more costly.
So, when my own congressman, Rep. Jason Lewis (R-MN), a frosh on the budget committee, shared a meme comparing the AHCA to the Affordable Care Act (ACA) on Facebook, it became clear that the GOP members of that committee ignored the conclusions of the CBO and decided to deploy some #alternativefacts.
Five friendly amendments
Here’s a rundown of the five claims the Republicans made in their meme, and an explanation on how some of us outside the House GOP caucus “bubble” might differ with their interpretation. The chart at right shows my amendments, the text below gives a little more explanation than can fit on a graphic.
Patients have access to the care they need and want
“Access” is a slippery word. We all have access to buy a Mazerati, but most of us can’t afford one. It’s the same when Ryan says people will have “access” to healthcare. People who’ve never had a serious illness in their families think the ACA makes it difficult to maintain insurance, but the CBO predicts that the Republican replacement would make it much, much worse.
The CBO estimates that 18 million Americans will lose their health insurance next year if the Republican plan its enacted. An additional 24 million more people will be uninsured by 2026 than would be if we just kept the Affordable Care Act (ACA). An article healthinsurance.org published earlier this week by Charles Gaba explains how the GOP replacement plan will cause many to lose their insurance.
Patients decide whether to buy insurance
By saying that they will allow patients to decide whether to buy insurance, the Republicans really mean that they will get rid of the individual mandate — an unpopular linchpin of the ACA designed to lower everyone’s insurance costs by ensuring a large, relatively healthy pool of purchasers. That’s the basic concept of insurance — when everybody “pools” together, the costs are spread across everyone. Most of them should be healthy at any given time, but their insurance makes health care available when its their misfortune to be sick or injured.
While eliminating the mandate may be good politics in the short term, it’s myopic public policy. A healthy populace makes our economy stronger and don’t we all want a stronger country? And all of us are equally one bad cancer diagnosis or one tragic car accident away from having our lives dramatically changed — with the ACA, that no longer means bankruptcy.
Consumers decide which benefits are most important to them
This is double-speak for allowing health insurance companies to strip away essential benefits to make policies cheaper. However, mammograms, maternity care, mental health care, substance abuse treatment and many other types of care that many Americans depend on may no longer be covered. The ACA forced insurance companies to include 1o essential benefits in all plans, which goes back to the basic premise of insurance — spreading risk across a large pool. Allowing insurance companies to pick-and-choose what they cover will result in many small, expensive pools rather than one big healthy one.
Rep. John Shunkus (R-IL) made headlines last week when he asserted that men’s policies shouldn’t share the cost of pre-natal care, showing himself oblivious to the fact that we all were born and we all had or have mothers. Don’t be distracted by arguments that you should be able to choose which medical procedures will be covered a la carte. One person’s criticism of a “one size fits all” policy is another person’s piece of mind that if they become unexpectedly ill, they won’t discover fine print in their policy that lets the insurance company deny them care.
Decreases taxes for all Americans
The ACHA gives with one hand, but it takes away with the other. Many working class Americans have only been able to purchase health insurance because of generous government premium subsidies and cost-sharing subsidies. For many of these newly-insured, it may have been the first time in their lives they could afford to see a doctor. The ACHA would do away with need-based subsidies and “replace” them with age-based tax credits that would reward Mark Zuckerberg and a same-aged minimum wage worker equally .
And as for the tax cuts the Republicans are promising, the CBO points out that they would disproportionately enrich corporations, billionaires and high wage earners. Louise Norris takes an excellent look at other unfair aspects of the GOP tax credit proposal in another recent healthinsurance.org post.
Lowers premiums, drives lower costs
According to the CBO, premiums will rise higher under the Republican replacement plan over the next six years than they would under the ACA. Its true that those Republican policies would begin getting cheaper in 2023 (?!), but that will only happen because those plans are likely to be much skimpier and in terms of coverage might resemble a piece of swiss cheese. Opting for an AHCA plan over an ACA plan would be like trading in a Ford Explorer for a Smart Car — and since when have we as American consumers been happy settling for less?
And some groups will get brutal rate increases. Older working-poor folks (many of them Trump voters) will get hit with rate increases of up to 750 percent, because of the elimination of need-based subsidies and the escalating costs to the AHCA plans. Harold Pollack takes a good look at how brutal the Republicans’ replacement plan would be from both a political and human perspective.
Pushing back on a fact-free Congress
My congressman is one of the many in Congress who avoid public town halls like the plague, yet many are adept at social media, posting misleading memes like the one I’ve discussed here. My member of Congress even posted a video with the ironic title of “Let’s talk about health care”. Its ironic because he’s using a one-way communication method to deliver party talking points, rather than actually engaging in a discussion with his constituents. Many women I know have a word for this: mansplaining.
It’s time to hold our elected officials accountable. We must insist that they put the needs of our country first. This includes doubling down on the individual mandate to bring more people into the pool, and expanding subsidies to higher income people — at least temporarily until a larger and healthier individual market can right itself.
Offering a replacement plan that will cost more, offer fewer benefits and cover fewer lives does not seem to be in America’s best interests.
Harold Pollack is Helen Ross Professor of Social Service Administration, and Faculty Chair of the Center for Health Administration Studies at the University of Chicago. He has written about health policy for the Washington Post, New York Times, New Republic, The Huffington Post and many other publications. His essay, “Lessons from an Emergency Room Nightmare,” was selected for The Best American Medical Writing, 2009.