Healthcare — looking at you, the Oval Office— is complicated. With Trumpcare— the common name for the repeal and replace bill intended to displace Obamacare— it seems as if everyone has been reminded of the fact that new isn’t always better.
While many media outlets have covered its flaws, there are tangible benefits too, albeit only for certain groups.
In this article, I’ll try to recap what’s good and bad about the bill as it’s presently constituted, including how it may help or hurt younger individuals and those chronically underemployed. (Granted, an accurate analysis is difficult, considering how frequently its details and provisions change.)
It’s important to note that as currently constructed, the bill will likely not become law.
“Honestly, there is no way to exhaustively cover all of the “bad” with Trumpcare.”
“Honestly, there is no way to exhaustively cover all of the “bad” with Trumpcare.”
Some Things To Take Into Consideration
As of this writing, on Tuesday, March 14, in the late evening, mumblings have begun to surface that President Trump is distancing himself from the plan that he initially heavily supported.
In fact, the plan, formally titled the “American Health Care Act,” has started to adopt different nicknames: Ryancare (in recognition of the heavy contributions made by Paul Ryan, Speaker of the House) and RINO-Care (i.e. a Republican-in-Name-Only plan.)
For those who know anything about Trump, it may come as a surprise that he’d be fine with the plan not bearing his name. Why the sudden change of heart, you may ask?
The belief is that our ever-impressionable Commander-in-Chief has a lot of advisers and associates in his ear, telling him that the bill— widely panned by those across the political spectrum— will lose him support, especially amongst those loyal to him who are less affluent. After all, we all know how much Trump values approval from others.
As the Washington Post reports:
“Trump loyalists warned that the president was at risk of violating some of his biggest campaign promises— such as providing broad health coverage for all Americans and preserving Medicaid and other entitlement programs— in service to an ideological project championed for years by Ryan and other establishment Republicans.”
So for all of those who think Trump is either a puppet or hasn’t done a single good deed for the American people, this may finally be one instance in which that isn’t necessarily the case.
Still, regardless of my opinion on the bill, I mostly just want to lay out the facts. The purpose of this article is to help you make your own informed decision.
For the sake of clarity, I will refer to the American Health Care Act as Trumpcare in this piece, eschewing its formal name or the increasingly-popular host of alternatives.
The (Potentially) Good
Something I was overjoyed about— at least in theory— was the notion that the individual mandate would be taken away with Trumpcare.
Essentially, this means that you wouldn’t be required to buy health insurance, or face a fine. This provision would seem to be of particular assistance to those who have unstable incomes, as they’d be able to decide whether they need or can afford a policy at any given time.
Unfortunately, the removal of the mandate is fool’s gold: under Trumpcare, if you were to lapse your coverage for a period exceeding 63 days, insurers could impose a 30% surcharge on top of your standard premium for an entire year.
With Obamacare, those who didn’t fulfill the individual mandate were simply forced to pay a penalty to the IRS.
(Personally speaking, I’d feel much more confident in the government treating me fairly, as opposed to a profit-driven insurance firm. Although, quite frankly, I harbor doubt about the intentions of either.)
It should also be mentioned the mandate’s fine amount was relatively low, particularly for those who don’t bring home a lot. (More details on fines associated with non-compliance, which seem to no longer be enforced, can be found here.)
Ultimately, it’s safe to say that this 30% “tax” would be assessed almost uniformly on poorer individuals, as they’d be the ones prone to lapsing coverage.
Incidentally, it is unclear as to whether a lapse in dental coverage would be subject to an insurer surcharge. However, it appears all but certain there would be no individual mandate on dental care— a rather unremarkable fact, considering how Obamacare never put a mandate on it in the first place.
While many pundits have pointed out that perhaps the thing that Trumpcare does best is simply preserving the best parts of Obamacare, the bill does help one particular demographic: young people.
Of course, someone has to pay the price, and in this case, it’s older people.
