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Commentary

Why Trumpcare’s Biggest Fans Are Going to Be Disappointed

May 04, 2017

Rosy rhetoric about Trumpcare is sharply out of line with independent reports and expert analyses.

On Thursday, the House of Representatives passed the American Health Care Act (AHCA) with a 217-213 vote. In its current state, this legislation would gut the Affordable Care Act's (ACA or Obamacare) central provisions if it ultimately becomes law. (No Democrats voted for the bill; 20 Republicans opposed it.)

That the bill passed after an initial failure in March is striking given the confluence of business and political albatrosses weighing it down—even with the benefit of a Republican-controlled Congress and a president who made Obamacare's demise a central campaign promise. The AHCA is currently in its third iteration yet has drawn consistent opposition from some of the most powerful medical and patient advocacy trade groups, including the American Medical Association, the American Heart Association, hospital organizations, and even the AARP, who all say it would be devastating for patients.

The Congressional Budget Office (CBO)—the official, non-partisan scorekeeper of how lawmakers' proposals may affect the economy and everyday Americans—hasn't yet had a chance to look over the final bill. Neither did many of the Congress members who voted for it. That's truly remarkable (and potentially unprecedented) for a reform package that affects one-sixth of the U.S. economy and millions of citizens. House Speaker Paul Ryan (R-WI), who made Trumpcare passage a top priority, was once a fierce critic of this kind of mad-dash legislative process—one that denies lawmakers an independent, empirical analysis while making it easier to pressure members of Congress to give in to political momentum.

CBO's earlier report suggested that Trumpcare would cost more than 20 million people their health coverage while significantly increasing premiums for the elderly, poor, and sick. Despite this, President Trump, Rep. Ryan, and other Obamacare opponents are making some lofty-but-dubious promises about the AHCA. For instance, Trump has insisted that Americans with pre-existing conditions will still be able to get affordable health insurance under the law. However, recent deals struck by the White House and conservative holdouts in Congress would give states the authority to nix those Obamacare protections and make it easier to charge sick Americans more for their care.

This doesn't even take Trumpcare's gutting of Medicaid into account; the legislation would not only jeopardize future coverage for millions of low-income Americans who have gained health insurance under Obamacare's Medicaid expansion, but actually transform the public program for the poor in a way that critics like the Center on Budget and Policy Priorities say would put even more financial strains on its beneficiaries and block others out entirely.

Furthermore, a bombshell Wall Street Journal report from Thursday morning found that even employer-provided health insurance could be affected by Trumpcare because employers would potentially be able to nix ACA-mandated caps limiting how much their workers have to pay out-of-pocket for their care.

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Yet the resounding message from the House GOP after its long-sought victory today is that the AHCA will improve "access" while lowering Obamacare's unsustainable costs. Of course, "access" to health care doesn't mean much if an insurance company can charge more if you're sick or if you no longer have cheaper public alternatives available to you at all. A Consumer Reports analysis from this week found that the ACA actually helped chop the number of personal bankruptcies in half; deep cuts to the health care safety net would almost certainly undermine that trend.

The moderate House Republicans who originally opposed Trumpcare over these kinds of concerns ultimately flipped thanks to a new amendment providing an $8 billion fund for high-risk insurance pools that cover sicker, medically expensive Americans, figuring that would at the very least be enough political cover for skittish lawmakers. That assessment has held true in the House, but industry and independent analyses suggest this amount of funding would be completely inadequate to address the needs of millions of people with pre-existing conditions. It's also still entirely possible, and perhaps even likely, that the current version of Trumpcare won't pass muster with Senate moderates—especially once the CBO has a chance to complete an official analysis.

None of this is to suggest that some of Obamacare's marketplaces don't have potentially catastrophic problems like high costs and fleeing insurers. But lawmakers had far more independent information about what it might or might not do when they green lighted the last administration's health care bill. That's not the case here. And though optimistic talking points about how "terrific" something as complicated as major health care reform will be may make for good short-term politics, American patients will ultimately find out whether or not they've been sold a bill of goods.

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