PNHP on GOP's re-branded and far meaner version of ACA

Doctors group: House GOP health plan is re-branded and far meaner version of ACA

The 'American Health Care Act' perpetuates the basic structure of the Affordable Care Act, including the subsidization of the private health insurance industry, while cutting benefits to the poor and middle class, and giving hundreds of billions in tax breaks to the rich

Physicians for a National Health Program, March 8, 2017

Physicians for a National Health Program decries the recently released Republican Obamacare replacement bill, the “American Health Care Act” (AHCA). That plan would constitute a major backward step in health policy, compounding the problems of uninsurance and underinsurance while handing over hundreds of billions of dollars to the wealthiest 2 percent of Americans.

Proposed as a replacement of the Affordable Care Act (ACA), the AHCA would maintain its basic structure. The bill would:

• Continue to channel billions of taxpayer dollars through wasteful private insurers;
• Sharply reduce the ACA’s subsidies (or “tax credits”) available to lower-income persons, particularly older adults, to purchase coverage;

• End the ACA’s cost-sharing subsidies for copayments and deductibles, increasing the cost of care for those with chronic medical conditions;
• Replace the ACA’s “individual mandate” penalty on the uninsured with a 30 percent surcharge on insurance premiums for those who experienced a lapse in insurance coverage;

• Slash federal funding for the Medicaid expansion beginning in 2020, and move towards a “per capita” cap on Medicaid spending that would squeeze state Medicaid budgets and push millions of enrollees out of the program;

• Increase the tax-favored status of Health Savings Accounts, which mostly benefit people in high income brackets;

• Reduce taxes on pharmaceutical, medical device and health insurance companies;

• Offer tax reductions totaling $274.6 billion over 10 years to the wealthiest 2 percent of Americans.

These and other provisions would take the nation in the wrong direction. Even with the ACA in place, 29 million remained uninsured in 2015; the ACHA would only push that number higher. And today, even many Americans with coverage face bankrupting medical bills for copayments, deductibles and uncovered services. By lowering the standards of private insurance plans and ending cost sharing subsidies, the ACHA would only intensify the problem of “underinsurance.”

The AHCA would replace the ACA with a worse, more regressive version of the original bill. This is not what Americans want or need. PNHP instead urges Congress to replace the ACA with a single-payer national health care program. Unlike the ACA or the AHCA, single-payer, Medicare for All reform could effectively control costs while creating a right to high-quality healthcare for everyone in America.



By Don McCanne, M.D.

Although the Republican leadership has made feeble attempts at crafting rhetoric to sell their American Health Care Act (AHCA) - their legislation intended to repeal and replace the Affordable Care Act (ACA) - nobody is fooled into thinking that they are proposing an improvement over ACA. Millions would lose their insurance and millions more would have worse coverage that leaves them even more exposed to unaffordable out-of-pocket expenses.

AHCA is being sold as an improvement in access yet clearly access to health care would be further impaired because of the financial barriers to care that it erects. Also, when we already greatly burden American workers with policies that shift wealth from the workers to the wealthy, AHCA would introduce numerous tax changes that would further benefit the wealthy, compounding the injustices of income and wealth inequality.

Although the Democrats are unified in their opposition to AHCA, there is considerable opposition from within the Republican ranks as well. Heartless conservative Republicans want even more cuts in the beneficial programs advanced by ACA, diminishing further protection against health care insecurity and financial insecurity for those with medical needs. Other more moderate Republicans are concerned that the cuts are too deep and heartless, and some are also concerned about the attacks on women’s health care.

The Republicans have been unable to resolve these conflicts behind closed doors. But they did promise that they would repeal ACA immediately and so they are moving ahead with this legislation. If it fails, then they cannot be accused of not having made the effort. Then they can move on to legislation that they are really passionate about - tax reform benefitting the very wealthy.

We must not lose perspective. The nation desperately wants better and more affordable health care. The subject is hot. Although Americans have been dissatisfied with ACA, they now recognize that the Republican proposals would be worse. Many of those who are doing well under ACA have changed from opposition to support of ACA. But those who continue to face financial hardship and impaired access to health care clearly want more and are particularly disappointed that Trump and his fellow Republicans are not delivering on their promise.

ACA was an improvement, but not enough. Its administrative complexity makes it nearly impossible to achieve high quality affordable care for all merely by enacting administrative tweaks. The seven years of Republican strategy has failed to improve on ACA, and their proposals would only make health care access and affordability worse. We need something more.

An improved Medicare for all - a well designed single payer national health program - is precisely what we need. With it we would have affordable, high quality health care for everyone. While the topic of health reform is hot, we need to get this message out. Now.