The bill doesn’t know what problem it’s trying to solve.
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Republicans in the House have finally released a bill to repeal and replace Obamacare: the American Health Care Act. The GOP healthcare bill keeps some of the most popular parts of Obamacare, like letting young adults stay on their parents’ health insurance until age 26 and requiring insurance companies to cover people with pre-existing conditions.
But the Republican bill gets rid of the key element that made Obamacare work: the individual mandate. Now that people aren’t required to have insurance, healthy people could leave insurance pools en masse, leaving sick people who are more expensive to cover.
Hypocrisy is a minor sin in politics, but still, it is remarkable how much of it there is to be found in this legislation. A core Republican complaint when Obamacare was passed was that the law delayed many of its provisions in order to reduce public outcry and manipulate the CBO’s score. The GOP bill is similarly aggressive with such tricks, delaying changes to the Medicaid expansion until 2020 and pushing Obamacare’s tax on expensive insurance plans out until 2025.
Because Republicans aren’t even trying to win Democratic votes, they’re stuck designing a bill that can wiggle through the budget reconciliation process (another thing they complained about Democrats doing). That means they can’t make major changes to insurance markets like repealing Obamacare’s essential benefit standards or allowing insurance to be sold across state lines. That last part is particularly striking, given that it was one of President Trump’s five demands in his speech last week. I’ve always been skeptical about the savings Republicans could wrest by changing those regulations, but now they can’t get those savings at all — which means sacrificing a key part of their theory of cost control.
This bill has a lot of problems, and more will come clear as experts study its language, the Congressional Budget Office release its estimates, and industry players make themselves heard. But the biggest problem this bill has is that it’s not clear why it exists. What does it make better? What is it even trying to achieve? Democrats wanted to cover more people and reduce long-term costs, and they had an argument for how their bill did both. As far as I can tell, Republicans have neither. At best, you can say this bill makes every obvious health care metric a bit worse, but at least it cuts taxes on rich people? Is that really a winning argument in American politics?
In reality, what I think we’re seeing here is Republicans trying desperately to come up with something that would allow them to repeal and replace Obamacare. This is a compromise of a compromise of a compromise aimed at fulfilling that promise. But “repeal and replace” is a political slogan, not a policy goal. This is a lot of political pain to endure for a bill that won’t improve many peoples’ lives, but will badly hurt millions.
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