GOP divided over Obamacare repeal plan
House Republican leaders this week vowed to push through a plan to repeal and replace the Affordable Care Act with a system of tax credits that could be used to purchase health insurance, but their efforts will face strong resistance within the party. Endorsed by House Speaker Paul Ryan, the 100-page draft legislation would eliminate Obamacare’s individual mandate that compels people to have health insurance, as well as all the taxes linked to the law. Income-based government subsidies to buy insurance would, from 2020, be replaced with tax credits based on age, ranging from a $2,000 subsidy for people under 30 to $4,000 for beneficiaries over 60. The credits would be refundable, meaning lower-income people could receive a larger amount than they paid in taxes. The proposal would also dial back Obamacare’s expansion of Medicaid in 31 states and offer states funds to establish high-risk pools to cover uninsured people with pre-existing conditions.
Buffeted by angry town hall protests, some GOP lawmakers expressed concern over the political fallout of repealing a program that has provided insurance to an estimated 20 million people. Those fears were heightened by a new National Governors Association study, which found that shifting to a system of age-based credits could cut the number of people covered by 30 to 50 percent in many states. Meanwhile, many staunch conservatives spoke out against the draft bill because of those refundable tax credits, which Rep. Mark Meadows, chairman of the House Freedom Caucus, condemned as “a new entitlement program.” President Trump, who has vowed to replace the ACA with “something terrific” and hasn’t yet endorsed the House bill, said it would take time to finalize a plan, explaining, “Nobody knew health care could be so complicated.”
What the editorials said
“Obamacare is collapsing,” said The Detroit News. Insurers are bailing out of its state exchanges and premiums are skyrocketing— the average annual cost of a family insurance policy now tops $18,000. But “killing the ACA altogether is not realistic,” not after the health-care industry spent billions of dollars adapting to it. Instead, Republicans should aim to fix the ACA and lower costs. They could start by repealing federal mandates that tell employers what they must include in their insurance plans and by allow-ing insurers “to sell products across state lines to encourage competition.”
The GOP’s replacement plan is “Robin Hood in reverse,” said the Newark, N.J., Star-Ledger. As the GOP scales back Medicaid and subsidies, “about 21 million Americans would lose their coverage.” Without the individual mandate, healthy young people won’t bother to buy insurance, which means premiums for the sicker, older people left in the pool will soar to unaffordable levels. “The biggest winners all around are the rich, who currently help finance Obamacare and under the GOP alternative would pay lower taxes.”
What the columnists said
The repeal plan may hurt Trump voters most, said Vann Newkirk in TheAtlantic.com. Premiums are already higher in rural red states than in blue urban areas, and “rural Americans rely much more heavily on public insurance.” They also have more limited access to quality health care and are on the frontlines of the opioid epidemic, which partly explains “the climbing mortality rates among middleand lower-class whites today.” By slashing insurance subsidies and pulling back Medicaid expansion, the House plan would leave millions of Americans without access to health care.
If some states want to stick with Obamacare, Republicans should let them, said John Davidson in TheFederalist.com. But there will be a cost. To states that want to keep their Medicaid expansion, Congress should say that the federal government will no longer pick up 100 percent of the tab but 60 percent—just as before Obamacare. States can hike taxes to pay for more generous coverage. “The same goes for individual health insurance markets.” Let the states control and fund them, and “let state voters hold state lawmakers accountable.”
Republicans are “so convinced Obamacare is a plague,” they’ve overlooked “Americans’ attachment to the new status quo,” said Jennifer Rubin in The Washington Post. For seven years, voters told pollsters they disliked the law. Threaten to take it away and it’s “How dare you!” Polls show Americans now favor Obamacare 48 percent to 42 percent, and more than 80 percent don’t want Medicaid rollbacks. Proceed cautiously, Republicans, or “face in 2018 the same kind of wave election Democrats faced in 2010.”