We’re nearing the endgame in the Republican effort to repeal and replace the Affordable Care Act, aka Obamacare.
House Republicans offered their proposal Momday, and the Trump White House may have something to say this week. Votes are possible this month.
There will be confusion. There will be anger. There will be attacks on socialized medicine.
But the truth will eventually become obvious: Trumpcare is Obamacare, only with less money.
It can hardly be otherwise. There are only three ways for the government to approach health insurance: 1) Let Americans fend for themselves; 2) enact a single-payer, government-run system; 3) provide public support for the private insurance market.
No one, not even the GOP, wants to tell Americans they’re on their own when it comes to health care (except perhaps for Sen. Rand Paul of Kentucky and other libertarian members of Congress.)
And while single-payer Medicare works for senior Americans, it’s very expensive.
If you rule out a single-payer system and a let-them-eat-cake approach, the idea behind Obamacare is the only option left.
Trumpcare concedes this.
At the same time, President Donald Trump has promised coverage that’s “much less expensive and much better” than Americans have now. For everyone.
That pledge will be nearly impossible to keep. Trumpcare may be cheaper, but for most Americans, it won’t be better.
▪ Republicans will offer refundable tax credits for the uninsured to purchase health coverage on the open market. That’s how the Obamacare exchanges work.
But the GOP will provide much less money for the credits.
A 28-year-old might get a refundable credit of $2,000, about $167 a month. You can buy insurance for that amount, but it won’t cover much, and the deductibles will be sky-high.
The result? Less expensive insurance, but less coverage, too.
▪ The GOP wants to end Medicaid expansion and give states a block grant to cover poorer residents without insurance.
Why would they do this? They could cover the poor with Medicare — both programs are government insurance. The answer is simple: It would cost the federal government too much.
The only reason to block-grant Medicaid is to spend less than Obamacare does. That will mean lesser coverage for some Medicaid patients.
Some Republicans know this, by the way, and they aren’t happy about it.
▪ Republicans want to end the individual mandate and fund high-risk pools for the uninsurable. They have no choice but to do this: In the absence of a mandate, no insurance company will cover patients with pre-existing conditions without massively high premiums.
But a high-risk pool is just another name for government insurance, which the feds could provide through Medicare. Using a state-run high-risk pool instead makes the goal obvious: Send the states less money for high-risk patients.
▪ The GOP proposes ending Obamacare’s minimum benefits requirements. Healthier people will likely buy those policies and then be shocked to discover they cover less.
People who get insurance at work may also face higher co-pays and deductibles.
Again, the policy choice: Spend less money for lesser benefits. Almost all of the GOP alternatives make this tradeoff.
The real Republican enemy isn’t Obamacare, which is basically a GOP invention.
Party members want to end the taxes in the Affordable Care Act. They know you can’t do that without cutting spending or you’ll increase the deficit.
They hope free market forces will drive down health care costs. Is there any evidence that will happen? Doctors and hospitals seem less than excited about taking less money.
Lower taxes and reduced spending are commendable goals. But we should be clear about what that means: For most Americans, health care will soon cost more money.