‘Unrealistic Care Act’ and Trump

I read the Murchison column (The Citizen, 7-26) about health reform. I disagree with many of his points.

Specifically, I do not believe that the GOP Congress has been spineless. It is just divided, which is natural in politics in a democracy. In the coup de gras, McConnell decided to pass comprehensive healthcare legislation with no input from the opposing party, and little from his own, a failed strategy. He is no legislative mastermind, but he was working with a flawed product to start with. Per Gallup, there was virtually no support for the bill.

Just before the original House vote on the GOP’s AHCA (the American Health Care Act), Tucker Carlson of FOX News interviewed President Trump regarding health reform.

Carlson stated that the GOP replacement for Obamacare, AHCA, would hurt the exact people who voted for him. Surprisingly, Trump agreed.

When we look at Trump’s campaign statements about healthcare versus the substance of the AHCA, the dichotomy becomes clear.

Trump said everyone would be covered by health insurance after the ACA’s (Obamacare’s) repeal. But the basic GOP replacement bill (the AHCA) was directly derived from the policies espoused by Speaker Ryan and Rep. (now Sec.) Price.

Ryan and Price have never been interested in full coverage for all, just theoretical “access” to buying a policy, affordable or not. Therefore, the AHCA did not accomplish Trump’s lofty goal.

On the flip side, Congressional conservatives in the Freedom Caucus (and libertarians like Rand Paul) have opposed the AHCA because they say it is “Obamacare light”.

They are 100 percent correct, but I will take it a step further. The AHCA should have been retitled the UCA, the “Unrealistic Care Act”.

The original GOP bill (and the Senate revisions as well) was much worse than Obamacare in a number of ways, as one can see from the bi-partisan Congressional Budget Office (CBO) analysis. First, between 2018 and 2026, 24 million lose coverage. With 52 million uninsured, we would have more Americans without insurance than we did before the ACA.

Many of these folks are the white lower middle income Trump voters, alienated by government but paradoxically often the recipients of government largess.

The CBO also examined the fiscal impact of the AHCA. On the surface, it looks good. The federal deficit is reduced by $337 million from 2017-2026.

The key is how it is reduced, what’s sliced out to reduce federal outlays by $1.2 trillion? As always, the devil is in the details.

A number of worthwhile programs are cut, including Planned Parenthood for a year. The long-term fiscal effect via unwanted pregnancies, for example, will be considerable (as well as the impact on quality of life for potential recipients).

But, the greatest “savings” would come from the elimination of ACA subsidies. Under Obamacare, there are generous subsidies given to lower income working people and others to enable them to afford the mandated comprehensive policies. These are gone, replaced by meager tax credits and high risk pools.

Even more insulting to the typical Trump voter are the tax cuts under the original AHCA’s $1.2 revenue reduction scheme. Who gets the tax breaks? The wealthy, of course.

To help fund the ACA, there is currently a “Health Insurance Payroll Tax” and a surtax on investments (dividends, capital gains). If the ACA is repealed, experts project that families making over $250,000 will receive a windfall of $600,000,000.

As for affordability, the CBO indicates that premiums under the AHCA will go up 15-20 percent by 2019. Then, they will fall to 10 percent less than current rates due to more of the healthy people coming into the pool (a questionable assumption, in my opinion) and state risk pools.

However, younger people benefit to a much greater degree than older people (the typical Trump voter) who can expect their current premiums to rise dramatically. The rates for older people 50-64 max out at 5 times the rate of younger people (versus 3 times now).

So, when all of the above is taken into account, what did we have for the typical older Trump voter under the proposed legislation? He/she would have seen: (1) a reduction in benefits covered by insurance; and (2) a substantial rise in premiums. Plus, he/she would see tax breaks going to the wealthy and health insurance corporations, but not themselves.

It is no wonder that Trump had begun to say that health reform is more complicated than he thought and that compromises may have to be made with Democrats.

There is a real question as to whether this albatross will be come to be labeled Trumpcare or Ryancare in the history books. My prediction is that someone as shrewd as Trump will eventually start calling the AHCA, the unrealistic care act, Ryancare before it is too late. In fact, if you read between the lines, he has already started by blaming Congress for failure to pass the bill.

Jack Bernard
Peachtree City, Ga.