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Will Trumpcare Trump Obamacare?

Posted by Christina Zink on March 10, 2017
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trump-1822121_1920.jpgThis week, house Republicans introduced the long-anticipated Obamacare replacement plan. This plan, called the American Healthcare Act (AHCA), has received a high level of criticism already from a surprising mix of people. Although it certainly is too soon to tell, it seems as if the bill will likely not pass before significant edits are made.

A few aspects of the bill have been met with strong approval. It introduces a Medicaid reform plan that allows Medicaid to continue expanding at least through 2020, an idea that is popular on both sides of the aisle. Additionally, the ACHA keeps the provision that adult-children under 26 can remain on their parents' insurance plans. However, medical interest groups, conservatives, and liberals have major oppositions to the specifics of the act as it stands today.

Opposition from Medical Interest Groups

"While we agree that there are problems with [Obamacare] that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations."
-Dr. James Madara, CEO of AMA [3]

The American Medical Association (AMA), the AARP, and the American Hospital Association have all made statements against the ACHA in its current form. The opposition is centered around access and affordability of care for vulnerable patient populations. Currently, the plan is best for young, healthy, and/or wealthy individuals, and is increasing costs for older Americans, as can be easily understood through a useful interactive tax credit map released by the Kaiser Family Foundation.

Opposition from the Right

Prior to the ACHA being introduced, Republicans were already split into two factions on what should be done with Obamacare (repeal-and-replace or repeal-and-delay). It seems as if the introduction of a replacement bill has further deepened the divide within the Republican party on this issue.

Conservative Senators, like Rand Paul (R-KY), believe that the bill doesn't go nearly far enough in dismantling Obamacare. The tax penalty introduced by Obamacare for not having health insurance would be replaced with a 30% premium penalty upon sign up for anyone who hasn't been covered in the past year. Paul argued that paying insurers this penalty instead of the government isn't any better for healthcare consumers.

Four Republican senators have previously stated that they would vote against any bill that stands in the way of Medicaid expansion. [2] All four of these senators - Rob Portman (R-OH), Shelly Moore Capito (R-WV), Cory Gardner (R-CO) and Lisa Murkowski (R-AK) - are from states that have benefited recently from Medicaid expansion. The draft of the ACHA as it stood last month was not acceptable to them, as in 2020 it phased out additional federal funding to states for Medicaid. They have yet to comment on the new revision of the bill.

Additionally, typically large Republican campaign contributors (like Koch brother-affiliated groups) have spoken out in opposition to the bill, meaning that even senators who do not oppose the bill as it stands may have concern due to campaign funding. [4]

"This will make millions of people — it's a question of 10, 15, 20 million people — off of having health insurance. It will be the biggest transfer of wealth from low- and middle-income people to wealthy people in our country."
-House Minority Leader Nancy Pelosi [1]

Liberal critics of the ACHA are concerned about the wealth inequality at would be promoted by this bill. As currently written, the ACHA includes massive tax cuts to the rich, while freezing or greating scaling back government assistance to the poor.

The ACHA also transitions Medicaid funding to a "block grant" system, which provides states with a fixed sum to support it's Medicaid enrollees. This type of funding may lead to deep Medicaid cuts.

Additionally, the bill officially defunds Planned Parenthood, a concept that is adamantly opposed by women's healthcare groups.

What Happens Next?

This sort of critical reception was likely to be expected. Something as large, complex, and important as healthcare reform stands to go through a long revision cycle before it faces a vote. Although certain Senators, like Sen. Paul Ryan, are pushing for a fast and urgent pass, it likely will take a while to get the specifics to a place that is pleasing to the majority of Congress.

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[1] Why the GOP’s Obamacare Replacement Is Infuriating Just About Everyone
[2] Four GOP senators pledge to vote against rolling back Medicaid expansion
[3] These 3 Powerful Groups Are Slamming the GOP’s Obamacare Replacement Plan
[4] Koch groups slam GOP health care replacement plan as 'Obamacare 2.0'

Topics: Policy