By JOE AUCIELLO
With the election of Donald Trump as president, the Republican initiative to dismantle the Affordable Care Act (ACA), or “Obamacare,” begins in earnest and with real traction, following several years of consistent but failed attempts that were merely symbolic. Now, the right-wing rhetoric is shaping into reality.
In February, President Trump met with state governors and health-care executives to begin to outline the initial framework of a long-promised but still- developing plan that would “save America from Obamacare.” It was a step towards the fulfillment of a major campaign promise and a pledge that was repeated in the new president’s first speech to Congress to “repeal and replace” the Affordable Care Act.
That Americans deserve and need better than what Obamacare has offered is hardly in doubt. That President Trump and his business buddies will provide better is definitely in doubt. In fact, it is becoming increasingly clear that the Republican-replacement plan is intended to provide less coverage to fewer people at higher cost—and with higher corporate profits—despite claims to the contrary from GOP leaders.
As of this writing, Republicans are sparring among themselves to determine the overall framework of their plan. In practical terms, this means a tug-of-war that will decide just how little health care will be offered, who will pay for it, and at what extra price.
Nonetheless, with any of the Republican health plans, millions of Americans will spend more for less. One key feature of the replacement plan is that obtaining health insurance will no longer be a requirement, as it was under the ACA. Instead, insurance companies will be able to charge up to 30% higher premiums for anyone who drops health coverage for even two months and then re-enrolls. Workers who lose a job or who are forced to take part-time hours instead of full-time are likely, therefore, to face increasing hardship or may lose health care entirely.
Other provisions of the replacement plan are equally harsh. The ACA income-based subsidies will be replaced by tax credits based on age, instead of financial need. The old and poor, who are likely to have the greatest need, will be less likely to afford insurance.
Federal funding to states that increase Medicaid coverage will be phased out under the House plan. States will be able to deny Medicaid coverage to the unemployed.
On these essential points, Republicans agree. Their only conflict is over how to achieve them.
Whatever bill emerges from the Republican-dominated Congress, there are few positive outcomes for workers, the poor, and elderly. Recent estimates from the Brookings Institution stated that approximately 15 million people would be without health insurance as a result, and congressional budget analysts estimated that 24 million people would lose coverage by 2026.
If the Republican health-care package has little to offer, as appears likely, then clever politicians must try to divert public attention from its actual contents and point instead to its tinsel and wrapping.
In fact, the first signs of the emerging Trump plan indicate the likelihood of increased hardship for millions—all in the name of liberty and freedom to choose. Florida Republican Dennis Ross commented, “Not everybody is going to have health care—some people just don’t care enough about their own care.”
Would a lack of income sufficient to afford medical insurance have anything to do with this supposed lack of interest in one’s own well-being? The Republican representative does not believe the question is even worth asking. Apparently, there’s not much that can be done for these “some people” because “whether they take it [health insurance] or not is like trying to legislate responsibility” (Cape Cod Times, Feb. 25, 2017).
Of course, Rep. Ross ignores the obvious fact that legislating responsibility is a legitimate and necessary role of government, whether it involves seat-belt laws, legal drinking age, etc.
Other Republican legislators, some more media-savvy than Rep. Ross, try to put a more positive spin on the hardships that Congress is preparing for the public. “We’re not going to send an IRS agent out to chase you down and make you buy health insurance,” said Rep. Michael Burgess of Texas. “If the numbers drop, I would say that’s a good thing, because we’ve restored personal liberty in this country.”
The numbers that the representative refers to are the number of people who will have health insurance. Those who lack the means to obtain health care would have to find comfort in their “personal liberty” to get sick, to suffer an injury, etc.
When Republican politicians reach for concepts like “liberty,” and “choice,” it is well to reply, “Liberty for whom? Choice to do what?” Typically, the answer involves the well-being of pharmaceutical companies and insurance corporations and their freedom to earn obscene amounts of money. Your choice means their profits.
And let’s not forget how well their executives are paid, in salaries and benefits totaling more than $20 million per CEO. One good source for such information is the following: http://www.aflcio.org/Corporate-Watch/Paywatch-2014/100-Highest-Paid-CEOs.
All of the health-care plans and proposals emanating from the Washington-Wall Street nexus, from ACA/Obamacare to the Republican plan, suffer from the same fatal flaw. They are all intended, in the first place, to create exorbitant corporate profits, and, in the second place, to provide some measure of “good medicine.” These two goals—money and health—are inevitably in conflict.
Capitalist America places the greater value on the health of business rather than on the health of people. The latter is simply a by-product of the former.
What should be on the public agenda now is a serious discussion about proposals for national health care and single-payer plans. This sentiment was brought forward repeatedly in speeches and interviews at the annual convention of Students for a National Health Program, meeting this month in Philadelphia. Matthew Moy, a fellow at the American Medical Student Association, told the Philadelphia Inquirer at the gathering, “When you believe that health care is a human right, the only way to adequately and efficiently provide that for everybody is through a single-payer system, which won’t waste money with a middleman insurance company telling you where you need to go.”
Americans will need to see through the right-wing fog of rhetoric in order to go beyond the Republican plan, beyond Obamacare, and towards a universal health-care system with access for all.
Photo: Toby Talbot / AP