It has been a lively few weeks across the healthcare sector which included numerous leaked drafts of the GOP’s proposed Affordable Care Act (ACA) replacement plan, an arguably well-received Congressional address from President Trump, and a frustrated Republican constituent voicing their concerns at town hall gatherings across the country. This week proved no exception as after much anticipation, the Republicans unveiled their plan to repeal and replace Obamacare.
The challenge continues as House Republicans begin trying to sell their plan to Congress as well as a wary (and weary) public.
This week we will take a look at some of the proposal highlights from the new legislation, initial feedback, and some of the public response throughout this process.
Individual mandate eliminated, Medicaid restructured under “American Health Care Act”
Though the newly released plan from the GOP raises many questions, a clearer picture about the future of America’s healthcare under the Trump administration has emerged. Significantly, the new plan, being referred to as the “American Health Care Act” would eliminate the controversial individual mandate, replacing it with refundable tax credits for individuals to purchase health coverage. According to a CNN report, the plan would also restructure Medicaid, and bar federal funding for Planned Parenthood for one year. Additionally, larger employers would no longer be required to offer coverage to full-time employers.
Carrying over a policy from Obamacare, individuals with pre-existing conditions would still be protected under the new proposal, but insurers would be allowed to hike premiums significantly for those who let their coverage lapse. In addition to protecting those with pre-existing conditions, two other popular ACA provisions will remain under the proposed plan—the ban on lifetime coverage caps and the rule allowing young people to remain on their parents’ health plans until age 26, reported the New York Times.
A big concern throughout this process centers around the Medicaid expansion which 31 states opted for under Obamacare and extended coverage to approximately 11 million low income adults, which under the GOP proposal would shut down at the end of 2019. Additionally, proposed overhaul of Medicaid that would largely alter how the program is funded has been a source of worry for many. “Radically restructuring the Medicaid program – with per capita caps or block grants – fundamentally undermines coverage for over 70 million poor and vulnerable children, pregnant women, elderly and disabled individuals in our nation,” said Carol Keehan, CEO of the Catholic Health Association. “Federal Medicaid funding caps simply shift the cost burden onto local and state governments, providers, and individual beneficiaries.”
With the new plan at last unveiled, big questions remain unanswered, including, how many people will be covered under the GOP plan, who will lose insurance, and how much will the proposal cost.
Obstacles foreseen for Republicans as plan advances
Over the past few weeks at town halls nationwide, frustrated voters expressed their concerns over the ACA repeal. Business Insider reported a farmer from Iowa told Sen. Chuck Grassley, “I’m on Obamacare. If it wasn’t for Obamacare, we wouldn’t be able to afford insurance,” adding, “Don’t repeal Obamacare — improve it.” Another constituent shared her story about how the law helped her when she was pregnant.
Furthermore, a recent tracking poll from the Kaiser Family Foundation showed a drastic climb in approvals for the ACA. The poll found support for the ACA at 48 percent, the highest level of favorability since shortly after the law passed in 2010. More key findings revealed that 65 percent of Americans would prefer to see “Medicaid continue as it is today” then the options offered by the Republicans and a “vast majority” say it is either “very important” or “somewhat important” for the replacement plan to ensure that “states that have received federal funds to expand Medicaid continue to receive those funds.”
The poll findings seem to portray a country greatly concerned about being caught in healthcare limbo with no concrete answers to fundamentally important questions—will they still have coverage, or be able to afford it under the new plan? Further fueling the uncertainty, lawmakers are moving forward without a “score” from the Congressional Budget Office (CBO)—an unusual move and one that has drawn criticism. The CBO’s input, which would advise how many people would gain or lose coverage under the proposed plan, some argue, should factor into lawmakers’ decision making. The American Hospital Association (AHA) conveyed in a letter to Congress that the legislation should not advance until the CBO can weigh in with a cost estimate. Previous analysis from the CBO found millions would lose coverage under a repeal.
Trump has given his support to the bill but many influential conservative groups and GOP lawmakers have already voiced their discontent calling the bill “bad policy” and “Obamacare-lite” as have moderates in the Senate and key healthcare industry stakeholders. In addition to public concerns, differences within the Republican party over the new plan may prove to be an insurmountable obstacle for Trump to deliver on his promise of “insurance for everybody.”