Thursday, March 09, 2017




Yes, this is Obamacare Lite.
It’s also Obamacare Cheap.

I have to say, I’m a little surprised at the new Republican bill to reform health care: the American Health Care Act. It would appear that the strong pushback from constituents and stakeholders such as state governors is having an effect: Republican congress members have crafted a bill that does retain some of the signature elements of Obamacare.

Financial assistance to help Americans afford insurance? Check. Not allowing insurers to deny coverage due to pre-existing conditions? Check. A list of “essential benefits” that all plans must cover? Check. Keeping young adults on their parents’ plans? Check. Cadillac Tax? Check. (Yeah, that one surprised me.)

In short, when hard-right Republicans call this “Obamacare Lite,” they’re not wrong. The problem for Republicans is that while Americans agree with them that premium increases and taxes and less choice are all bad outcomes, they still believe that the government does have a role to play in helping everyone obtain health care. They agree with the spirit of the ACA, if not the letter of the law.

As CNN reports,  “The bill on the table right now is closer to a restructuring, than eliminating Obamacare.”

So Republicans are trying to thread the needle—get rid of the parts of Obamacare that people don’t like, while not throwing millions off of their insurance plans and letting them fend for themselves.

But there’s a bigger point—and a bigger problem—here, one that harkens back to one of the cornerstones of Republican principles. The AHCA is an effort to keep some of Obamacare’s reforms, but pay much less for it. They are pushing to cut the taxes, fees, and other elements of the ACA that conservatives are philosophically opposed to. They also believe the ACA imposes regulatory burdens on businesses that are cumbersome and unnecessary.

So, it’s Obamacare on the cheap. Unfortunately, in America, health care isn’t cheap. We have the most expensive health care system by far, with outcomes that are simply not as good as they should be, considering how much we pay for them.

The ACA had a number of initiatives that attempted to cut down on rising health care costs. So far, they’ve had limited success. And this new GOP bill simply assumes that more “choice” and less regulation will reduce costs. That’s more of a wish than a plan. In real life, cutting corners on health care often raises, rather than lowers, costs in the long run.

The truth is, the ACA probably should’ve put more money into providing health care, not less. The problem, for both insurers and consumers, is that the system continues to cost more than their budgets can cover. Yes, we should cut back on health care cost increases. But that’s a nut we still haven’t cracked—and the old mantra of getting government out of the way is simply not going to work. Reducing the number of insured Americans is not the way to cut costs. 

Today, any effort to cut back the scope of the ACA is going to be problematic for providers, state governments, and the consumers of health insurance. Providers will lose insured patients, and hospitals will be forced to do more charity care—which will force insurers to raise premiums. Insured patients will have higher copays and deductibles, and many will lose some or all of the subsidies. It’s hard to see this law not resulting in millions losing coverage.


At first glance the Medicaid piece stays pretty much the same until 2020, when states will start to have to pay more for that population. But… that’s just kicking the can down the road, isn’t it? And there’s troubling language in the bill suggesting that mental health treatment could be degraded over time with the Medicaid changes.

That brings us to my last point. Whether you call it Obamacare Lite or Obamacare Cheap, this proposed law is simply inferior to the current law. It will cover fewer people. It will almost certainly make health insurance more expensive for many.

So far, trying to create Obamacare Cheap has not met with a lot of support. Put aside the opposition from both ends of the political spectrum, the stakeholders affected by this bill are not fans. Groups like the American Medical Association, the American Hospital Association, and AARP have come out against the bill. The current medical director of Medicaid has spoken out against it. The health insurance industry’s biggest lobbying group, Americas Health Insurance Plans, has asked for major changes.

Also troubling is the fact that House Republicans are trying to push the bill through committees before the CBO can score it—a sure tell that Republicans know an impartial analysis will find the numbers in their bill will not add up.

As Ezra Klein plaintively asks in the video below, what’s the point of all this? If we end up with a fix for Obamacare that still does some of the same things, only not as well, what have we accomplished? Yes, Republicans can say they kept their promise. But if the country is worse off for it, is that really what we want?



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