GOP Health Plan Reduces the Deficit, But Leaves Millions Without Care
For more than seven years, Republicans obstructed and rallied their base with the idea that Obamacare was “America slouching toward socialism.” What’s more, Republicans promised they would repeal and replace President Obama’s signature legislation with a better way. Repeal and replace was a great message, but GOP leadership failed to craft serious replacement legislation. And now we’ve learned that their rallying cry was only that — a good campaign mantra.
To be fair, there were plenty of draft bills. In fact, Tom Price, the current Secretary of Health and Human Services, was the lead author on one such bill. (Though it lacked the seriousness needed to replace the current law.) And the House of Representatives in the 114th Congress voted nearly 60 times to repeal Obamacare. This week, however, Republicans are struggling to lead — with an incoherent rollout of their signature piece of legislation since winning in November — and reassure Americans that their plan is better. At least nine GOP senators have expressed grave concerns about the draft bill, coming from both moderate and conservative wings of the party. Arkansas Senator Tom Cotton pleaded with the House leadership to “pause, start over. Get it right. Don’t get it fast.”
For the most part, the debate has largely focused on two critical questions. First, how will policymakers ensure that current Obamacare recipients keep their health insurance? Second, what can policymakers do to address Medicaid, specifically for the 32 states (including the District of Columbia) that expanded Medicaid? The latter question has been a source of contention among Republican leaders in the states and leadership in Washington.
But an even more serious question has largely been on the sidelines: How will policymakers fix Medicare and keep our promise to our nation’s seniors?
Before they had a viable opportunity to repeal and replace Obamacare, the Republicans criticized the ACA for cutting $700 billion from Medicare. Originally, this large funding stream from Medicare was used to slow the reimbursement curve, particularly for hospital providers. The ACA, however, rerouted this funding to help pay for subsidies for the exchanges, which ensured that tens of millions of Americans had access to health insurance.
Yet, in their haste to repeal Obamacare, the Trump-Ryan plan will leave 24 million hard-working Americans without access to health insurance, according to the Congressional Budget Office estimate. And, alarmingly, the plan also leaves a massive hole in Medicare funding, hurting millions more seniors who are more likely to visit hospitals. Moreover, the failure to restore Medicare funding will leave a devastating economic burden on the very communities that President Trump promised to protect — rural and middle America — where the local hospital is often the economic engine and the only provider of health care.
It’s not surprising that so many of our governors are sounding the alarm. Ohio Governor John Kasich warned that the bill “is counterproductive and unnecessarily puts at risk our ability to treat the drug addicted, mentally ill, and working poor who now have access to a stable source of care.” Michigan Governor Rick Snyder politely suggested “it needs a lot more work.” Indeed. In there were nearly 1 million Michiganders who were newly covered under Obamacare’s Medicaid expansion and health-care marketplaces. Michigan hospitals agreed to a nearly $10 billion reduction in Medicare to pay for the coverage. Now, the Trump-Ryan plan would cut coverage without restoring Medicare funding — leaving poor, sick Trump voters out in the cold. It is astonishing that the president would turn his back on his supporters in a state where nearly 5 million voters turned out to vote last November and where he won by fewer than 11,000 votes.
A tweet storm by Senator Bob Casey regarding the impact the Trump-Ryan health-care plan would have on Pennsylvania’s seniors was staggering. The numbers he cited were downright embarrassing. Take for example, Berks County, Pennsylvania, where the president won the county by more than 18,000 votes: 50–64-year-olds will lose $11,020 in credits, paying 72 percent more under the Trump-Ryan health-care plan. The question that Senator Casey posed in a later tweet was even more poignant: What will the Trump-Ryan health-care plan do to Medicare finances? It’s a question the GOP leadership needs to answer.
Rather than driving America's health-care system off a cliff, Republicans should work with Democrats to fix what ails the Affordable Care Act. That’s their best bet for keeping President Trump’s promise to cover more Americans without cutting Medicare and Medicaid.
Harold E. Ford, Jr., a former member of the U.S. House of Representatives, is a professor at the University of Michigan Gerald R. Ford School of Public Policy.