The Facts and Myths about GOPcare and Obamacare
It is time to break through all the noise with the facts and myths about GOPcare and Obamacare. Whether you want to call it American Health Care Act, GOPcare or Trumpcare, the new GOP replacement for The Patient Protection and Affordable Care Act (ACA) (Obamacare) is nothing more than a huge tax cut for the rich. The republicans have removed all the revenue funding the ACA subsidies, which made the richest Americans subsidize health insurance for the poor. GOPcare ends the 3.8% capital gains surtax on capital gains, which would have generated $158 billion over the next 10 years. It also ends the 0.95% Medicare surtax on the rich, which would have generated $117 billion. It will surprise no one that 90% of that windfall goes to the top 1%.
The other means of shifting more wealth from the poor to the rich is by changing the subsidies based on income, to tax credits based on age. Since income, not age, is what makes health insurance unaffordable for many, this will result in as many as 15 million losing health insurance. Under ACA a 60-year-old, earning $20,000 per year, who got about 90% of their premium subsidized, will now get only a $4000 tax credit to buy a $10,000+ plan. At the same time, a 60-year-old, earning $74,000 per year who received no subsidy under ACA will now get the same $4,000 tax credit.
The GOP removed the word “affordable” from the name of their healthcare plan because that is not one of its goals. Their new buzzword is “accessible”. Of course healthcare was always accessible, but only to those who could afford it, and it is still going to be the same way. Someone earning $20,000 per year can not afford a $10,000 healthcare plan, so the only access they will have is to the junk plans barred under ACA. So when the GOP says they are bringing back choice, what they mean is the choice to buy a junk plan that covers nothing and is close to 100% profit for the insurance companies.
Of course repealing ACA also means cuts to Medicare and Medicaid, something Trump promised he would not do. On Friday, Paul Ryan bragged on conservative pundit Hugh Hewitt’s radio show that GOPcare cuts billions from Medicaid, with his usual evil grin. ACA also began the process of closing the Medicare donut hole for medication.
The Myths About The Patient Protection and Affordable Care Act
All of their changes are being done under the pretense that the Affordable Care Act was in a death spiral. That myth was started by the republicans when premium increases for 2017 were announced. It was then further exacerbated by the CEO of Aetna. Last summer, Aetna were planning on expanding their participation in ACA from 15 up to 20 states. At the same time they were trying to get a $34-billion merger with Humana approved. Aetna then tried to use their participation in ACA to extort the federal government into approving the merger, threatening to pull out of the ACA if it wasn’t approved. When the merger was rejected by the Obama administration, Aetna followed through on their threat, pulling out of all but 4 of 15 states. They claimed it was a business decision. They were simply losing too much money on the ACA exchanges. Recently a court found that to be a lie. The federal judge ruled that Aetna made its decision in response to a federal antitrust lawsuit blocking its proposed merger with Humana. The CEO of Aetna then claimed Obamacare was in a “death spiral,” something all healthcare experts say was a blatantly false statement. ACA has some problems, but they come nowhere near the definition of a death spiral.
The main issues Ryan and the GOP point to when they falsely claim that Obamacare is failing are the premium increases, and the fact that over 1000 counties are down to only one insurer on the exchanges. What they don’t tell you is that both issues are mostly confined to republican-led states where they intentionally sabotaged the implementation of ACA, refusing to expand Medicaid, or to set up their own exchanges, and defunding risk corridors.
Most republican-controlled states refused Medicaid expansion, because without it they knew ACA would not work properly. In the states that accepted Medicaid expansion, the increase in premiums was generally much lower than the average yearly increases before its implementation. In the 10 years before ACA, premiums rose between 10-20% each and every year, in all 50 states. GOP selective memory is a wonderful thing!
When it comes to the issue of only one insurer on some exchanges, Ryan and the Republicans always quote that statistic by counties. That is not a coincidence. You may have noticed that during Ryan’s Powerpoint presentation there was no map showing where these counties are. The reason for that is because most of those 1000 counties are in a handful of Republican-led states where they intentionally sabotaged Obamacare implementation. ACA is working where it was implemented, and failing where republicans created a self-fulfilling prophesy by sabotaging it.
Kentucky is the perfect example of a red state where it was implemented, but Republicans still undermined it using disinformation. By expanding Medicaid and setting up an exchange, Kentucky managed to cut their uninsured rate by half. Their state-run exchange was marketed as Connect, but many people in the state didn’t even realize it was Obamacare. A poll taken recently showed Connect was very popular in KY, but Obamacare and ACA were not. Of course all three are the same thing, but that confusion led Kentucky voters to elect a Tea Party governor who campaigned on repealing Obamacare.
The Facts About The Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act reformed healthcare, and mandated minimum coverage for all healthcare plans. ACA forced insurers to cover pre-existing conditions, no caps, and free preventive care with no deductibles in all plans, both employer and through the exchanges. This included a wide range of services and procedures like yearly checkups, colonoscopies and cancer screening for women. Most importantly, it put the emphasis on preventive care, which has been shown to be much more cost effective long-term. Over time, this would get healthcare costs in the US down, and more in line with those in other developed countries.
Repeal of ACA means more out-of-pocket expenses, even for those on employer plans. Even if you are one of the few on a Cadillac employer plan that covers pre-existing condition and no caps, without ACA mandates that only lasts while you keep your current job. The GOP and Trump lied when he said they would keep the good parts of Obamacare and get rid of the individual mandate. Trump told a real whopper when he said he had a secret plan to provide better coverage at a lower cost for everyone. Premiums in a private insurance market are going to vary, depending on what they cover, the amount of co-pays, and amount deductible. The more extensive the coverage and the lower the deductibles, the higher the premiums. The only way to lower premiums without lowering the cost of healthcare in the United States, is the reintroduction of junk policies. These policies were outlawed by Obama because they covered nothing, and were almost 100% profit for the insurance companies.
The Realities Of Healthcare
There is no country in the world that has a successful private, for-profit, health insurance system. Free market health insurance doesn’t work because no insurance company is willing to insure the old and sick unless they are forced to. The only healthcare that works is universal healthcare where everyone pays in through their taxes, and healthy/sick and old/young balance out. Paul Ryan complains that the healthy are paying for the sick, but that is the very definition of insurance. I have never had a car accident, so I pay for all of those who do, and when my luck runs out I will be covered. Single-payer universal healthcare works, but you would only know that if you ask someone who has it. Republicans will tell you that Canadians are streaming over the border to use our healthcare system. That is another myth. Occasionally the ultra-wealthy use it to get shorter wait times or elective surgery. As in all developed countries with universal healthcare, Canadians are more satisfied with their healthcare system than we are with ours. They have lower costs, with better outcomes, and much lower drug prices.
The reason the GOP only have a tax cut for the rich and no healthcare plan to replace Obamacare is because the ACA was based on the Republican plan first proposed by the conservative Heritage Foundation, with an individual mandate, later adopted by Romney in Massachusetts. They only abandoned it when it was adopted by President Obama as a blueprint for the Affordable Care Act. It does need tweaking, as every major piece of legislation does, but GOPcare is a tax cut for the rich, disguised as a healthcare plan, and is as useful as a wet paper bag when you are on fire.