The long-awaited House GOP bill to repeal and replace the Affordable Care Act was met with fierce opposition from across the political spectrum this week, with staunch conservatives denouncing it as “Obamacare lite” and Democrats warning that it would strip millions of Americans of coverage. The new bill, known as the American Health Care Act, keeps some popular Obamacare features, like prohibiting insurers from denying policies for pre-existing conditions. But it replaces the existing system of income-based premium subsidies with age-based tax credits of $2,000 for a young person to $4,000 a year for those in their 60s. Because those credits are lower than most subsidies, analysts estimate that between 14 million to 24 million people will become uninsured because they could no longer afford coverage. The individual mandate, which imposes tax penalties on people who go without health insurance, will be scrapped and instead allows insurers to charge 30 percent higher premiums for new customers who go 63 days or more without coverage.
President Trump said the bill would ensure Americans receive “good health care,” while House Speaker Paul Ryan praised it as “a monumental, exciting conservative reform.” But the plan came under attack from conservatives, with Rep. Justin Amash (R-Mich.) denouncing it as “Obamacare 2.0.” At least four Senate Republicans expressed concerns about its impact on poor people in their states who have received Medicaid coverage through Obamacare’s extension of that program.
There's not much to like in this bill. Take the plan’s approach to Medicaid. After 2020, Medicaid would be transformed from an open-ended entitlement to one funded by fixed federal block grants to the states. Those grants likely won’t rise in line with the increasing cost of health care, which portends a gradual erosion of coverage for millions of poor Americans.Conservatives love the fact that it cuts "entitlements". Originally Medicaid was simply a safety net for the very poor and the disabled, but the Affordable Care Act turned Medicaid into insurance for adults above the poverty line. Block grants would force states to cut education and other necessary expenses for Medicaid if they want to keep people on the plan.
Think those tax credits will make coverage more affordable? Then you don’t know anything about health insurance in America. While Obamacare’s subsidies went up with premium rises, the GOP plan offers a flat tax credit. If premiums go up—which they will—too bad. On top of that it repeals the tax increases that paid for Obamacare. Those in the top 0.1 percent would get an average tax cut of more than $195,000. The GOP proposal will hurt Trump voters most, said Jonathan Chait in NYMag.com. Young people, the affluent, and customers in urban areas—where insurance policies tend to be cheaper—could actually get more support from Ryancare than they do from Obamacare. But older, poorer customers in high-cost, rural areas “would get absolutely hammered.” One 60-year-old man from North Carolina interviewed by The New York Times would see his family’s tax credit reduced from $25,164 to $11,500. Such cuts “make any decent insurance plan not remotely affordable.”
In their attempt to satisfy all GOP constituencies, the bill’s authors have satisfied no one. Staunch conservatives don’t like the tax credits included to win over Republican moderates, and moderates don’t like the Medicaid cuts intended to win over conservatives. But in fairness to its designers, no bill could have united all the Right’s disparate factions. Because on a fundamental level the Republican Party doesn't want the government involved in health care system at all. Given those limitation this was probably the best they could do.