Perhaps no single piece of legislature has been more hotly contested in the last decade of American politics than Barack Obama’s 2010 Affordable Care and Patient Protection Act — also known as the ACA, or Obamacare.
Hailed by its proponents as the health care reform America needed, and vilified by conservatives who said the program would bring about “death panels,” Obamacare may have stumbled during the implementation phase — but it has also led to the highest health care enrollment numbers America has ever seen.
Despite its overall successes, the Trump administration has made the repeal and replacement of Obamacare a top priority. The GOP’s multi-faceted “Trumpcare” replacement, the American Health Care Act, has faced critique from both sides of the aisle. While Obamacare is far from perfect, you have to ask whether the motive here is really to deliver Americans a better system.
The State of Obamacare
To understand how the two proposals differ, we’ll begin with a look at where the American health care system stands today.
The concept of Obamacare sounds fantastic — that is, to bring health care to millions of Americans who would otherwise be unprotected, including those with pre-existing conditions. It has allowed young people to remain on their parents’ policies until they can afford health care of their own, and has dramatically expanded Medicaid to provide coverage for Americans living below the poverty line.
You might remember hearing the words, “If you like the coverage you have now, you can keep it.” That’s true, for the most part. The 50 percent of Americans who receive coverage through their employers can continue to receive that coverage — however, costs incurred by the changes the ACA brought about have bumped up the bill for employers.
What, then, is so wrong about a system that has delivered health care to millions of Americans who wouldn’t otherwise have it? Largely, the way it’s funded.
Too Rich for GOP Blood
For conservatives who see “big government” as the enemy, Obamacare is an atrocity. In large part, this comes from the tax increase that was required to fund the Affordable Care Act.
Expanding government services like Medicaid and Medicare so broadly comes at a price. For young, healthy people, the outcome is higher premiums. Some Republicans have even suggested allowing these government systems to expand so much is incentivizing health care fraud.
As more people with high costs of care enter the system, health care premiums have increased steeply since the ACA’s inception. That makes the ACA unattractive for young people who can’t benefit from the specialized care their money is going toward. But how would the GOP’s proposed replacement correct these issues?
How Trump’s Plan Is Different
The most clear-cut difference between Obamacare and Trump’s American Health Care Act is the removal of the individual mandate. Under Trumpcare, not all Americans would be required to have health care. That means providers wouldn’t be mandated to take on people with pre-existing conditions without charging them much higher rates.
If the applicant pool for Trumpcare reflects the current enrollment pool for Obamacare, many of the young people paying higher premiums to amortize the cost of health care for older, less healthy Americans would benefit from reduced premiums.
Trumpcare would repeal the tax increases brought about by the ACA and pull funding from today’s Medicaid and Medicare programs, a move liberals and the Congressional Budget Office warn could result in leaving millions of Americans without coverage — particularly people living below the poverty line.
What Is the Cost of a Life?
Trump’s plan asks less of insurers, who are currently struggling to boost revenue because of the costs associated with Obamacare’s mandate to cover Americans with pre-existing conditions. When insurers become frustrated and leave the public marketplace, there is less competition, and premiums go up for everyone.
Unfortunately, the ultimate result would put us back where we were before Obamacare was instated, possibly even worse off from the standpoint of keeping the nation healthy.
The elderly, sick and poverty-stricken would miss out on the benefits Obamacare provides, and the same people who at one time suggested Obamacare would bring about “death panels” are now backing a bill that would unquestionably lead to unnecessary deaths from lack of care. Everyone likes to save a little money, but shouldn’t we ask ourselves where our priorities lie on this issue?
A Moral Dilemma for the GOP
The many iterations of the American Health Care Act that have come before Congress are a testament to the need for a better solution. While party-line GOP members with no bipartisan interest at stake might get behind it, familiar faces like Ted Cruz and Rand Paul have said they won’t put their names behind a measure that puts American lives in danger.
Despite the challenges that come with it, the better solution at the moment appears to be revising our existing health care system. Even Republicans admit there are certain aspects of Obamacare that can’t be taken back. Shouldn’t it be possible to come together and improve the existing law?
A Shot in the Arm for Obamacare
One way to save Obamacare is through increased enrollment. If only the old and sick continue to subscribe, there is no way to moderate the cost for all users. About 10.5 million people still have no insurance and are eligible for Obamacare.
Different solutions have been proposed to right the enrollment problem. One is higher fines for those who choose not to enroll, but a better solution might be to implement the government-run health care option that didn’t make its way into the final bill in 2010.
A public option would force insurers to remain competitive and reduce the load on government-backed Medicaid and Medicare. While it might not include the level of care offered by private-sector companies, it would stabilize the economic model and level out premium spikes.
With relations between Congress and the president getting worse by the day, it seems less and less likely that Trumpcare will be the future of America’s health care system. If our government wants to keep Americans healthy, it would be better off putting an effort into fixing the system we have than prolonging this game of political pong.