Obamacare mandated that health insurance companies couldn’t charge older individuals more than three times what younger people paid, despite the disproportionate cost of providing healthcare to the former.
Due to the restrictions that Obamacare put on the practice of “age rating”— basing premium amounts on how old one is— the former president’s signature law actually made healthcare more expensive for most young people.
(Said another way, if you subscribe to the theory that ain’t no such thing as a free lunch, young people were regularly treating seniors to Michelin-starred restaurants.)
Under Trumpcare, insurance companies could charge seniors up to five times what they charge younger individuals. Young people win, old people lose; it’s a zero-sum game.
One estimate found that those aged 20-to-29 might save 15% on their premiums. Those 60 and older might pay 22% more, however.
Even for the younger demographic, it may be a moot point for many, considering how Trumpcare would preserve the Obamacare provision allowing those 26 and younger to continue to stay on their parents’ plans.
Trumpcare would also purportedly help businesses, which in many cases would no longer be liable for their employees’ healthcare.
There are certainly positives, but nearly all of them come with a caveat.
Honestly, there is no way to exhaustively cover all of the “bad” with Trumpcare.
First, let’s start with what everyone’s talking about: a recent report released by the Congressional Budget Office (CBO), a nonpartisan federal agency, found that under Trumpcare, 24 million Americans would be poised to lose their health insurance by 2026.
(But hey, silver lining: the federal government would apparently save $337 billion during this same period.)
Just over the coming year, 14 million Americans could lose coverage, although some may do so voluntarily— i.e. they don’t feel the pressure to have coverage, absent a mandate.
The Trump administration reacted strongly to the report, saying in essence, that it “offered an incomplete picture.”
That’s not even touching on how premiums would go up— the CBO estimates say they would increase anywhere from 15% to 20% in 2018 and 2019— although they would apparently decrease over time.
Many groups would be affected adversely, including women. Much has already been said about how Planned Parenthood would be defunded.
Here are some of the bill’s other major flaws, as highlighted by ObamacareFacts.com:
- There would be few incentives for healthy people to enter the market. Insurance companies need a combination of healthy and unhealthy individuals in order to effectively balance out risk.
- The aforementioned removal of the employer mandate to provide coverage would not only expose poorer people to being uninsured, but it could force states to pick up the slack in many cases.
- It would cut the expansion of Medicaid and cost assistance.
- The plan would overwhelmingly benefit those who earn incomes 400% or more above the poverty line.
- It’s an extremely partisan plan, concocted by Ryan et al., with little input from others.
- Although not clearly defined, it would seem as if the standard of what constitutes “minimal essential coverage”— the bare bones of what can be provided— would be lowered.
Perhaps most importantly, it’s appalling that this is the best that Republicans could do. They moaned and groaned for nearly a decade, but when it finally came time to take a swing, they seem to have struck out.
As many in the media have pointed out, a wide base of Republicans believe that healthcare is a privilege instead of a birthright— a position unheard of in nearly every other developed nation.
This ideology of apathy is reflected in every element of the plan, from policy to implementation.
None of this is to say that Obamacare is perfect; it is not. It started as a 906-page document that expanded as time elapsed, making a thorough reading impossible. Progressives would have preferred a single-payer system; instead, they got a compromise.
Nevertheless, just like the lite version of a soda tastes worse than the full-calorie version, there is little doubt in my mind that “Obamacare lite” would leave a comparatively sour taste in the palates of Americans.
Daniel Steingold is a writer from Los Angeles, CA who’s an advocate for alliterative artistry. Admittedly ambivalent towards social media, he halfheartedly hopes hospitable humans heap plentiful praise upon his prose periodically posted to Facebook.
His two known writing projects, one used and one abused, are The Article Review (thearticlereview.com) and A Wiki a Week (awikiaweek.com), respectively. He enjoys learning about everything under the moon, because, well… the sun BURNS his ghostly white skin.