Like many people here in central Illinois, I got an email from my Republican Congressman Darin LaHood, explaining why he voted for the latest Republican health plan. He called his message “The Truth about the American Health Care Act (AHCA)”. Then the Congressional Budget Office (CBO) released its non-partisan analysis of how the AHCA would actually work. Let’s see what the truth is.
Perhaps the most important element of any health care policy is how many people will be covered. The great achievement of Obamacare was shrinking the number of Americans without health insurance. The Center for Disease Control says that proportion dropped from 16% in 2013 to 9% in 2016. The CDC adds: “the greatest decreases in the uninsured rate since 2013 were among adults who were poor or near poor.”
LaHood says, “our bill will increase access”. The CBO tells a different story: “enacting the American Health Care Act would increase the number of people who are uninsured by 23 million in 2026” compared to Obamacare. That would mostly happen in one year: “in 2018, 14 million more people would be uninsured”.
LaHood also said, “this bill does not undermine preexisting conditions.” Obamacare required insurers to cover everyone, regardless of preexisting conditions. The Republican AHCA allows states to apply for a waiver of the federal requirement that insurance plans cover preexisting conditions, and then sets up so-called “high-risk pools” of money to help pay for the most expensive patients, that is, those with preexisting conditions. Those people would pay higher premiums, but still be insured.
What LaHood doesn’t say is that the amount of money that the Republican AHCA allocates to the pools is not enough to cover people, especially poor people, with preexisting conditions. The CBO says: “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.” The bill does undermine people with preexisting conditions.
LaHood actually said that himself. Because Illinois is a Democratic state, he said, “There’s nobody who said that Illinois is going to seek a waiver whatsoever, so the insurance that people have right now, they’re going to be able to maintain that. ... And they won’t charge you higher premiums if you maintain your coverage. I believe pre-existing conditions for my constituents are adequately protected in this legislation that we passed.” Americans in other states won’t be so lucky.
LaHood says that the Republican bill will “drive down costs”. But the CBO says it’s much more complicated, and that “some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care”. Those people are the elderly, the unhealthy and the poor.
The CBO says the AHCA “would reduce federal deficits by $119 billion over the coming decade.” Here is how that would happen, again details missing from LaHood’s message. Medicaid spending, the federal health care program for the poor, would be cut by $834 billion, about 25%, a huge cut. That would partially be accomplished by putting a cap on how much Medicaid money would be spent on an individual.
Why does the plan save only $119 billion when Medicaid will be cut by $834 billion? The ACHA is also a giant tax cut for rich people, over $600 billion. The very very richest families, those making over $300 million, would each get an annual tax cut of about $7 million. Obamacare included extra taxes on couples making more than $250,000, 3.8% on investment income and 0.9% on wages. Those families are in the top 2% of Americans, and have seen their incomes rise much faster than the rest of us over the past 20 years. Those taxes would disappear. More families who itemize deductions on their taxes, again the wealthiest, would be able to deduct medical expenses. Families making as much as $290,000 a year would get some federal credit when buying health insurance. Low-income Americans would directly pay for these tax cuts, because their expenses would go up: the big losers in the Republican plan would be older Americans with low incomes, exactly the people who benefitted from Obamacare.
Every health care plan creates winners and losers, people who get more coverage or pay lower premiums than before, and people who lose coverage or pay higher premiums. Obamacare greatly expanded coverage, but led to some higher premiums and higher taxes, because the new people who got covered were typically those who cost more to insure: poor people and those with bad health histories. The Republican AHCA reverses that – poor Americans will be the losers, while the rich will win big.
Telling the truth also means telling the whole truth. Did LaHood tell the truth about the Republican health care bill? No. He lied about increasing access. He didn’t mention the tax break for the rich. He lied about the reduction in protections for people with preexisting conditions. He didn’t mention that the poor would pay more for health care.
That’s just like everything else in the Republican agenda for America – give money to the rich, take benefits from the poor. But don’t expect Darin LaHood to tell you the truth about that.
Published in the Jacksonville Journal-Courier, May 30, 2017