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AHCA is ill-considered; start over

Fri., March 17, 2017

One of the talking points against the proposed Affordable Care Act was “uncertainty.” What will this do to health care providers? Health care costs? Consumers? Insurance markets? The economy (it was called a job killer)?

We have those answers now (and they’re not all satisfactory), but this certitude is now being thrown into doubt with a replacement plan that raises many of the same questions. And the likely answers are even less encouraging.

The ACA was put together with input from the important stakeholders. Republican architects of the American Health Care Act did no such outreach. In fact, their plan was kept locked away from the prying eyes of even fellow Republicans. When it was finally unveiled, it was rushed to a couple of committees and voted on two days later. The independent analysis of the Congressional Budget Office came the following week, and the findings were distressing.

CBO says 14 million Americans will be without coverage shortly after the mandate to purchases is dropped. That number swells to an estimated 24 million in 10 years. Nonetheless, Republican leadership, including Rep. Cathy McMorris Rodgers, is touting the plan. They say it is a first step and should be judged as such. But there is no guarantee those other steps will ever occur, or that Republicans will be in power to follow through.

It’s clear that Republicans struggled to achieve consensus on a replacement, so they’ve focused on repeal. But the same conservatives who didn’t want government controlling one-sixth of the economy are still unhappy.

President Trump said the replacement would be better and cheaper for consumers, which was music to the ears of governors who didn’t want to see millions of people losing coverage. But this bill doesn’t accomplish that goal, which is why even Republican governors are very nervous.

In short, this bill introduces unnecessary disarray, not only in the individual insurance market, but with Medicaid and Medicare.

Hospitals have adjusted to the ACA, and are experiencing fewer visits to emergency rooms for non-emergency care. Charity care has declined. In December, Chris Bandoli, the Washington State Hospital Association’s senior vice president for government affairs, said: “Our No. 1 priority is to try to protect the coverage expansion that’s taken place.” He added: “You can’t just throw 750,000 Washingtonians off health care coverage and expect it to be OK.”

WSHA came out against the AHCA and reiterated that opposition after CBO issued its analysis. The American Hospital Association is also against the bill. The American Medical Association is also opposed, saying it cannot condone that many people losing health care coverage. The American Association of Retired Persons is pointing out the exorbitant rise in premiums for people ages 55-64. It also is critical of the repeal of the Medicare payroll tax that extended the solvency of Medicare by four years.

President Trump recently stated that health care is complicated, but this bill glosses over those complexities. Congress should start over, rather than pass this massive disruption.