The American Health Care Act was first publicly released on March 6, and it has been met with disapproval from both sides of the aisle. The bill is part of Republicans’ plan to repeal and replace the Affordable Care Act, more commonly known as “Obamacare.” The bill does prevent health insurers from denying patients with pre-existing conditions and allows children to stay on their parents’ plan until they are 26, which are two of the more popular individual clauses of Obamacare. However, the AHCA is lacking for a number of reasons.
During the transition period, Donald Trump said in an interview with the Washington Post that he was finishing up an Obamacare replacement plan that aims to provide “insurance for everybody.” The AHCA is definitely not that plan. Although Trump said he was “proud to endorse” the bill upon its release, the non-partisan Congressional Budget Office has estimated that 14 million Americans would lose coverage by 2018, 21 million by 2021, and 24 million in 2026 relative to current law.
This is due largely in part to a shift in the way tax subsidies to help Americans pay for healthcare will be distributed. Under Obamacare, these credits were based on income, but in the AHCA, they are based on age. For example, a 27-year old making $20,000 annually would get the same $2,000 tax credit as a 27-year old making $75,000. Clearly, this would hurt the low-income patients Obamacare was intended to protect. Bill Gates, the wealthiest person on the planet, would qualify for the largest tax credit simply because he is 61.
One of the most controversial clauses of Obamacare was the individual mandate, not included in the AHCA. This forced Americans to obtain health insurance or pay a fee for not having it. Barack Obama himself criticized Hillary Clinton for including an individual mandate in her healthcare plan during the 2008 Democratic primary. However, the individual mandate was probably necessary for Obamacare to be effective at all. Ultimately, there need to be healthy people in the healthcare system, and the individual mandate tries to force this to happen. Having healthier people in the system powers the average premium, because they are less costly to insure. If healthy people do not have an incentive to stay in the market, costs will rise for the sick, making insurance less accessible.
However, there is a statistic in the CBO report on the AHCA saying that market health-insurance premiums will be 10% lower on average than they would be under Obamacare by 2026. This is true, but misleading, because the AHCA allows insurers to sell less generous plans, paying for a smaller fraction of actual healthcare expenses than the plans on the market today.
Another subject of debate surrounding the AHCA has been the massive tax cuts included within the bill. The top 0.1% of earners would get a $207,000 tax cut annually. Under Obamacare, there was a maximum of $500,000 for an individual executive’s compensation that an insurer could deduct as a business expense, but this is not included in the AHCA. Democratic Representative Sandy Levin from Michigan called the AHCA “the beginning of a huge giveaway to the very, very wealthy.” Republican Senator Rand Paul from Kentucky also criticized the AHCA saying, “You socialize the insurance company losses but privatize the billions they make. I’m not for a gift for the insurance companies.”
With all of its flaws, passing the AHCA could be political suicide for the GOP. Kaiser Family Foundation figures showed that the areas most affected would be parts of Alaska, Arizona, Nebraska, Tennessee, and Oklahoma – all of which were states Donald Trump won. Also, key areas of swing states such as Pennsylvania, Michigan, and North Carolina would be hit hard. There is plenty of room for improvement in the American healthcare system, but it’s fairly obvious that the AHCA would not be the right answer for most Americans.