By, Penny Mack
Full Title: As AHCA moves forward, Republicans Maintain Obamacare is a Failure
It’s been little more than a month since Republican leaders pulled the first version of the American Health Care Act (AHCA) out of a House of Representatives vote, leaving Republicans feeling defeated yet defensive about their plans for health care. In the wake of pulling the bill, President Trump told the press that “the best thing [Republicans] can do, politically speaking, is let Obamacare explode.” House Speaker Paul Ryan seemed to echo the same sentiment, saying “the worst is yet to come with Obamacare.” Throughout the Republican party, before and after the failed AHCA, the general rhetoric has been that the Affordable Care Act (ACA), frequently referred to as Obamacare, is in a death spiral. But what is actually going on with Obamacare, and what does failure for a health insurance bill look like?
Essentially the healthcare system is a collective effort: the more people that are enrolled in Obamacare, or any health care plan for that matter, the lower the premiums, the baseline cost for a healthcare plan. That means that if people stop signing up for healthcare, or if people decide to leave the plan, the cost of premiums goes up. It’s supply and demand: the more people want health care, the less it costs for everyone enrolled.
In the last year, Obamacare enrollment has shrunk 4% and premiums are on the rise. But this doesn’t actually affect most Obamacare enrollees. The ACA (Obamacare) provides subsidies that cap premiums for anyone whose yearly income is between one and four times the federal poverty level. That means that a family of four, for which the federal poverty level is $24,600, will be eligible for subsidies as long as their income is below $98,400. Since 83% of Americans using Obamacare receive subsidies, the majority of consumers will not have to pay any more for health insurance despite premium costs rising.
Furthermore, the Congressional Budget Office, a nonpartisan group in charge of producing “independent analyses independent analyses of budgetary and economic issues,” ruled that Obamacare would remain stable.
Nonetheless problems remain with the system. Many insurance companies have pulled out of Obamacare due to falling signup rates, thus leaving consumers with fewer options for healthcare and allowing for monopolies and high premiums in some areas. The fewer insurance companies available to choose from, the higher the premium costs they can demand from consumers.
Yet Republicans seem determined to remain anti-ACA, and maintain that the premium increases and few plan options have made health care unaffordable and undesirable in their districts.
But the Republicans’ AHCA hasn’t proven to be very popular either. 215 votes total were needed to pass the bill, and with no Democratic “yes” votes, no more than 22 Republicans could vote no. According to the New York Times, at least 33 Republican house members were predicted to vote no.
Most of these no votes were members of the House Freedom Caucus, a far-right group of Congresspeople who believe the new healthcare plan is just “Obamacare-lite”– too liberal. Their main complaint was that the bill builds in subsidies for middle class Americans, much like the subsidies provided in Obamacare. In the eyes of the House Freedom Caucus, these subsidies are a welfare handout that will be abused by Americans who rely on them too heavily. Other Republican no’s came from Republican congresspeople from liberal districts, districts that heavily rely on Obamacare, or representatives alarmed by the CBO’s report that the new bill would raise the uninsured rate.
Although the Republicans voted to repeal Obamacare many times during Obama’s presidency, the split party struggles to find an agreed-upon solution. But President Trump seems to have used the failed vote to identify his opponents: “We must fight [the Freedom Caucus], & Dems, in 2018,” he tweeted, referring to the 2018 midterm elections.
Revisions to the AHCA have now convinced the Freedom Caucus to get on board. “The AHCA is not full repeal [and] there is more work to be done. But because of the hard work of conservatives, we have a better bill today,” wrote the Freedom Caucus’ twitter account. The revisions implemented to convince the Freedom Caucus “allow insurers to provide a more limited package of health benefits than the Affordable Care Act requires. With a waiver, states could also allow insurers to charge higher premiums to people with pre-existing conditions, if states had an alternative mechanism such as a high-risk pool or a reinsurance program to provide or subsidize coverage for people with serious illnesses.” Obamacare doesn’t allow for rates to change just because someone has an illness that existed before their insurance plan began. The revised AHCA would allow companies to hike up rates for people starting a plan with a pre-existing condition. Essentially, “rates for a person with cancer, diabetes or multiple sclerosis could be far higher than the standard rate, effectively pricing the sick out of the market without technically blocking coverage.”
The House passed the bill on May 4th, though the results were a small four vote margin. The AHCA now moves to the Senate, where many are unsure whether it will succeed. Like some house representatives, many Republican senators are wary to support the bill due to their states’ dependence on Medicaid and the ACA. The American people themselves are wary– the bill’s approval rating stands at 21%. Ellen B., head of Winsor’s Current Events club, says the bill is disliked with good reason: “In effect, the Affordable Health Care Act fails to complete any of its expressed aims – it neither makes healthcare more affordable for Americans nor makes it easier to obtain. Instead, the AHCA would dramatically cut Medicaid benefits, restricting healthcare access for millions and making it more difficult for schools to treat disadvantaged, disabled kids. [Massachusetts] Representative Kennedy said it best – ‘the more you need’ healthcare, the ‘further out of reach’ it will be. The bill hasn’t been supported by any independent organization of healthcare professionals, which further underscores the threat that the AHCA poses to American lives.”
Whichever way the vote swings in the Senate, the work behind revising and passing the AHCA bill in the House makes clear that the Republicans seemed determined to override Obamacare in whatever way possible.