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Trumpcare or Ryancare: Pick Your Poison

The Republicans have released their plan to supposedly provide Americans with affordable health care. The bottom line: it won’t. Scott Lemieux at Lawyers, Guns and Money cuts to the chase with this summery of the proposal:

The proposal defunds Planned Parenthood. No federal funding can be made, either directly or indirectly, by Medicaid to a healthcare organization that “provides for abortions,” other than those done in cases of rape or incest or to save the life of the mother.

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Essential health benefit rules are repealed. As of Dec. 31, 2019, ACA rules that required qualified health plans to provide hospitalization, maternity care, mental health services and other benefits would be sunsetted. That’s likely to make maternity coverage, among other services, immensely expensive, if available at all. State could maintain the standards if they wish, but the federal standards would be eviscerated.

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Income-based premium subsidies would be replaced by age-based subsidies, which will hurt working-class families in many states. Under the ACA, subsidies to help individual buyers afford premiums and (for poorer households) deductibles and co-pays were based on household income. The GOP measure will base them on the buyer’s age, instead, with older buyers receiving more help than younger. The GOP plan limits subsidies to $4,000 per individual; under the ACA, which also keys subsidies to the cost of benchmark insurance plans in the buyer’s home market, the subsidies theoretically could be several times higher.

As we reported last week, this scheme would reduce subsidies to many of the people who need them the most, while awarding them to recipients who don’t need them.

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The Medicaid expansion is killed. As of Dec. 31, 2019, the Medicaid expansion is repealed. Traditional Medicaid will be block-granted, a system almost certain to result in less federal funding for the joint state-federal program than it would have received, over time. The neediest and sickest Americans will increasingly be on their own, as states get less federal help to provide them with medical services.

All of Obamacare’s taxes are repealed, another boon for the rich. Everything from the tax on tanning salons and medical devices to the surcharge on high-income taxpayers will be gone. As we explained earlier, this amounts to an enormous tax cut for the wealthy — at least $346 billion over 10 years, every cent going to taxpayers earning more than $200,000 ($250,000 for couples). The proposal would sharply raise the limits on contributions to tax-advantaged Health Savings Accounts — another gimme for the rich.

The ACA needed fixing, mainly the cost. This proposal is going to be far more expensive, especially for older people at a time when their wages are going down and the amount they must spend on health care rises. Health insurance will go back to the market base system we had prior to he ACA but exponentially worse.

Be prepared to loose your doctor, your health insurance and quite possibly your life.

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