In the hope that they will give cover to the Supreme Court gutting a key provision of the Affordable Care Act (ACA), three prominent Republican members of Congress revealed a plan to replace the ACA last week. Headline: Americans — middle-class, seniors and low-income — would pay more to get lousy insurance and many more working Americans would go without health coverage.
We'll get numbers and more detailed analysis in the next few days and weeks, but here is the story they will tell.
Paying more: The GOP will tout that the skinny benefits will lead to lower premiums. But what matters to people is what they pay for coverage after the tax credits on the ACA. The GOP plan will eliminate them entirely for middle-class people who earn more than three times the federal poverty level, or $60,000 for a family of four. And it reduces the tax credits for people who earn up to three times the poverty level.
Skimpy plans also come with higher out-of-pocket costs (deductibles and copayments), which will mean even more Americans who are covered still skipping care because they can't afford to see the doctor.
Seniors, too, would pay more as the Republicans would allow them to be charged five times as much as younger people, instead of three times.
More uninsured: The cuts in tax credits, along with the repeal of the requirement that larger employers pay for coverage, will mean fewer people will be able to afford insurance. And millions of Americans would lose their coverage because the Republican plan repeals the expansion of Medicaid. The GOP replacement — allowing people who make less than the poverty level to buy into Medicaid — will price a huge portion of people newly covered by Medicaid out of the market. The GOP plan also appears to support Medicaid block grants, which translate into huge cuts and fewer people covered over time.
Bye-bye to preexisting condition protection: The Republican plan pretends that it guarantees coverage for people with preexisting conditions, but only if the person is always covered. If there is a break in coverage — which is much more likely under their plan for the reasons explained above — then you can be denied coverage. And you can be charged higher premiums if you've been ill.
There's a lot more, but those are key highlights which would result in tens of millions of Americans, including middle-income people and seniors as well as lower-income working families, losing health coverage, paying more for coverage and getting worthless coverage.
It's easy to be cynical about the Republican plan, because the political blowback if it were implemented would be massive. But one other provision in the plan just underlines that cynicism. The plan keeps the $700 billion in Medicare cost reductions that the GOP made the centerpiece of their campaign ads attacking ObamaCare in the 2010 and 2012 elections.
All this in the hope that five Supreme Court justices can be convinced to make a politically motivated ruling in the King v. Burwell case. The thinking is that if Republicans can show some alternative to the ACA, the five conservative justices will be more willing — despite overwhelming, settled judicial practice by the court — to overturn the section of the ACA that provides tax credits to the more than 9 million people who get coverage from insurance purchased through the federal exchange. Cynicism anyone?
Kirsch is a senior fellow at the Roosevelt Institute and a senior adviser to USAction. Follow him @_RichardKirsch.