Over 20 years ago, congressional Republicans shot down the Clinton administration’s proposals for revamping American health care, which they derisively called “Hillarycare.” After they took control of Congress in 1994 they could have worked with President Clinton to come up with a fix for our health care system (or more accurately our health insurance system), but they did nothing. The Supreme Court’s selection of George W. Bush after the 2000 elections gave the GOP complete control in Washington for six years, and still they did nothing about health care.
When President Obama called for health insurance reform, Republicans went back to their old playbook, slapping the tag “Obamacare” on his proposal, and apparently assuming that they could kill it the same way they had brought an end to the plan proposed almost twenty years earlier. But much to their surprise, the Affordable Care Act passed, and millions of Americans were able to buy health insurance, many for the first time in their lives. The law wasn’t perfect, but instead of offering ideas to strengthen and improve it, all Republicans talked about was “repeal and replace.” They have been very long on the “repeal” part, having voted over 60 times in the House to abolish the law, but they have come up short on proposals of their own to replace it. Until now.
On June 22, House Speaker Paul Ryan released the Republican plan for replacing Obamacare as part of a package of GOP ideas called “A Better Way.” Ryan teased the release of the plan in a June 6 video, which opens with the Speaker saying, “Let’s face it, people know what Republicans are against.” Truer words have never been spoken. But now, Ryan says, he’s going to tell us what Republicans are for.
The health care proposal keeps some of the provisions of the Affordable Care Act, such as the requirement that insurers cover people with “pre-existing conditions.” But it proposes putting those people in “high-risk pools” which have the potential to be so expensive that nobody who needs to be in them would be able to afford them. The whole idea behind the huge insurance pools created by Obamacare is that the premiums paid by healthy people who don’t need much medical care would make coverage more affordable for those with conditions such as cancer, heart disease or other maladies that require expensive care. Removing those people from the big pool and putting them in their own pool with nothing but other sick people will make the cost of their premiums skyrocket.
The Republican plan includes tax credits for people to buy insurance from private insurers. But there are no specifics when it comes to the amount of those credits or how they would be applied. Would you have to pay the full premiums all year, and then get some money back come tax time? That would not be affordable for many people. And what happens when your insurance costs more than what you pay in income taxes? Would you be able to get the full amount of your premiums back, or would it be capped at the dollar amount of the taxes you paid?
Another part of the plan involves expanding health savings accounts, which allow you to set aside money tax-free to help pay for health care. But if you barely make enough money to make ends meet, how are you going to come up with money to contribute to a health savings account?
Ryan’s plan also addresses Medicare, and the cuts to the Medicare Advantage program that came along with the Affordable Care Act. The Medicare Advantage program has been a darling of Republicans because it fits with their mantra that the private sector can always do things better than government. However, the Henry J. Kaiser Foundation reports that just before Obamacare took effect, in 2009, Medicare was paying out some 14 percent more per beneficiary to insurance companies for Medicare Advantage programs than what it cost to cover them under traditional Medicare. The changes in the program brought by the ACA were designed to get those costs under control. Going back to the pre-ACA days when it comes to Medicare Advantage will cost more, and make the program less, not more secure, as Ryan claims.
International Business Times reports that another change Ryan is proposing is an increase in the eligibility age for Medicare, from 65 to 67, starting in 2020. So not only will Americans with serious illnesses have to pay a lot more for their insurance premiums, they’ll have to pay more for a longer time, because they’ll have to wait two more years for Medicare.
Medicaid is part of the proposal, too, with the current Medicaid expansion under Obamacare being replaced with block grants to states. In other words, Medicaid will be drastically cut.
The rest of the plan is nothing more than warmed over GOP ideas that have been circulating for years. Buying insurance across state lines is one of them. But as critics have repeatedly pointed out, what will happen if that is allowed is insurers will locate in the states with the fewest consumer protections. That is exactly what credit card companies have done, and there is no reason to expect health insurers to operate any differently.
Of course, it wouldn’t be a Republican health care plan without a call for reform of medical malpractice laws. The GOP has wanted for years to make it harder for patients to sue for malpractice, and to cap awards in court cases. But their notion that malpractice awards are a major factor in ever-increasing health care costs is not borne out by facts. A 2013 report from Johns Hopkins, one of the leading providers of medical care in the country, said that “catastrophic” malpractice payouts add little to medical costs.
The Obama administration is not impressed. A statement released from the White House calls out Ryan’s proposal for what it is: “Nothing more than vague and recycled ideas to take health insurance away from millions and increase costs for seniors and hardworking families.”
So once again Republicans give us the same tired ideas for fixing health insurance and health care, instead of joining Democrats to improve the system which is currently in place, and which is working for many people. But they have to do something, right? They can’t allow people to continue to benefit from a program that they derisively tagged with the president’s name, and which is helping millions who now happily refer to it as “Obamacare.”
Here is Paul Ryan’s video introducing his “Better Way” plan:[youtube https://www.youtube.com/watch?v=nuys9Eo_68c?rel=0]
Featured image via video screenshot