The structure of the Affordable Care Act comes out of a straightforward analysis of the logic of coverage. If you want to make health insurance available and affordable for almost everyone, regardless of income or health status, and you want to do this through private insurers rather than simply have single-payer, you have to do three things.
1.Regulate insurers so they can’t refuse or charge high premiums to people with preexisting conditions
2.Impose some penalty on people who don’t buy insurance, to induce healthy people to sign up and provide a workable risk pool
3.Subsidize premiums so that lower-income households can afford insurance.
The GOP proposal basically accepts the logic of Obamacare. It retains insurer regulation to prevent exclusion of people with preexisting conditions. It imposes a penalty on those who don’t buy insurance while healthy. And it offers tax credits to help people buy insurance. Conservatives calling the plan Obamacare 2.0 definitely have a point.
But a better designation would be Obamacare 0.5, because it’s really about replacing relatively solid pillars with half-measures, severely and probably fatally weakening the whole structure.
First, the individual mandate – already too weak, so that too many healthy people opt out – is replaced by a penalty imposed if and only if the uninsured decide to enter the market later. This wouldn’t do much.
Second, the ACA subsidies, which are linked both to income and to the cost of insurance, are replaced by flat tax credits which would be worth much less to lower-income Americans, the very people most likely to need help buying insurance.
Taken together, these moves would almost surely lead to a death spiral. Healthy individuals, especially low-income households no longer receiving adequate aid, would opt out, worsening the risk pool. Premiums would soar – without the cushion created by the current, price-linked subsidy formula — leading more healthy people to exit. In much of the country, the individual markets would probably collapse.
Here's what Mr. Pierce of Esquire had to say:
Our Nation Is Not Healthy
And this new plan is the culmination of 25 years of conservative thought.
There's more than a little delicious irony in the fact that the shebeen was late in opening on Tuesday because I had to go in for regular medical treatment for a chronic condition handed down to me by my Celtic-Norman ancestors. That gave me a good chance to look over the malodorous sheaf of shredder-fodder produced by the House of Representatives as an alternative to the Affordable Care Act. This isn't a plan. This is not a burlesque of a plan. This is not even a ghost of a plan. And everybody hates it.
. . . And here is something else that it is not. It is not TrumpCare. It is RepubliCare. The bill that dropped like a dead fish in a sanctuary late Monday evening is the culmination of nearly 25 years of Republican policy thinking since Bill Clinton put health care reform at the top of the agenda in the 1992 campaign. All of the greatest hits are in there, and they're all just as cruel and stupid and unworkable as they ever were. This is why it's RepubliCare:
- Health Savings Accounts! Start saving when you're three and if you spend the rest of your life living atop a flagpole, you might be able to afford half-a-round of chemo when you're 60.
- Health Insurance Across State Lines! Let's apply the always consumer-friendly business model of the credit card industry to something people literally need to stay alive.
- Block Grants! Also known as the Scott Walker Cronies Supplemental Income Act of 2017.
Any plan that combines "Republican" and "care" is lying.
And they will never admit that we're all in this together and need to stand up for each other.
"we're all in this together and need to stand up for each other."
~ Jerry Wesner
Republicans are trying to put forward something that will convince the distracted that "See, we can give you health care too." But the cost will doom it; many can't afford to join; others will bet that they'll stay well. Then, when it collapses, they can say "See? Government shouldn't get involved with health insurance!"