Watch List: Health Care 2. Affordable Care Act

This week is a big one in Washington, D.C. The Republican majority is going to try to ram through a bunch of things quickly in hopes that we don’t have time to assess and react. Keep watch, and call your representatives on things that you think they should oppose (or support). Here is a good guide to effectively doing this (I also follow Emily Ellsworth on Twitter): I am calling and hope you will, too. I’ve had some good conversations with congressional staffers. Contact information for your House representative is here and for your senators is here. The phone calls are quick and easy when you have a few talking points (you can email, too, but it may not be as effective). Here are some thoughts about the Affordable Care Act:

Affordable Care Act

Okay, a lot of people don’t like the Affordable Care Act (ACA, or Obamacare as some call it), although only about 25% of Americans are in favor of full repeal at this point. When you drill down on a lot of its key features, the majority of Americans do like them. Here’s a summary from the Associated Press last month:

“Among the provisions with support across party lines:

Allowing young adults to stay on a parent’s insurance until age 26.
No copayments for many preventive services.
Closing the Medicare prescription drug coverage gap known as the “doughnut hole.”
Financial help for low- and moderate-income people to pay their insurance premiums.
A state option to expand Medicaid to cover more low-income adults.
Barring insurance companies from denying coverage because of a person’s medical history.
Increased Medicare payroll taxes for upper-income earners.”

And while there is a lot still left to fix about U.S. healthcare, the ACA has had a couple of major positive effects: It’s brought down the numbers of uninsured Americans to the lowest levels in history (and had record signups in 2016), and it’s also had a big effect on bringing down overall health expenditures in the country. Here’s a more in-depth article and a graph:

Yes, it hasn’t fixed all of our problems, and we need to do that. But this idea of immediate repeal without a concrete replacement is putting political ideology before the country’s best interests. Statements that the ACA is in a “death spiral” and other feeble and untrue quips trying to justify immediate repeal are being called out for the bunk they are—here’s a good article by Tierney Sneed on that. If you have to tell lies or cherry-pick your facts to try to get your way, chances are you’re hiding something important.

One thing to know is that fully repealing it is going to be hugely expensive. Knowing this, Republicans have chosen to try to hide these costs (likened to “shutting off the alarm before starting the fire”).  But they can’t shut off all the alarms: “a recent analysis by the bipartisan Committee for a Responsible Federal Budget found that completely killing the law (which Trump claims he will begin doing “on day one” in office) will cost taxpayers $350 billion over the next decade.” (Report is here.) This committee’s report concludes that “It is imperative that policymakers avoid a return to the rapid and unsustainable health care cost growth [pre-ACA] that threatened and in many ways continues to threaten families, businesses, and our nation’s fiscal future.” In other words, avoid the chaos and expense that immediate repeal without replacement will cause.

So what about the idea of repeal and delay, and that nobody is going to lose their insurance? Don’t believe it for a second. The only question is how many millions will lose coverage (it could go as high as 20 million people!). The chaotic uncertainty that repeal and delay inflict on the insurance industry means they have to pull back severely and/or raise rates catastrophically to cover that uncertainty. Here is a good article from J.B. Silvers, former healthcare CEO, and a good quote: “If we want [private insurers] to continue to do the good things required by the ACA, we can’t make it so uncertain. What this means is that the mechanisms designed to reduce risk and a stable set of operating arrangements must be reaffirmed as core principles of all reform and replace efforts. This shouldn’t be hard for market-oriented Republicans, if they can leave behind their political baggage. Blind talk of repeal with no clear way to build confidence among the private insurers, which will be needed in the replace phase, leads to market failure.”

Drew Altman, president and chief executive of the Kaiser Family Foundation, recently reported on surveys of what Trump voters want. Hint: it’s not what Republicans are planning in Washington right now. “In general, the focus among congressional Republicans has been on repealing the Affordable Care Act. There has been little discussion of the priorities favored by the Trump voters who spoke to us. But once a Republican replacement plan becomes real, these working-class voters, frustrated with their current coverage, will want to know one thing: how that plan fixes their health insurance problems. And they will not be happy if they are asked to pay even more for their health care.” Yet that’s where current plans are headed.

The New York Times also summarized the likely pending effects: “Most experts and much of the health industry — including trade associations representing insurers, hospitals and doctors — have warned that repealing the law without an adequate substitute could be disastrous.” And “Republican leaders in Congress and Mr. Trump seem eager to show that they can quickly deliver on their campaign promises. If the good of the country is not enough to give them pause, then they might consult their own political self-interest before stampeding to enact policies that will hurt so many Americans.”

In short, this ludicrous idea to immediately repeal the ACA without a solid replacement is fiscally and morally irresponsible. A vote to repeal the ACA without an equivalent or better replacement in place is a vote to sicken, bankrupt, and ultimately kill a hell of a lot of people. Americans deserve better than this, and I hope that Congress will provide a credible solution. It doesn’t matter what your political affiliations are on issues this big: the negative effects are going to be widespread and non-partisan unless we get them to change course. Call your representatives and let them know what you think.

10 Jan 2017 update: Alaska Senator Lisa Murkowski has joined several other Republican senators in asking for a delay of the ACA repeal: “Five senators on Monday evening introduced a measure that would delay the next steps on repealing the Affordable Care Act by more than a month.” Senator Murkowski relates on her web page that “Know that I will work with Alaskans to deliver a better system…” Perhaps Senator Sullivan will join her in support of this?