For seven years, Republicans repeatedly vowed to replace the Affordable Care Act with a plan that would lower health care costs, improve coverage and expand choice for every American. Now that they've had to detail what that plan looks like — the newly introduced American Health Care Act (AHCA) — voters should judge them on how well they delivered.
Have congressional Republicans, and by extension President Trump, addressed the problems that consumers care about? Or does their plan prioritize a political agenda of cutting taxes for wealthy special interests and weakening public health programs such as Medicaid?
Critical information is still lacking for the new Republican alternative to former President Barack Obama's Affordable Care Act. The legislation still has yet to be "scored" by the respected, nonpartisan Congressional Budget Office, meaning that its overall cost, impact on the national deficit and effect on the uninsured rate are unknown. Without this information, it is reckless to try to rush the AHCA through Congress.
Still, there are enough details known about the AHCA to draw some disturbing conclusions. While the plan retains some of the Obama law's popular components, such as preexisting condition protections and coverage for young adults on parents' plans, the AHCA falls well short of meeting the high expectations created by Republicans. Several points of concern fairly leap out during a review of the bill:
• It comes up short on innovative prescriptions to rein in the cost of medical care, a critical driver of insurance costs.
• The flat, age-adjusted tax credit assistance of $2,000 to $4,000 a year will likely reduce the amount of aid many people currently get to buy coverage under Obamacare.
• It would stick many older Americans with higher coverage costs. The bill allows insurers to charge older people who buy insurance on their own — such as retirees who haven't hit the Medicare eligibility age of 65 — up to five times more than younger people for similar coverage. The bill's tax credit assistance for this age group is not a guaranteed five-fold increase.
• The bill calls for a sweeping overhaul of Medicaid funding, which could dramatically reduce the amount of federal funding for a program that covers millions of low-income people and pays for much of the nation's nursing home care. In fact, Medicaid cuts appear to be the main way the GOP plans to finance the AHCA. The bill would repeal key taxes levied by the Obama legislation on high-income Americans and on some medical industry groups to pay for reforms.
Those watching the debate unfold ought to do some personal homework as they assess the GOP plan. A call to an insurance broker would be helpful for those who buy coverage this way. A new interactive county-by-county map from the Kaiser Family Foundation allows people to compare the financial assistance they received under the Obama reforms and what aid would be likely under the Republican plan. In general, older and poorer Minnesotans get more assistance under Obamacare. Younger and wealthier Minnesotans would fare better under the Republican plan.
This trade-off illustrates a key point about health care. No plan can cover everything for everyone at a price everyone agrees with. There are always trade-offs. The AHCA's flaws not only reflect this hard reality but raise serious questions about whether the bill is intended to serve consumers or the political aims of the Republican Party.