Arsenic was a poison favored by Victorian mystery writers. The victims would be fed small amounts, not suspecting the cause of their increasing discomfort. At a certain point, the arsenic buildup would send them into organ failure and death.
The Republican House health care plan would apply a similar slow-working toxin to the Affordable Care Act. In this case, many of the millions enrolled in Obamacare would not realize what’s happening to their health care until it’s too late.
House Speaker Paul Ryan’s approach has drawn fire from conservative groups that want to basically repeal the whole thing. They scorn the American Health Care Act as “Obamacare Lite,” hardening an entitlement. These conservatives deserve points for honesty. Their fix for Obamacare is a beheading — quick and efficient. Everyone would know it’s dead.
That said, the conservatives are giving Ryan and his colleagues too little credit. Their plan also sets up Obamacare for collapse — and again, with the advantage of keeping its beneficiaries in the dark.
For starters, they would maintain current funding for the Medicaid expansion until 2020. Thus, many of the 11 million low- and moderate-income working families receiving subsidies wouldn’t appreciate the consequences for several years.
That’s when the tax credits would shrink to a shadow of what they are under Obamacare. Rural areas would get hit hardest. In Chadron, Nebraska, for example, the subsidy would be cut by more than half, from $6,670 under Obamacare to $3,000 under the Republican House plan.
Many have complained about high deductibles, and understandably so. However, Obamacare does offer some financial assistance for such out-of-pocket costs. That would be gone under the House plan.
The bill would provide $15 billion to the states for “high-risk pools” covering sick people private insurers don’t want to touch. But in 2020, that federal subsidy would shrivel to $10 billion.
The bill would end the individual mandate requiring everyone to obtain insurance or pay a fine. That would encourage the young and healthy to drop their coverage, leaving a weakened insurance pool heavy with expensively ill patients.
Yes, the plan also would impose a 30 percent surcharge on those who drop their insurance but later want to sign on. Makes sense until you ask: Who would later sign on? The answer is people who’ve suddenly discovered they have a serious medical condition and need the coverage.
After all, insurers still could not charge more to those with pre-existing conditions. Seeing as the penalty would probably be far lower than the costs the patients are facing, they’d surely want to secure coverage. In sum, getting rid of the mandate this way would encourage the healthy to leave and the unhealthy to join.
Subsidies would be tied to age. A 60-year-old would receive $4,000 in tax credits, and a 25-year-old $2,000. That sounds somewhat OK, given that older people tend to have more health issues. However, the proposal would let insurers charge 60-year-olds rates up to five times more than they bill young people (versus three times now). So there would go the tax credit advantage — and then some.
More bad incentives. Many people ages 60 to 64 who are in relatively good shape might drop coverage, wagering that in the event of a health crisis, they could crawl across the age 65 line and into the promised land of Medicare. Those with already high health costs would stay in the Republican plan, further burdening the program.
President Trump has given the House plan his blessing. But given the squads of Republicans, never mind Democrats, arrayed against it, the House bill seems destined for an early demise. And it would be no mystery why.
Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at firstname.lastname@example.org.
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