The AHCA debate is missing crucial healthcare costs

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The verdict is out. According to the Congressional Budget Office (CBO), the American Health Care Act would lower premiums and reduce the deficit by $119 billion over the next 10 years. It would also leave 23 million people in the United States uninsured by 2026. 

The CBO report paints a bleak picture in terms of healthcare access for half of the country if the American Health Care Act (AHCA) in its current form was made law: higher deductibles, and less coverage. This is particularly perilous for those with pre-existing conditions, or for mental health, substance abuse, maternity and rehabilitation coverage. 

{mosads}Whether or not you like the AHCA really depends on what you prioritize. And certainly, the rhetoric circulating in the wake of the CBO report has been all but predictable, on both sides.


House Republicans point to increased premiums under ObamaCare, which they say has increased by 105 percent since 2013. Speaker Paul Ryan (R-Wis.) calls the AHCA “a rescue mission.” He says the report “confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit.”

However, this statement omits details of the report, which shows the reduced premium would primarily benefit young adults while raising premiums for older people, or that the premiums would go down, but so would eligible health care benefits 

At the release of the CBO report, the official GOP Twitter account was alight with a flood of tweets highlighting how much premiums had risen in each state since the 2013 implementation of the Affordable Care Act (ACA), with “Thanks, #ObamaCare” closing each tweet. 

On their part, Democrats highlight the 23 million people predicted to be without health insurance by 2026, cuts to Medicaid, and to coverage for maternity, mental health, and addition services. They also highlight the AHCA’s lack of protections for people with pre-existing conditions. CNN called the CBO report “a gift for the 2018 campaign” for the Democrats.   

These depictions are all strategically partial reflections of the CBO report, which enables each side to depict the other’s plan as disastrous. 

As faculty in Global Health Studies at Northwestern University studying health sector reform for over a decade, it’s disconcerting that the majority of elected officials in both parties are remarkably silent on the major driver of the healthcare crisis in the United States: the actual cost of health services. That’s the conversation that has to happen. It’s a nonpartisan issue. It’s precisely what’s underlying this entire debate. 

Republicans are rightly concerned about controlling the national deficit. According to the CBO, federal debt is at its highest level since the Second World War, and is expected to continue rising because of government spending on Social Security, health care programs like Medicare, and interest on existing debt. The fact that baby boomers are aging and life expectancy is increased means more people will become eligible for Medicare, and will stay on it longer. This spells disaster not only for our deficit, but also more widely for the national economy.

The Democrats’ objection seems to be about health care as a human right, but really never deals with the very real concern of how the federal government can pay for that human right under the current system. 

There is division among Senate Republicans regarding what to do about the AHCA, and in particular about existing protections for people with pre-existing conditions. Some want the protections repealed, others favor those protections.

One of the few members of Congress talking about health care costs in relationship to insurance premiums is Sen. Bill Cassidy (R-La.), who recently said on the Senate Floor, “One way we can lower the cost of health insurance is by lowering the cost of health care.” Few Democrats are expressing interest in his plan, however.

The merits of Cassidy’s approach are up for debate. But that neither Republicans nor Democrats are putting the costs of healthcare at the center of the debate is mind-boggling. The costs of insurance are a direct reflection of the costs of health care. The costs of health care are out of control. People can’t even shop around to compare providers or products for price, safety and efficacy. 

What is happening in terms of healthcare costs in the United States is egregious. Big Pharma increases the cost of life-saving drugs while paying their CEOs enormous salaries. Many providers and hospitals charge hidden fees.

An estimated $144 billion of your taxpayer dollars was spent on improper payments to Medicare and Medicaid last year. According to Bloomberg, the American healthcare system ranks near the bottom in terms of efficiency. There is no transparency, accountability or efficiency in terms of healthcare costs in this country. And our health outcomes for all that egregious spending are some of the poorest of developed countries.

Neither the ACA nor the AHCA directly address the costs of healthcare. Whatever Congress ultimately decides to vote into law must deal with healthcare costs, or it’s doomed to fail. It will either plunge the nation into untenable debt, which will compromise all other government spending and our overall national economy, or it will cost-shift the burdens of paying out-of-control healthcare costs to the people, which will certainly cause loss of life.

Neither position is politically, morally or fiscally tenable. Costs are at the core.

Noelle Sullivan is an Assistant Professor of Instruction in global health studies and anthropology at Northwestern University, a board member of Worldview Education and Care, and a Public Voices fellow with The Op-Ed Project. Follow her on Twitter: @ncsullivan.


The views expressed by contributors are their own and are not the views of The Hill.

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