Whether you see good things or bad in the Ryan-Trump health insurance plan to replace Obamacare probably depends on whether you identify more with Robin Hood or the Sheriff of Nottingham.
Many Republicans in the House of Representatives, especially the most conservative, feel the Affordable Care Act, former President Obama’s signature policy achievement, went too far in taking from the rich to give to the poor.
President Trump, like many congressional Republicans, is eager to deliver on promises to undo Obamacare. Trump seems eager for a legislative “win” to maintain his frenetic pace of executive order change and promise-keeping.
“We’re going to do something that’s great and I’m proud to support the replacement plan released by the House of Representatives,” Trump declared at the White House last week. “We’re going to take action. There’s going to be no slowing down. There’s going to be no waiting and no more excuses by anybody.”
In the campaign and since, Trump has often promised to replace Obamacare with something better, cheaper and more available for ordinary Americans — Obamacare on steriods but at less cost. But that’s not what the House bill being pushed by Speaker Paul Ryan looks like. Maybe health care was one of those campaign promises we weren’t supposed to take seriously or literally. It’s hard to tell with this president. What he tweets at dawn morphs by the time aide KellyAnne Conway explains it away at noon.
Trump has said several times that the Republican health plan would cover more people, reduce their premiums and costs, avoid cutting Medicaid, and leave no one worse off than now.
But that’s not what the non-partisan Congressional Budget Office analysts see in the Trump-Ryan American Health Care Act.
Aiming to reduce the role of government in health care and cut government costs, the GOP plan would lead to 14 million people losing health insurance in the first year and up to 24 million after a decade, according to the OMB. This plan would repeal unpopular fines that Obama’s law levies on people who don’t carry health insurance. It also would replace income-based subsidies, which the law provides to help millions of Americans pay premiums, with age-based tax credits that may be skimpier for people with low incomes and the elderly.
The Republican legislation would limit future federal funding for Medicaid, which covers low-income people — about one in five Americans.
About $337 billion would be saved over a decade, but at the expense of the elderly, the poor, and the lower middle income ranks.
Democrats say the bill would leave many people uninsured, shifting costs to states and hospital systems that act as providers of last resort. Thus, even as it reduced the federal deficit in one way, it might create deficits in other ways — including a return to people using expensive emergency room services rather than cost-efficient primary care.
The bill also adds up to big tax cuts for the rich as much as $883 billion over a decade by some estimates — cutting more than 20 taxes enacted under Obama’s heath law with the bulk of the savings going to the wealthiest Americans. The bill takes back from the poor to give to the rich.
“Repeal-and-replace is a gigantic transfer of wealth from the lowest-income Americans to the highest-income Americans,” said Edward D. Kleinbard, a professor at the University of Southern California law school and former chief of staff for the Joint Committee on Taxation
The Ryan plan would preserve popular consumer protections in the Obama law such as insurance safeguards for people with pre-existing medical problems, and parents’ ability to keep young adult children on their insurance until age 26.
But it would hit some Americans hardest because it wouldn’t provide a larger tax credit to people with more expensive plans, which tends to be those in rural areas and the elderly.
Senate Finance Committee Chairman Orrin Hatch, R-Utah, wouldn’t rule out changes by his chamber, where significant numbers of moderate Republicans worry the measure could leave too many voters without coverage.
Another voice of reason was Ohio’s Republican Gov. John Kasich, who said “Phasing out Medicaid coverage without a viable alternative is counterproductive and unnecessarily puts at risk our ability to treat the drug-addicted, mentally ill and working poor who now have access to a stable source of care.”
“The right way to fix Obamacare is by Republicans and Democrats working together,” he added.
We agree and hope enough Republians do too. After the CBO analysis showed Ryan’s bill shifting the burden onto the poor and elderly, some nervous Senate Republicans suggested changes to the bill were needed.
They told Trump administration officials they wanted to see lower insurance costs for poorer, older Americans and an increase in funding for states with high populations of hard-to-insure people. And at the beginning of the week the White House made some conciliatory statements about the need to listen to all sides and the possibility of deals being struck.
So, is there hope for Nottingham and Robin Hood to find common ground when the sheriff seems firmly in charge – and when Prince John in this narrative is the hard right, which wants no replacement for Obamacare at all?
We’re hoping so.