Yes: Even as it takes shape, Trumpcare’s a sure bet to beat Obamacare
Even after narrow passage of the American Health Care Act in the House this month, we don’t fully know what Trumpcare will become.
But we do know what Obamacare has produced — broken promises, disappointment, government overreach and dysfunctional health insurance markets around the country.
And we do know that after the Senate has its say on the issue and further difficult-but-necessary compromises are reached, the final version of Trumpcare will turn out to be whatever a majority of both bodies delivers to President Donald Trump for his signature.
Hint: He will say, “It’s great!”
Great or not, it will in any case be better than Obamacare, even though that’s admittedly setting a pretty low bar.
We should not forget that Obamacare — the Affordable Care Act, or ACA — failed to deliver on its inflated promises.
Enrollment in its state-based marketplaces fell well short of initial projections and stalled. Insurance premiums there spiked significantly higher in recent years. Many participating private insurers incurred substantial losses and started looking for the exit doors.
Most ACA coverage gains were limited to individuals heavily subsidized by taxpayers or pushed into expanded Medicaid coverage that paid less for health care and accordingly delivered poorer results.
Obamacare tried to shift and hide health care costs but failed to reduce them. The Obama administration even tried to stretch the health care program beyond its legal limits but it simply could not subsidize, coerce and tax enough people and businesses to reach its goals.
More fundamentally, Obamacare critics objected to the federal government’s growing role in limiting their personal health care choice.
So what’s ahead? Cautious steps in a different direction that starts to re-balance our investments in health care and hopefully better health. For instance, the new plan is likely to prefer:
▪ Private markets over bureaucratic edicts
▪ Positive incentives to obtain and maintain affordable coverage instead of mandates and ever-growing regulations to buy what you don’t want
▪ More decentralized decision making by patients, their trusted agents, and state and local officials
▪ Lower taxes, higher-value choices, and clearer rewards for performing better, working harder, and acting more responsibly
▪ Better targeted subsidies that still ensure generous protection of the most vulnerable Americans
The legislative effort to begin this policy shift remains a work in progress, with plenty of aspects of last week’s House bill needing refinement and improvement.
And ideally, the final version of Trumpcare will ease the excesses of Obamacare without creating new ones.
For example, we should expect a more gradual reduction in the future growth of Medicaid, a re-balancing of insurance subsidies, further boosts in safety-net funding and regulatory protections for high-cost individuals, and a greater willingness to accommodate different regional and political perspectives.
The final version is likely to effectively end the unpopular individual mandate to purchase only federally approved insurance, eliminate the employer coverage mandate, repeal a medley of growth-reducing taxes, and allow average Americans a greater choice and voice in how they want to spend their resources to protect and enhance their health.
Health policy reform should do even more, but the legacies of our partisan politics, sunk costs, institutional inertia, shortened time horizons and deeply held illusions about the leveraging of other people’s money set low ceilings on what can be achieved in the near term.
Hence, we may have to settle for the advice ascribed to the late, noted sage Yogi Berra: “When you come to a fork in the road, take it.”
Tom Miller is a resident fellow at the American Enterprise Institute and co-author of “Why Obamacare is Wrong for America.” Readers may write him at AEI, 1789 Massachusetts Ave. NW, Washington, D.C. 20038.
No: Millions will lose coverage to pay for it
The Affordable Care Act — also called Obamacare or the ACA — extended health insurance to 20 million people while closing loopholes in existing insurance for everyone.
The GOP proposal to replace it would take health insurance away from 24 million people and reopen those loopholes.
While marketed as an ACA repeal, the GOP plan actually goes far beyond what the ACA ever did, attacking long-standing programs like Medicaid and health providers like Planned Parenthood. The bill does this all while giving the 400 wealthiest households in America an average tax cut of $7 million.
Doctor groups like the American Medical Association, seniors groups like the AARP, patient groups like the National Breast Cancer Coalition, hospital groups like the American Hospital Association and consumer advocates like me are united in opposition to the proposal.
And no wonder. It would gut protections for pre-existing conditions, reinstate annual and lifetime caps on coverage, eviscerate Medicaid, gouge seniors, and block women from going to the provider of their choice.
In fact, the only enthusiasm for the GOP proposal has come from groups dedicated to lobbying Congress on behalf of tax cuts for the rich.
Under the GOP plan, states could allow insurers to once again discriminate against people because of their health history. One recent study found that 27 percent of adults have a pre-existing condition that would price them out of coverage if their insurance lapsed.
The bill would shunt the sickest patients into high-risk pools. In the past, high-risk pools only helped about 2 percent of those in need — a far cry from the 27 percent who could be faced with unaffordable premiums under the GOP bill.
As bad as this is for everyone, the GOP’s plan is particularly bad for women.
Pregnant women, women with previous C-sections, survivors of rape, and many more would all face skyrocketing premiums.
At the same time, states could also allow insurance companies to drop coverage for essential health benefits like prescription drugs and devices, including contraception, and maternity and newborn care. These practices were common before the ACA.
For example, a 2009 study by the National Women’s Law Center found that only 12 percent of plans sold on the individual market covered maternity care, and women were typically charged more than men for the same plan — sometimes as much as 84 percent more.
Older adults who buy their own insurance will be charged nearly twice as much under the GOP plan. That’s because the bill allows insurers to charge people over age 60 five times as much as younger adults. Women in their 50s and 60s who lose coverage through divorce or widowhood would find it particularly hard to get affordable coverage.
At the same time, the GOP plan slashes financial aid to help folks afford insurance, replacing the ACA’s subsidies with much skimpier support that doesn’t take the cost of insurance into consideration and provides the same help to a woman earning minimum wage as one who earns six times as much.
Someone living in a rural area — where insurance is often more expensive — wouldn’t get any more help than an identical person living where premiums cost less. The bill also paralyzes Medicaid, capping and ratcheting down federal support so that it provides less help each year.
Since its creation, Medicaid has been a flexible program capable of responding to both economic recessions and public health crises. The GOP bill would tie states’ hands, forcing states to cut benefits or drop children, pregnant women, disabled people and seniors from coverage.
The GOP plan isn’t a good replacement for the ACA. It’s a threat to the health of millions of people. The Senate should scrap it and work on a plan that actually improves the ACA.
Cynthia Pearson is the executive director of the National Women’s Health Network and the co-founder of Raising Women’s Voices for the Health Care We Need. Readers may write her at NWHN, 1413 K St. NW, fourth floor, Washington, D.C. 20005.