So far, the only thing the White House has said about its plans to replace the Affordable Care Act is that it would provide “insurance for everyone” and that people would be “beautifully covered,” but comments coming out of Washington indicate that not everyone will be able to obtain coverage under the replacement plan.
Bloomberg reports that one of the core ideas of the yet-to-be unveiled Republican replacement plan is the removal of Obamacare’s individual mandate — the requirement that most people obtain some sort of health coverage or pay a nominal financial penalty.
GOP lawmakers have acknowledged that removing this requirement will result in fewer people having health insurance. Rep. Dennis Ross (FL) tells Bloomberg that this is okay because “some people just don’t care enough about their own care.”
He contends that people will still have the option of buying insurance, but that the government won’t be in the business of “trying to legislate responsibility.”
Rep. Michael Burgess goes a step further, telling Bloomberg that having fewer people with health insurance is a “good thing, because we’ve restored personal liberty in this country.”
While these lawmakers are painting repeal of the individual mandate as a victory for freedom of choice, they appear to be overlooking concerns raised by those who argue that loss of this requirement could also make it difficult or impossible to obtain coverage.
The nonpartisan Congressional Budget Office recently released its analysis of one Obamacare repeal plan and concluded that 10 million Americans would likely drop their coverage in the first year simply because they no longer had to have it.
With fewer people looking to buy coverage for themselves, the CBO said that some insurance companies would choose to exit certain marketplaces, resulting in less competition and higher premiums for those still opting to purchase insurance.
According to Bloomberg, one way the GOP plan intends to encourage people to pay for coverage is by allowing insurers to charge higher premiums to individuals who have gone without insurance. The Affordable Care Act currently prohibits insurance companies from charging higher rates to people who have not recently had coverage.
The still-in-the-works Republican plan could, like Obamacare, also provide tax credits to help individuals pay for coverage. However, Bloomberg notes that unlike the Affordable Care Act, these subsidies would be based on age, not financial need. So lower-income Americans may not be able to afford insurance.
A big question for the GOP is what to do about Obamacare’s expansion of Medicaid coverage to include millions of additional Americans. Many Republicans have called for paring back this expansion — and 19 states have thus far stayed away from participating in Medicaid expansion — now some of those states that reluctantly agreed to increase their Medicaid rolls recently let it be known that they wish to keep their lower-income residents covered.
The GOP’s Obamacare repeal efforts are currently tethered to a budget resolution measure, which would allow them to pass the law through Congress with only a simple majority in the Senate; Republicans don’t have the 60 votes needed to pass a traditional bill through that chamber.
However, the resolution has reportedly been hampered by disagreement about the best way to proceed. Yesterday, former Speaker of the House John Boehner, now a private citizen, predicted that the party he once led wouldn’t be able to come up with an easy swap for the Affordable Care Act.
“Republicans never ever agree on health care,” said Boehner, noting that the GOP will come up with a “fix” for Obamacare, but that you “shouldn’t call it repeal-and-replace, because it’s not going to happen.” In his view, “Most of the framework of the Affordable Care Act … that’s going to be there.”
It’s also not known how closely the GOP’s proposal will match whatever the Trump White House recommends. The administration is expected to unveil its concept of an ACA replacement at some point in the next month.
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