Over seven years of promising to “repeal and replace” the Affordable Care Act, Republicans finally produced an actual plan last night. Congressional Republicans didn’t bother to wait until the Congressional Budget Office (CBO) scored the plan, so they don’t actually know how much it will cost. And if they do know how many people will lose coverage under this plan — they aren’t saying.
In his effort to “Make America Great Again,” President Trump promised that he would replace the ACA with something “better” — meaning it would have broader benefits, costs less, and cover more people. The plan that Republicans have introduced does none of those things. And this development presents a political opening for progressives. (Vox has a great breakdown of the ACA and the new bill here.)
The Republicans never actually thought they would be in a position to really repeal and replace the ACA, thus, it really didn’t matter that their math didn’t add up or that the complexities of health reform would make any number of their ideas a non-starter. As long as they were in strict opposition to Barack Obama, they only needed to sound good — not actually promote coherent policy.
But now, things have changed. The Republicans control the White House and all of Congress. They now have the burden of governing. Now, much to their dismay, they must pass something. And there is broad disagreement even among them on what to do.
The reason the GOP didn’t wait for the CBO to score the bill is because they know it’s a budget-buster. Why wait and hand the Democrats a tool to beat you over the head with? And they aren’t even pretending that the new American Health Care Act will cover as many people as the Affordable Care Act currently does. Beyond those two realities are even bigger problems — this new bill contains no individual mandate, and replaces the ACA’s subsidies with tax credits. In other words, it will be easier for rich people to get covered, and far more difficult for poor or sick people to get covered. This new bill also contains almost no incentive for young people to sign up — since there will be no penalty for not purchasing health insurance.
This entire enterprise is a disaster. As The Washington Post notes, the GOP is slow-walking through minefields. The Democrats still have the burn scars from the last time they tried to fix health care in America. Now, they’ll have front-row seats as the Republicans flambe themselves. This represents the first policy opening for a liberal return to governing. The progressives should just sit back and watch the show, and be prepared to pick up the pieces in 2018 and 2020. And should anyone doubt that obstructing a president’s efforts to reform health care is bad politics, well, just look at the Republicans now in power.