On March 23, we face the seventh anniversary of the Affordable Care Act, the law that made health insurance unaffordable and medical care less accessible. Republicans on the campaign trail promised to repeal the law, and Americans are counting on them to stick to their promise.
So why doesn’t GOP leadership’s proposed American Health Care Act (AHCA) fully repeal ObamaCare? Republican Congressman Justin AmashJustin AmashDemocrats defend Afghan withdrawal amid Taliban advance Vietnam shadow hangs over Biden decision on Afghanistan Kamala Harris and our shameless politics MORE rightly called it “ObamaCare 2.0.”
Voters angry over ObamaCare have given Republicans control of Congress, control of state legislatures, and new governorships over the last three elections. During the 2016 election, conservative activists and Americans of every political stripe hurt by ObamaCare’s high costs, narrow networks and limited choices used their ballots to paint America’s political map an unmistakable Republican red.
Is Republican leadership colorblind?
Republicans are in charge today because President Obama misled Americans about the Affordable Care Act. Despite telling them, “If you like your doctor, you will be able to keep your doctor,” they lost their doctor. And despite promising them that if they liked their health plan they could keep their health plan, their plans disappeared. The law actually outlaws the most affordable insurance policies – major medical, catastrophic, indemnity coverage – unless you’re under the age of 30.
Americans expect decisive action. President Trump is ready to sign a bill to repeal ObamaCare. It could be the same repeal bill Republicans sent to Obama in 2015. So why is GOP leadership offering a non-repeal replacement bill that looks and feels like ObamaCare?
The AHCA repeals most of the ObamaCare taxes and doubles contributions to Health Savings Accounts, but it restructures several other provisions, keeps much of ObamaCare intact, and maintains federal control over health care.
For example, the ACA’s individual mandate and penalties will be zeroed out but the GOP adds a new federal “continuous coverage” mandate with a 12-month, 30 percent penalty paid to insurers. The 40 percent federal “Cadillac” tax will stay in place with an 8-year delay. ObamaCare’s premium subsidies will be replaced by federal AHCA subsidies (refundable tax credits). The federally controlled ObamaCare exchanges, which have cost $9 billion, are kept in place. Three federal redistribution programs that led to insurer lawsuits and bailout attempts by the Obama administration (risk-adjustment, risk corridors, reinsurance) will stay in statute. The ‘guaranteed issue’ mandate for people with preexisting conditions is retained along with a $100 billion federal program to pay insurers for their care.
And the more than 40,000 pages of burdensome federal ACA regulations and guidance documents are not repealed.
The AHCA is a recipe for disaster. Republicans won’t be able to say they repealed the law and Americans will know they didn’t. The GOP will own the replacement plan and everything that goes wrong because of it.
But don’t expect health plans to complain too loudly. Anthem, the nation’s second largest health plan, has already given its support. The $100 billion Patient and State Stability Fund subsidizes their high-cost patients. Medicaid expansion dollars will continue health plan profits for at least three years. Refundable tax credits will subsidize the purchase of their policies on and off the government exchanges. Health plans will receive a tax break for CEO salaries over $500,000. The Health Insurance Tax loathed by the industry will be repealed. And the 30 percent penalty for lack of continuous coverage will be paid directly to insurers.
Expect ObamaCare 2.0 to continue the pain of the Affordable Care Act. The bill does not guarantee that health plans will lower premiums, open networks or expand choices.
Two days after the unveiling, Trump called leaders from six conservative groups together to discuss their opposition to the GOP bill. Hopefully their concerns were heard. The AHCA is not the answer to what ails health care in America. It’s not a repeal and it’s not built on the principles of limited government.
This is President Trump’s moment to shine. His “art of the deal” skills can ensure that the GOP promise of repeal becomes the GOP reality of repeal. Only with repeal can we begin making health care great again in America.
Twila Brase, R.N. is co-founder of the nonprofit Citizens’ Council for Health Freedom, a national patient-centered health freedom organization based in St. Paul, Minnesota. She is also the founder of a patient-focused initiative, The Wedge of Health Freedom.
The view expressed by contributors are their own and are not the views of The Hill.