Explanation of the recently announced American Health Care Act usually starts with an expressed need to clean up the mess that the Affordable Care Act (ACA) — or Obamacare — had made.
Most all agreed that the massive transformation the program of health care had brought about could use some tweaking and refinement, but clearly a seven-year campaign against the Affordable Care Act left a blurred view of what the program did for consumers. If the ACA had created a mess, the recently proposed replacement of it will certainly create an even messier and unfair situation.
Virginians in particular will suffer a double hit on health care, especially for those most in need. The General Assembly would not approve an expansion of Medicaid that would have brought health care to as many as 400,000 uninsured most in need in the Commonwealth and would have expanded the health care network with the $4 billion that would have flowed into the state. While the new program would eliminate Medicaid expansion in 2020, persons would have been able to get health care in the interim rather than to go without or have to seek help at free clinics or one-time-a-year Remote Area Medical (RAM) clinics. States that have expanded Medicaid would continue to get full coverage for persons already enrolled but would get a lesser amount for new enrollees beginning in 2020. That provision alone would add to the $4 billion loss already incurred in Virginia.
There are 327,000 Virginians who gained coverage under the ACA as it expanded access to affordable health care. The proposed replacement to the ACA would do away with federal health insurance subsidies that helped people afford their monthly premiums and lowered out-of-pocket expenses. Subsidies would be replaced with tax credits. Currently insurers can charge older customers up to three times what they charge younger customers; under the new plan that would increase to five times.
Although some would never acknowledge it, there are features of the despised Obamacare program that were maintained. Insurers would still be banned from denying coverage based on preexisting conditions. Dependents would still be able to stay on parents’ insurance plans through age 26. Caps on annual or lifetime coverage would still be banned.
Clearly fewer people will have access to affordable care under the AHCA. Virtually every developed country in the world with the exception of the USA has decided that access to health care is a basic human right. What is the biggest objection to the program enacted under President Obama? It included targeted taxes on investment income and wages for the very high income individuals and couples. The new AHCA eliminates many of the taxes. The wealthiest 400 households including the billionaires in the new administration would get an average tax cut of $7 million per year while taxes for many low-income working families would increase. Eliminating the two taxes on very high-income households would cost the federal government $275 billion over 10 years.
Most Virginians will lose under the replacement proposed for the ACA. Only the very rich will gain. Maybe that is what the debate is really about!