AHCA and Obamacare: Amend and Enhance, not Repeal and Replace

Dr. Deane Waldman
|
Posted: Mar 21, 2017 1:19 PM
AHCA and Obamacare: Amend and Enhance, not Repeal and Replace

The GOP just released their fix for our healthcare system called the American Health Care Act (AHCA). The whole country—supporters of Obamacare and opponents alike—has been waiting to see what the newly ascendant Republicans would do.

We expected a tsunami. We got a dribble. We were promised Repeal and Replace for Obamacare. We got Amended and Enhanced.

Taking Elizabeth Barrett Browning out of context, “Let me count the ways.”

When the Democrats pushed through Obamacare in 2010, they released a CBO cost estimate of $900 billion over 10 years. In fact the former president’s namesake law is now estimated to cost more than $2 trillion but nonetheless, the bill advocates had some idea of cost and warned us.

The authors of the AHCA released and promoted a bill before they had any idea of how much it would cost. In essence, they said, “Trust me!” With job approval ratings for Congress hovering under 20 percent, the American people do not trust people in Congress, Republican and Democrat alike.

The just-released CBO report says the AHCA will “save” 337 billion dollars over 10 years. Such savings presumably reflect a reduction in the $2.6 trillion price tag for Obamacare. So, instead of spending $2.6 trillion we don’t have, the GOP’s solution will have us spend $2.3 trillion we don’t have. This is not what anyone would call a solution for U.S. overspending on healthcare.

The U.S. is overspending on healthcare and yet Americans are not getting timely care. Just ask a veteran. That is because money is first used to pay for bureaucracy and that money cannot be used to pay for patient care. What will the AHCA do about that? Nothing.

The AHCA purports to “help Americans afford coverage.” Will Congress ever learn that the goal of healthcare is not insuring people? What matters in healthcare is, or should be, CARE. When insurance does not lead to timely care, as with Obamacare, it is both useless and wastes trillions of dollars.

The AHCA is touted to return “control from Washington back to the states.” Yet the bill leaves all the federal insurance regulatory mandates in place. Eligibility, verification, reimbursement schedules, and benefits packages—the main cost drivers for any state’s budget—are decided by Washington, not by the state. How does that return control to the states?

“Young Americans can continue on their parents’ plans until age 26.” The key word missing in that sentence is able-bodied. Medicaid was not intended for the poor or the young. According to the original 1965 law, Medicaid was designed to be a state administered program for those “unable to support … their medical needs.” In other words, being able-bodied disqualified you from Medicaid.

Speaker Ryan proudly assures us that with AHCA, “Washington will no longer force Americans to purchase expensive, inadequate plans they don’t need and cannot afford.” However, since the GOP leaves all the Obamacare insurance regulations in place, Washington will indeed tell you that you can only buy “expensive, inadequate plans … [you] don’t need and cannot afford.”

Medicaid is both a fiscal and humanitarian disaster. It is tremendously dollar inefficient, takes over and consumes each state budget, and at best, has questionable medical outcomes. One study showed that Medicaid patients did worse after surgery than patients with no insurance at all! Bad results for which we pay large sums of money—not a good deal. Yet AHCA “strengthens Medicaid.”

An ostensibly positive feature of AHCA was repeal of Obamacare’s odious new taxes. That was most encouraging until you read the fine print. The uniformly hated Cadillac tax was not actually repealed: it was just put on hold until 2025 when it returns.

AHCA repeals the Obamacare subsidies and then replaces them with new subsidies, called tax credits. Whatever you call it, when you take money from one group to give away for free to another, that is income redistribution through subsidy.

The AHCA raises the limit of contributions to your HSA from ObamaCare’s $2550 to $6550. Why is the federal government limiting how much I can spend of my own money on healthcare?

There are more similarly egregious parts of this bill that make healthcare even sicker than it was under Obamacare. But the above should be enough to make one categorically reject the AHCA because it achieved no improvement in access to health care for Americans. For Obamacare, the AHCA is Amend and Enhance rather than Repeal and Replace.

Notice there is no mention here of the CBO estimate regarding loss of insurance for 14-24 million Americans. Coverage is not what matters in healthcare: CARE is what matters. If AHCA or any other bill fails to improve access to timely care, then it is of no help and undeserving of our support.