The Republican House of Horrors Offers a Terrifying Health Care Vision
Halloween arrived early this year featuring the Republican house of horrors seeking to fulfill their long lust to repeal the Affordable Care Act.
While there are legitimate criticisms of the ACA—notably the 28 million still uninsured and its failure to limit escalating out-of-pocket costs—the coverage gains made through the ACA, through Medicaid expansion and the crackdown on insurance abuses, are largely eviscerated by the GOP plan.
Instead we have a plan that again fetishizes a market-based health care fundamentalism that saw the U.S. plummet in a wide array of health care barometers, including infant mortality and life expectancy rates and people skipping needed care due to cost compared to the rest of the developed world, especially before the ACA.
With the hodgepodge plan hurriedly released Monday night, the House majority attempts to straddle growing public support for a government role in establishing health security for the American people and approval of the Tea Party crowd that views any fingerprints of public protection as akin to Satanism.
The bill fails on both counts, while also betraying promises made by candidate Donald Trump that "we’re going to have health care for everybody" that is "far less expensive and far better."
The principal effect of the new bill will be the loss of existing health coverage for tens of millions of people, without any restraints on health care industry pricing practices that add up to massive health insecurity for the American people.
Pretending to retain popular components of the ACA, the bill offers refundable tax credits to replace the ACA subsidies to buy private insurance, temporary continuation of the ACA Medicaid expansion, and requiring insurers to sell insurance to people with pre-existing conditions. But it’s like fools gold, each component sabotaged by the not-so-fine print.
- Medicaid expansion, the mechanism of most of the ACA expanded coverage, is temporarily retained, but open ended federal funding would be ultimately replaced by a cap on federal payments that would encourage financially strapped states to slash eligibility of those covered and sharply cut covered services.
- Refundable tax credits would provide less financial support than the current ACA subsidies, and by most initial analyses provide far less help for low and moderate-income people.
- A 30 percent premium penalty surcharge on people who allow their “continuous coverage” requirement to lapse completely undermines the false promise that the bill retains the ban on insurers denying coverage for people with pre-existing health conditions. Even through the ACA health exchanges, insurers routinely change plan designs yearly in ways to increase out of pocket costs and limit patient choice through narrower networks. The surcharge will increase insurer incentives to engage in these practices.
- Cuts in minimum covered health benefits, services now required by the ACA. Those would expire in 2020.
- Elimination of funding for Planned Parenthood is a significant attack on women’s overall health care. Planned Parenthood clinics provide a wide array of needed health services.
- Reduced funding for public health. Elimination of the ACA’s Prevention and Public Health Fund will disproportionately harm low-income people and patients with chronic illnesses like diabetes and heart disease that will worsen the health of communities and facilitate the spread of infectious diseases. As reported today by Vox, affected programs include the federal vaccines program, and programs to reduce heart disease and hospital acquired infections.
The architects of the new bill have exploited the repeal and replace meme with paybacks to some of their wealthiest friends and donors.
The draft bill includes a roll back of most corporate and high income taxes used to pay for the ACA, and, "as Rep. Keith Ellison has noted, a tax cut for wealthy people’s investment income and tax deduction for health care CEOs making more than $500,000 a year."
If you follow the rhetoric of the repeal-and-replace crowd, they pay a lot of lip service to restoring "freedom" and "liberty." But their approach to health care restricts freedom in the most personal aspect of our lives: health care.
Freedom to choose junk insurance has nothing to do with getting the care we need. In fact, it is the false choice of a faux freedom. This bill lets insurance shape what procedures doctors do, what drugs we take, and even which doctors we can see.
Nurses know there is only one real fix for our broken, dysfunctional, profit-focused health care system—an improved Medicare-for-all system, much as the rest of the developed world assures health care for its people.
NNU’s California affiliate, the California Nurses Association, is sponsoring a bill in California that could become the national model as an alternative to both the ACA and the fraudulently named GOP American Health Care Act.