Is The American Health Care Act The Best We Can Do?
US Rep Debbie Wasserman Schultz (D-FL) at a House Budget Committee markup of the Republican health care bill on Capitol Hill, March 16, 2017.
On May 4, 2017, the House of Representatives passed the American Health Care Act (AHCA) by a narrow margin, even though the Congressional Budget Office (CBO) had not officially reviewed and reported on the bill's impact.
This is concerning because it brings into question whether the promises made by the President and Republicans can be fulfilled. At this point, the true impact and cost of the plan is not known.
But the consensus appears to be that, despite the assurances, premiums will likely increase, deductibles will not improve, and patients could be denied coverage because of pre-existing conditions. If that wasn't enough, the bill also threatens to increase our deficit, based on prior reviews of similar Republican healthcare proposals. First, adopting the measure before the CBO review is akin to building a skyscraper based solely on the architectural proposal before structural engineers have confirmed whether the design is likely to collapse under real world physics.
Many are concerned because the bill allegedly allows state governments to waive basic coverage benefits, including maternity care, protections for people with pre-existing conditions, decreased federal insurance subsidies, and cuts in Medicaid support.1 For some patients, those provisions may be lifesaving, and cutting them could pose a threat to the well-being of millions of Americans, especially those who lose their insurance coverage.
While Republicans refute this often-cited Democratic talking point, there is data to support that uninsured patients prior to the Affordable Care Act (ACA) had a higher mortality risk than those who were insured. Controlling for other risk factors, being uninsured carries a hazard ratio of 1.8 compared to insured individuals. That risk has not improved since the 1980s.2
There is clearly a philosophical and political divide in this country that is obstructing the progress of health care. Overall, we are not doing well. For example, among developed nations, we have one of the worst maternal mortality rates — with the risk of death at least 3 times higher than for Canadian mothers.3 This is simply unacceptable.
We have a healthcare system that remains fragmented, is still too expensive for the majority, and still inaccessible to many who need it most. Rather than propose changes to identify pitfalls in the current healthcare law and improve those factors, Republicans have proposed a bill that places us further behind the rest of the developed world, and reverses much of the limited progress that we've made over the last few years.
We can all argue about the general ineffectiveness of the ACA and about specific provisions of the law that overly complicate health care. But there is no arguing that the law has changed health care for the better, particularly for its true beneficiaries — namely those Americans who did not have health insurance through their employers and could not afford to buy individual policies.
The exorbitant costs associated with an individual plan or for a pre-existing condition prior to the implementation of the ACA meant that many individuals went without insurance. For example, in the 1990s my mother lost her job and was quoted a monthly insurance premium for an individual policy that was equal to 50% of the salary she had just lost — just to cover her pre-existing hypertension. In today's post-ACA world, she would have qualified for insurance subsidies and, at the very least, could have found affordable coverage for a catastrophic event.
Part of the unwillingness to work together comes from a general sense of hyper-partisanship in Washington. Party has become more important than country, and both sides are guilty of politicizing issues to promote re-election campaigns and maintain party numbers, both in the House and Senate.
While I do not always agree with either side, Democrats will likely find themselves on the right side of history regarding the issue of health care. The philosophical hatred among many Republicans towards the individual mandate, insurance subsidies, and Medicare expansion — which were removed from the current GOP bill — is unheard of and irrational. They're ignoring the fact that many of their constituents, not their financial sponsors, benefit from those provisions of the ACA.