The ACA Is Not Safe! Your Healthcare Will Never Be Safe With The GOP In Control

ATTENTION: The ACA/Obamacare is not safe! In fact, healthcare for Americans will never be safe as long as Republicans control Congress and the White House. I have often written that destroying the ACA and gutting Medicaid goes hand in hand with massive tax cuts for business and the wealthy. The whole thrust of the Republicans' efforts to repeal the ACA and gut Medicaid for the last nine months was to reduce the budget baseline so that they could pass massive and, more importantly, permanent tax cuts in the 2018 budget because it would not increase the deficit beyond the ten-year window. With the failure of repeal in the 2017 budget window, Republicans are now trying to tie tax cuts together with rolling back healthcare in the 2018 budget.

As I wrote yesterday, the current 2018 budget framework assumes that the House version of ACA repeal becomes law. That means gutting Medicaid, "saving" at least $1 trillion and repealing many of the important elements of the ACA, including its tax hikes. Democrats believe that the Senate version may also include nearly half a trillion dollars in cuts to Medicare. As one unnamed Senator said, "the health care bill was about hidden tax cuts. Now the tax bill is about hidden health care cuts". Republicans don't care which way it goes as long as they get both. They need the ACA, Medicaid, and now Medicare cuts to "balance" the budget, in other words, pay for the tax giveaway they want to make.

Yesterday, I also outlined the way the Trump administration is sabotaging the ACA. The refusal to enforce the individual mandate, the shortening of the re-enrollment period, the pulling of funding for navigators and advertising, the denial of state waivers to help stabilize the ACA, and the continual threats to stop paying the CSRs to insurance companies are all efforts to willfully sabotage the ACA. Estimates are that these efforts have already increased premiums by about 20% and these actions will further erode the enrollment of healthier, younger Americans which will drive rates up further in 2019.

Today, the NY Times and others are reporting that the Trump administration will roll back the requirement that birth control coverage be provided as part of health insurance coverage. The rollback could expand the reasons for companies of all stripes to deny contraceptive coverage not just on religious grounds but on something as amorphous as "moral convictions", pretty much opening the door to any company so inclined to deny the coverage. As one health expert said, "Affordable contraception for women saves lives. It prevents pregnancies. It improves maternal mortality. It prevents adolescent pregnancies." But the GOP doesn't care about science.

More frightening is the what Andy Slavitt describes as "synthetic repeal". This plan effectively destroys the ACA without ever having to take another specific vote on it in Congress again. There is no replacement offered in synthetic repeal. It simply guts Medicaid, the protection for pre-existing conditions, and the insurance and individual mandates, effectively destroying the ACA and Medicaid at once. It offers absolutely nothing in its place. As Slavitt describes it, there are three legs to synthetic repeal: an Executive Order coming next week, the budget/tax plan, and the aforementioned sabotage of the ACA.

The Executive Order would allow what's known as "association health plans". These plans would allow virtually anyone to set up a health care plan with minimal coverage and offer it across state lines. These plans could and would discriminate against those with pre-existing conditions, only enrolling healthy, younger people at a low cost. It would essentially make those junk insurance plans that the ACA eliminated legal again. Even worse, however, is that the order would prohibit states from regulating those plans, essentially opening up junk insurance to the entire country. State insurance requirements like those in California and New York would effectively be sabotaged. The end result is that the ACA starts to look like more like high risk pool as that would be the only place for people with pre-existing conditions to get health care. Accordingly, premiums will skyrocket and insurance companies will withdraw from the market. By 2019, there really will be large swaths of the country where the ACA will provide no insurance, essentially effectively repealed. And the real beauty of the Executive Order is that there will be no CBO score to measure how many Americans will end up losing their insurance entirely or access to plans that provide real coverage. It will be in the tens of millions. But the GOP doesn't care about independent analysis.

Synthetic repeal makes ACA repeal almost moot. To paraphrase Slavitt's tweet, "Synthetic repeal would butcher ACA beyond recognition. The GOP could go back for a draconian full repeal with yes votes coming out of necessity". Please read his whole thread.

Do not be bamboozled by all this talk of tax reform. Anytime a Republican mentions the words "tax reform" or "tax cuts", recognize that it is also a code for gutting health insurance from millions of Americans. Our healthcare will never be safe as long as Republicans have control of government.