Republicans are still touting their ability to offer Americans lower premiums under their proposed Better Care Reconciliation Act (BRCA) but according to the Congressional Budget Office, they are able to do so only by offering inferior coverage to people buying insurance through the marketplaces.

Premiums for a “typical “insurance plan under the GOP’s BRCA would be 20 percent lower than a “typical” plan under the Affordable Care Act but consumers would have to pay 74 percent more to get equivalent coverage, according to the Henry J. Kaiser Family Foundation.

Currently, under the ACA, people who buy insurance through one of the health care exchanges receive tax credits that, in effect, help reduce yearly premiums—in some cases, by as much as thousands of dollars each year.

While the Senate bill keeps these tax credits in place, as reported in The Huffington Post, it reduces the amount of money available overall by eliminating extra subsidies meant to reduce out-of-pocket spending for lower-income consumers. In addition, the oldest Americans, particularly those living close to the poverty line, according to Kaiser, can expect to see a fourfold increase in their premiums. The youngest Americans, on the other hand, would see a slight decrease in their premiums, though nothing close to the 20 percent repeated by Republican talking heads.

Ironically, reductions in benefits would hit older and white blue-collar workers harder than most—the very Americans who put Trump in office.

Similar to the House bill passed in May, the Senate’s so-called health care bill funds massive tax cuts to the highest earners by eliminating aid to older and lower middle-income adults. In other words, BRCA does more to provide tax relief than to provide quality health care, awarding the biggest tax breaks to the richest Americans—the very folks who make up the GOP’s donor class.

And despite all sales pitches to the contrary, BRCA would not give older and working class Americans more “choice” at a lower price but would instead require deep funding cuts to the federal Medicaid program—which makes it possible for many low- and middle-income families and older Americans to access proper health care and many of the clinics and hospitals in America’s rural and working class communities to keep running.

According to the nonpartisan Tax Policy Center, the top 10 percent of earners would receive over 60 percent of the Senate bill’s savings in the form of tax relief.

Before the ACA passed in 2010, insurance companies were free to determine whichever benefits they chose to cover in their plans, and the best plans typically included the most benefits. Even with a so-called “Cadillac plan,” however, consumers were still at the mercy of lifetime caps on coverage and other restrictions that kept a company’s costs low and profits high. When of the remarkable achievements of the ACA is that the law defined “essential health benefits” and required insurance plans to cover a long list of essential items and services, including emergency services; hospitalization; maternity and newborn care; mental health and substance services including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

In order to offer lower premiums, many, if not most, of these “essential benefits” would have to be cut from any plan offered under BRCA or paid for with higher premiums and/or heftier out-of-pocket expenses, such as deductibles and copays. The Senate bill also allows insurance companies to vary premiums (much more than the ACA does) by age, which typically results in significantly higher costs for older Americans who are, because of their age, placed in high risk pools.

At the same time, in the private sector, consumers looking for those “beautiful” plans “at a fraction of the cost” promised by President Trump would find plans “beautiful” in name only. Under Trumpcare, better coverage, equivalent to the comprehensive coverage—with “essential benefits”—consumers now enjoy under Obamacare, would cost much more, not less, and many Americans would be forced to either buy stripped down plans with higher out-of-pocket expenses or forced to drop their coverage altogether.

This dire predicament is precisely what Republican Speaker of the House Paul Ryan is referring to when he disingenuously says, “People will choose not to buy something they don’t like or want,” to explain why 22 million Americans losing coverage under the GOP’s replacement plan is really no big deal.

Both versions of the GOP’s health care replacement plans penalize America’s poor and elderly, many of whom will be without insurance because of deep cuts to Medicaid—$772 billion over the next ten years (as shown in the CBO chart below). Consumer subsidies from the federal government to offset health care costs will also be cut by a whopping $408 billion while the Senate plan reserves a mere $107 billion to be redistributed to states (most probably in the form of Reagan-era block grants) to help them deal with the health care crisis (and myriad public health crises) that this bill will precipitate in nearly every state in the nation—the very problems the Affordable Care Act sought to stabilize and correct, with some very real success.

While it’s clear to most health care experts and policy makers, and even some GOP senators, that the ACA could be easily improved with several targeted fixes, the Republican leadership seems hellbent on doing the most harm to the nation’s health care system through repeal.

Historically, the Republican Party has never really been interested in the business of providing all Americans with affordable quality health care—at least not since Teddy Roosevelt at the beginning of the last century. In fact, Republicans were perfectly happy with the state of health care insurance in America the way it was before passage of the ACA. Health care is, as President Trump opined, “very complicated” and, more importantly, the effort goes against the modern Republican Party’s raison d’etre: to implement tax cuts for the wealthy and to reduce the federal budget (which is just another way of implementing more tax cuts) as they made perfectly clear with both the House and Senate versions of their health care bills.

“You can’t choose to be healthy or ill the way you can choose to be a Republican or a Democrat,” points out Adrienne LaFrance in The Atlantic. “If you’re lucky, it won’t be catastrophic. But eventually, everyone’s luck runs out.”

Pricing sick, poor and old people out of the insurance market in order to pass on billions in savings to the most affluent among us is not only immoral and cruel, it is, unfortunately, in keeping with the GOP’s fanatical pursuit of “less government.” As budgets shrink so too does the power of the federal government to protect Americans from powerful individuals and self-interested factions, e.g., Charles and David Koch and their billionaire club, the Koch Brothers Network.

And yet, if we put politics aside for a moment, even the most partisan among us would have to agree that this repeal and replace pursuit is woefully short-sighted too. After all, you and I may be healthy at the moment but what happens when we, or someone we love, really does get sick, seriously sick? And one of us most certainly will. Isn’t that the very time we’ll need comprehensive health insurance most? Isn’t that the time we should be able to turn our full attention to the myriad personal and existential challenges that come with illness, knowing that the practical care and support we need is already waiting there for us, as Americans — care wisely guaranteed by a government dedicated to the health and well-being of its citizens, even in the most difficult of times, especially at the very end of our lives?

– Danielle Bizzarro


  1. Yes, the only way to lower premiums is to offer bad plans. That’s the fix Ted Cruz is proposing. As long as one plan is ACA compliant in a state, the others do not have to be. That means people will be signing up for substandard plans again that might cover an emergency but nothing else. And you know those insurance companies will have mighty narrow definitions of “emergency”. Healthy today, heart attack or diabetes tomorrow, without coverage. Don’t let them get away with this.

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