OBAMACARE REPLACEMENT FACES HEADWINDS

House Speaker Paul Ryan (R-Wis.) warned his conservative colleagues March 10 that the GOP’s replacement bill for Obamacare was “as good as it gets,” when it comes to offering affordable health care to ordinary citizens. Former President Barack Obama signed the Affordable Care Act into law March 23, 2010 without one Republican vote, promising patients they could keep their own doctors and health plans. When that didn’t happen and health care premiums escalated without control, it didn’t take long for Obamacare to implode, with insurers taking full advantage. Instead of fixing Obamacare over the last six years, the GOP-led Congress only wanted to repeal Obama’s signature legislation. Obama sacrificed his presidency, railroading national health care legislation without any Republican support. Now the GOP struggles to find a suitable replacement for Democrats and Republicans.

Obamacare was flawed from the get-go, enabling employers with 50-or-more employees to opt out of providing health insurance for employers working under 30 hours a week. Many of the nation’s biggest employers, including Home Depot, Walmart and Trader Joes, dropped 30-hour-or-less employees from coverage, forcing them to buy Obamacare. With income-based subsidies, the Obamacare loophole caused an undue burden on U.S. taxpayers to subsidize gainfully employed workers. Congress could have worked to fix the corporate loophole but, more importantly, insurance industry price gouging. Ryan’s new bill eliminates the so-called individual mandate, requiring young healthy subscribers to buy insurance. Objecting to Ryan’s new GOP bill, Tea Party conservatives, headed by the House Freedom Caucus, Rep. Jim Jordan (R-Ohio), rejected Ryan’s new plan.

Objecting to progressive tax credits to subsidize insurance based on age [from $2000 to $4,000], Jordan called Ryan’s bill Obamacare-lite, not admitting that there’s only so many ways to use private insurance markets to provide health coverage. Without any controls over premium prices, Ryan’s bill will find his plan at the mercy of the insurance industry. Complaints about escalating premium prices and rising deductibles won’t stop unless Congress mandates price controls. Democrats and some Republicans already object to Ryan’s plan to reduce Medicaid enrollment, turning cash over to states in block grants to manage health insurance for the poor. American Medical Association already signaled concern about Ryan’s bill limiting Medicaid coverage for the low income groups. AMA expressed concerns about age-based tax credits, opposed to Obamacare’s income-based subsidies.

Freedom Caucus’s Jordan opposes any government payouts on health care, citing it’s not in the U.S. Constitution. “The replacement bill, as written, would reverse the coverage gains under the ACA, causing many Americans to lose the health care coverage they have come to depend on,” said Dr. Andrew W. Gurman, AMA president. What the AMA liked about Obamacare was that more doctors, hospitals, clinics and laboratories, found a way to get paid. With Ryan’s bill providing less coverage to the poor, but, more importantly, not requiring young people purchase health insurance, less subscribers would be available to the medial industry. “We believe that credits should be inversely related to one’s individual income,” said Gurman, worried that the GOP’s health care bill would be too costly for millions of Americans. Gurman’s concerns about the poor losing health coverage were echoed by other experts.

Talking about drastic cuts under Ryan’s plan to Medicaid and government subsidies, Harvard economics professor David Cutler worried that Medicaid cuts would boot millions off of health insurance. “Huge Medicaid cuts huge subsidy cuts for low-and-middle-income and big tax cuts for high-income people,” said Cutler. “That’s’ the strategy, concerned about Ryan’s plan. Instead of talking about regulating the insurance industry, Cutler talks about Ryan’s plan not subsidizing enough citizens. While it’s true that Obamacare subsidies paid for more subscribers, it’s also true that the government can’t continue racking up the national debt now hitting $20 trillion. When the government runs out of cash next week, Culter and other Obamacare advocates will scratch their heads. Given there’s no price controls to Obamcare, policies have gone through the roof.

Ryan finds himself dancing on a tightrope, rejected by both liberals and conservatives, signaling that his new health care bill is getting it right. Whether liked or not, conservatives like Jordan are going to have to live with government subsides, something essential to any health care legislation. Whether the GOP subsidies are enough to keep down health care costs, Ryan should consider what Obama failed to do: Install price controls on health insurance carriers. “Bottom line, you are looking at a much more uncertain environment,” said Matt Fielder, Health Care analyst at the left-leaning Brookings Institution. When Health and Human Services Director former Rep. Tom Price (R-Ga.) gets done with Ryan’s bill, it’s going to go through changes despised by liberals and conservatives. Democrats and Republicans should work together to get it right this time around.