- If the Republican Congress has failed to produce a credible alternative health care bill over the last 6 years, is it plausible that they can do so over the next 2-4 years? Rep. Sander Levin of Michigan, Chairman of the Ways and Means Committee when the ACA was signed into law, has said that “the American Academy of Actuaries has highlighted concerns about premium rate hikes” under the GOP non-Plan. In a letter to Speaker Ryan, the Academy made clear that: “Delaying the effective date of repeal while a replacement is worked out likely won’t be enough to assure the stability and sustainability of the individual market.” Health Plans, hospitals and researchers have all echoed the same worry, says Mr. Levin.
- Since Trump expects to issue Executive Orders to undo some of the ACA provisions and policies, what will be the effect on an alternative plan, and how will the newly insured under ACA be affected? According to some reports, Trump is more concerned about shoring up the stability of the insurers than of addressing the devastation of the about-to-be uninsured.
- According to a NY Times article at MSN.com, Mike Pence indicated last Wednesday that the replacement would “probably encourage greater use of personal health savings accounts and make it easier for carriers to sell insurance plans across state lines. Also, it would encourage small businesses to band together and buy insurance through ‘association health plans’ sponsored by business and professional organizations.” Trump has endorsed some kind of state-run “high-risk pools” for people with pre-existing conditions. None of which answers the question of how millions of people unable to afford these before they got ACA coverage will be able to afford these measures after repeal!
- The thorniest question, of course, comes down to affordability and mandated coverage. The latter can perhaps be put off, but the former is going to determine what the millions of former ACA-covered clients are going to be able to afford during the interim period and beyond it. Without adequate subsidies, millions of people will again simply not be covered. And by the way, guess where many Republicans want to put that money they will save on no more subsidies? According to the Tax Policy Center, the primary recipients will be those earning over one million dollars annually. Another use will be to shore up large insurance companies that lost money during the first few years of operation in the ACA exchanges (because of their own miscalculations, by the way!).
- Another tremendously important dilemma is the fact that certain provisions of the ACA depend on other provisions in the law to work effectively. This is one more reason why many health care professionals are warning against repeal. Doctors, hospitals and even some insurance companies are warning against repeal because of what the absence of certain provisions will do to them and their livelihoods. Medicare and Medicaid will be affected by the ACA repeal and that could affect payments to hospitals and doctors.
- Not only are there provisions within the law that work with other provisions, but repeal would likely affect the entire healthcare system and professional groups like the American Medical Association are sounding the alarm. For example, repeal could have an effect on Medicare recipients who could lose access to free preventative care and more affordable prescription drugs.
- No one has taken the time or made the effort to address the one thing in the law that was included to protect consumers and to advocate for reasonable changes and adjustments in the law. That is the section on consumer advocacy and protection. (Please see my posting of 9/29/2013 for details). Republicans despise consumer advocacy and oversight boards, but they don’t want you to realize that so they keep quiet on that matter while they surreptitiously try to eliminate every such entity they can find! Soon, you will have zero such groups to advocate for your needs, while the favored 1% of wealthiest citizens will continue to reap every possible government dole-out that becomes available.
- Another thorny issue that repeal of the law portends is that its successes will be thrown away with repeal, which is something that Republicans cover-up by telling the Big Lie that the ACA is falling apart from the inside out. Not so. In fact:
So, he concluded: "Dive in. Stay at it. Have faith in America and in fellow Americans. It is in the power of ordinary citizens to bring about change with our hearts, our ideals, and our enthusiasm. Believe in your ability, and in the Creed at our Core: "Yes, WE CAN!"
Thank you, Mr. President, for your grace, your determination, your capacity to focus on the good, and your undiminished commitment to the fundamental values that have nourished, sustained and inspired us for centuries. I am committed to grass roots activism to bring about meaningful change in our democracy and will continue that quest in the spirit you have manifested throughout your Presidency. I am also committed to preserving your distinct legacy in any way I can because the successes and the achievements of your terms must be preserved for the edification of future generations. May many blessings be yours in the next phase of your life of service.