President Trump promised time and again on his election campaign to repeal and replace Obamacare, also known as the Affordable Care Act (ACA), and immediately upon taking office, he swiftly signed an executive action that economically “unburdened the states” of the ACA. Finally, Congress is pushing the official replacement, a grossly underwhelming bill released to public eyes on March 6 and already approved by the House Ways and Means Committee on March 9 following a grueling, 18-hour session. Ultimately, it mirrors Obamacare far more than Congress wants to admit, and its only substantive changes actually serve to disadvantage the lower and middle classes.
The Republican replacement for Obamacare is called the American Healthcare Act (AHCA). Protests have been ongoing for many weeks, demanding healthcare not be simply stripped away from citizens, and congressmen like Paul Ryan have had to contend with constituents in their districts asking why their own party was taking away their healthcare plans. The AHCA establishes several answers to many of the questions citizens and pundits alike have been asking the Obamacare opposition since Obamacare’s inception, but the following four mandates are of the utmost importance:
- Repeals Individual Mandate – Individual Mandate is a part of Obamacare that legally requires all U.S. citizens to have minimum essential coverage. Those who refuse are fined annually. Individual Mandate works in tandem with Guaranteed Issue, another provision that legally requires insurance providers to insure all applicants with policies that at least meet the minimum essential coverage criteria. Those below or at the poverty line (based on annual income) may not be able to afford the policy that this law forces them to buy, so the federal government subsidizes their insurance policies, essentially paying a sizable portion of the premiums on citizens’ behalves. Ideally, this would insure everyone, but many remain uninsured because their states did not comply with the law and, instead, opted out of the ACA’s Medicaid expansion. The AHCA, if passed, does little more than simply allow citizens to go uninsured—a minor change with only negative potential and no observable upside.
- Maintains Coverage for Pre-existing Conditions – The AHCA will continue to sustain coverage protections for people with pre-existing conditions. Despite this being one of the main provisions of the bill, it is the same provision that Obamacare initially introduced. The new bill carries over Obamacare’s protections for pre-existing conditions, and the only change is, yet again, a negative one in that it allows insurance companies to charge higher premiums for those who do not use their coverage within a certain timeframe, compensating for the revenue insurers didn’t see under Obamacare. In other words, it is a means by which insurance companies will reap the profits they missed while Obamacare was forcibly lowering premiums for individuals.
- Allows Children to Remain on Parents’ Plans until Age 26 – The AHCA allows dependents to remain on their parents’ (or guardians’) insurance policies until their 26th Much like maintaining coverage for pre-existing conditions, this feature of the AHCA is also a remnant of Obamacare that has been kept. This provision serves as yet another example of how the AHCA fails to make any substantive reform besides changing the name of the law and re-empowering corporations.
- Defunds Planned Parenthood – This is a critical provision of the AHCA that Conservatives have waited long to get passed, and without Obama to veto it, they can now make it reality. Federal law already disallows the direct funding of abortions regardless, but Republicans oppose research currently being supported by the Women’s Health Services Organization. According to Planned Parenthood, though, this actually sacrifices health services other than abortion for millions of Medicaid recipients who receive healthcare through Planned Parenthood.
- Offers Refundable Tax Credits – A provision in the actual text states, “In the case of an individual, there shall be allowed as a credit against the tax imposed by this subtitle for the taxable year the sum of the monthly credit amounts with respect to such taxpayer for calendar months during such taxable year.” These refundable tax credits will be similar to tax returns, except they are intended to be used for health insurance; however, the federal government cannot control what citizens do with their own money, and as such, citizens can spend these tax credits however they wish. In fact, given that low-income families are those most likely to need these tax credits, it is a constant possibility that those who receive them may have other, more immediate expenses that press them to spend these tax credits elsewhere, leaving them to find their own means by which to secure health insurance later. This actually puts them in a worse position. Conservatives and liberals alike argue that these tax credits amount to nothing more than another entitlement program, and both Republicans and Democrats from the 32 states presently benefitting from the Medicaid expansion initiated by Obamacare say they will not support a plan that simply absconds with the coverage of millions of people.
Democrats have belabored committee sessions on this to such an extent that they have exceeded even midnight with their sessions; nevertheless, at 4:28 a.m. on March 9, CNN broke news that the House Ways and Means Committee finally broke an 18-hour session to be the first committee in the House of Representatives to approve the bill. In lieu of this minor victory, though, House Speaker Paul Ryan inadvertently concedes that his own party does not support the bill when trying to convince Conservative skeptics to get onboard. Rep. Mo Brooks (R-AL) explains the common sentiment of Congressmen who feel the bill threatens their ability to get reelected come midterms due to the way in which the bill disadvantages so many: “It is a lump of coal. Ultimately, it’s gonna result in the demise of our country or at least contribute to our debilitating insolvency and bankruptcy.”