Republicans face a revolt over health bill
The long-awaited House GOP bill to repeal and replace the Affordable Care Act was met with fierce opposition from across the political spectrum this week, with staunch conservatives denouncing it as “Obamacare lite” and Democrats warning that it would strip millions of Americans of coverage. The new bill, known as the American Health Care Act, keeps some popular Obamacare features, like prohibiting insurers from denying policies for pre-existing conditions. But it replaces the existing system of income-based premium subsidies with age-based tax credits of $2,000 for a young person to $4,000 a year for those in their 60s. Because those credits are lower than most subsidies, analysts estimate that between 2 million to 20 million people might become uninsured because they could no longer afford coverage. The bill scraps Obamacare’s individual mandate, which imposes tax penalties on people who go without health insurance, and instead allows insurers to charge 30 percent higher premiums for new customers who go 63 days or more without coverage.
President Trump said the bill would ensure Americans receive “good health care,” while House Speaker Paul Ryan praised it as “a monumental, exciting conservative reform.” But the plan came under withering attack from conservatives, with Rep. Justin Amash (R-Mich.) denouncing it as “Obamacare 2.0.” At least four Senate Republicans expressed concerns about its impact on poor people in their states who have received Medicaid coverage through Obamacare’s extension of that program. One of those, Sen. Susan Collins (R-Maine), criticized her House colleagues for releasing the bill before it had been scored by the Congressional Budget Office— a process that will reveal whether the legislation will add to the deficit and how many people will lose or gain coverage. “We need [the] cost estimates,” she said. “That’d be most helpful,”
What the editorials said
“What’s not to like? A lot, actually,” said The Baltimore Sun. Take the plan’s approach to Medicaid. After 2020, Medicaid would be transformed from an open-ended entitlement to one funded by fixed federal block grants to the states. Those grants likely won’t rise in line with the increasing cost of health care, which “portends a gradual erosion of coverage” for millions of poor Americans.
Reforming Medicaid might be the bill’s great achievement, said The Wall Street Journal. Originally a safety net for poor women, children, and the disabled, Medicaid morphed into budget-busting “insurance for able-bodied adults above the poverty level.” Block grants would force states “to set priorities and retarget Medicaid on the truly needy.” In the individual market, a loosening of rules about what plans must cover should create “a more vibrant market with more choices than Obamacare permits.”
What the columnists said
Ryan’s bill “is awe-inspiringly awful,” said Paul Waldman in The Washington Post. Think those tax credits will make coverage more affordable? Then “you don’t know anything about health insurance in America.” While Obamacare’s subsidies went up with premium rises, the GOP plan offers a flat tax credit. “If premiums go up—which they will—too bad.” Still, it does repeal the tax increases that paid for Obamacare. “Those in the top 0.1 percent would get an average tax cut of more than $195,000.”
The GOP proposal will hurt Trump voters most, said Jonathan Chait in NYMag.com. Young people, the affluent, and customers in urban areas—where insurance policies tend to be cheaper— could actually get more support from Ryancare than they do from Obamacare. But older, poorer customers in high-cost, rural areas “would get absolutely hammered.” One 60-year-old man from North Carolina interviewed by The New York Times would see his family’s tax credit reduced from $25,164 to $11,500. Such cuts “make any decent insurance plan not remotely affordable.”
This plan is going nowhere, said Ross Douthat in The New York Times. In their attempt to satisfy all GOP constituencies, the bill’s authors have satisfied no one. Staunch conservatives don’t like the tax credits included to win over Republican moderates, and moderates don’t like the Medicaid cuts intended to win over conservatives. But in fairness to its designers, no bill could have united all the Right’s disparate factions. Because on a range of issues, “the Republican Party as an organism does not know what it believes in anymore.”
Jeff Malet, James Gibbard/Tulsa World/AP ■