EDITORIAL: GOP health plan fails its basic test: Do no harm

March 10--Writing in anticipation of a Republican health insurance plan, we said any such proposal should be judged by its effect on the 20 million Americans who gained coverage under the Affordable Care Act.

"Any plan that results in fewer people having coverage isn't a replacement. It's retrenchment. And that isn't acceptable," we said in our Feb. 24 editorial ("20 million reasons to retain and repair Obamacare").

By that standard, the legislation unveiled this week by Speaker Paul Ryan and quickly pushed through two House committees is a dismal failure.

There isn't an official calculation -- because the sponsors didn't submit their bill to the nonpartisan Congressional Budget Office for review -- but health policy experts across the political spectrum concur that millions of people would lose their insurance if the House bill is enacted.

No state would be as hard hit as California, where the uninsured rate has fallen to a record low of 7.1 percent, according to the Centers for Disease Control and Prevention.

The national uninsured rate is 8.8 percent.

Among other things, the Republican plan would replace premium subsidies for people buying policies on insurance exchanges with tax credits based on age, with older people getting the greatest benefits. However, insurers would be allowed to charge older policyholders five times as much as younger policyholders. And tax credits would be denied for anyone whose insurance policy covers abortion, eliminating virtually all plans offered in California.

The GOP plan would rescind the mandate that almost everyone must purchase health insurance but still requires insurer to sell policies without regard to pre-existing conditions -- creating an incentive for people to wait until they get sick to buy insurance. That provision alone almost certainly would undermine the risk pools that are the foundation of the insurance system.

To offset tax cuts for upper-income people and some health-related services, the Republican plan would cut funding for Medicaid, which produced some of the biggest insurance gains -- at least in states such as California that opted into an expansion that provided coverage for millions of lower-income Americans whose employment benefits don't include health insurance.

Don't look for anything to control the crippling costs of medical care. There aren't any in this bill. In fact, it would postpone the only cost-control provision of Obamacare -- the so-called Cadillac tax on gold-plated insurance plans.

This plan, which is destined to be called Trumpcare, doesn't come close to the president's promise to "expand choice, increase access, lower cost and provide better health care."

Democratic opposition was predictable. But hospitals, physicians and even some Republicans are lining up in opposition to Ryan's American Health Care Act.

Avik Roy, one of the most outspoken GOP critics of Obamacare, said the GOP plan would make coverage unaffordable for millions. "Otherwise," he wrote, "it's great."

Roy was being sarcastic. Rep. Jason Chaffetz, R-Utah, was not when he offered a health care plan for lower-income Americans. "So maybe," Chaffetz told a CNN interviewer, "rather than getting that new iPhone that they just love and they want to spend hundreds of dollars on, maybe they should invest in their own health care."

Thousands of people have turned out for town hall meetings across the country, including recent sessions in Santa Rosa and Petaluma, calling on Congress to protect health insurance gains. If the legislation advancing this week is enacted, those calls will have gone unanswered.

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(c)2017 The Press Democrat (Santa Rosa, Calif.)

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