The 2010 Affordable Care Act had two aims: Insure more Americans, and control and rationalize the health care market and its costs. The first, unquestionably, has happened. The second? It's complicated -- premiums have increased, but maybe not so much as without the ACA's reforms.
But Obamacare's biggest victory -- the one Republican lawmakers are now scrambling to counter -- is this: The ACA has extended health care coverage to 20 million Americans. Simply repealing it is no longer an option.
And that's a problem for Congressional Republicans who don't come close to agreement about what health care should be, who deserves to have it and who is responsible for providing it. That's one reason Obamacare drew such heated opposition; even its staunchest critics knew that once passed, it would be nearly impossible to pull back.
Think of how
So the American Health Care Act, released Monday by
All of those promises are running aground on the reality of the health care market, and the political need to ensure Republican voters aren't hung out to dry -- here in
The American Health Care Act is bad policy. Congressional
Republican opposition to the ACA has relied, frequently, on the notion that folks who don't want health insurance shouldn't be forced to buy it, and that policy premiums are too high -- but the former is the only way to control for the latter. Some
It's an hodgepodge of talking points and ideological fragments circumscribed by political reality that cannot make good on its promise.
The legislation keeps some popular Obamacare provisions: Insurers still won't be able to decline to provide coverage because of pre-existing conditions, young people will be able to stay on their parents' insurance until age 26, and lifetime caps on coverage will stay gone. The
But that's the good news.
Start with the analysis by Standard and Poor's that says 6 million to 10 million Americans will lose health care if the
Or the fact that
Take the Health Savings Accounts that are a favorite of House Speaker
Or the way the
And look at the loathed-by-the-right individual mandate, which the American Health Care Act ditches in favor of incentivizing for the insured to maintain continuous coverage through a steep premium for anyone whose policy has lapsed for more than 63 days. Lapsed coverage for longer means paying a 30% penalty on a new policy's premium, a feature that seems likely to convince a healthy uninsured person to stay uninsured, and which moves the revenue stream generated by the tax penalty for folks who flouted the mandate from the public coffer to insurers' hands.
Or those refundable tax credits for low-income insurance customers -- something else that conservatives like as little as direct subsidies -- that are less generous for the elderly, who are more likely to be sick and need coverage, than those for the young. The tax on capital gains, investment income and dividends levied on top earners that helped fund the
The American Health Care Act promises to insure fewer people, at greater cost. In short, it's a mess.
Those features of Obamacare that most offend its critics are the safeguards that could make a market-based health care system functional. Substantial alterations mean insuring fewer people, and that some of those who retain coverage will pay more. The Affordable Care Act is dense and complicated legislation. To reaching the goal of increasing market-based health care coverage, it had to be.
That's why the American Health Care Act is such a headache. Policy should have a point, serve a constituency, address a need. This bill, on its face, accomplishes none of those things. So the question for
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