Why I Would Vote No On The AHCA As Is…


On Thursday, the House of Representatives will bring to the floor the Republican health care reform plan, set to repeal much of the Affordable Care Act.

The confusingly named American Health Care Act has been much criticized; this was as expected on the political Left, but quite viciously as well from the Right. I myself have extensively discussed why I am confused and angered by much of the bill.  From my previous post, I continue to believe the following is the worst mistake of all:

My biggest complaint about this bill is that there really is no governing philosophy in its writing. It neither pleases conservatives nor moderates. It makes half measures to increasing patient choice, but retains taxes such as the Cadillac tax, while at the same time maintaining the employer based health insurance system. It doesn’t maximize Federal support for the poor, nor does it full adopt the free market. It surely does some good things, such as expanding HSA/FSA and moving to a refundable tax credit system, but never fully seems ready to jump in with both feet in a full free market model of national health care. The muddle created by the GOP here makes it very difficult to make a sound, concise argument regarding specifically what their goal is. The President, Speaker Ryan, and the rest of Congress are likely to have a tough road ahead to make this sale to the American people.

Since that time, Republicans have been amending and altering the bill in small ways to try to make it more acceptable to the larger electorate. Some of the attempts, such as the so-called “Manager’s Amendment”, attempts to make the bill better to convince wary Republicans. Other attempts, such as the now labelled ‘Buffalo Buyout’, are simple classic horse trading of Federal dollars for votes, that have muddled the Beltway swamp for years (anyone remember the Obamacare “Cornhusker Kickback?”).

However, the amendments have failed to resolve my earlier complaint. What is the goal of this bill, Republican Party? Is it to make health care more affordable for the individual? Is it only to increase patient choice?  Is it to decrease federal spending? Decrease taxes? Or is it only a political tool to reverse Barack Obama’s signature achievement?

Even at this late date, I can’t answer that question. Proponents of the bill have made all the above claims, but actual reading of the bill fails to back up their claims.

Here is an example: let us take one key problem with the AHCA: does it really decrease cost for individuals?  The answer is very likely ‘No’, at least for most people. For example, one of the most glaring problems with the AHCA is that it will significantly increase net premiums for low-income Americans in their fifties and sixties. Health care pundit Avik Roy has talked extensively about this glaring defect:

For example: a 50-year-old childless adult making 200 percent of the Federal Poverty Level—$24,120—would face net annual premiums of $1,520, on average, under the ACA. Under the AHCA, she would see net annual premiums of $4,078, a difference of $2,855.

Now, this problem is solvable, and Roy provided the easiest solution: equalizing the tax treatment of employer-sponsored and individually-purchased health insurance. This has been a long stated goal of conservatives, in fact.

So you would expect the Republicans in power would use this solution, and happily go along their merrily way.

You would also be very wrong. Instead, Republicans failed to confront this cost issue for near elderly people (though there is a vague ‘promise’ of additional Federal spending that, as of the moment, still is absent from the final bill).

The added amendments did further increase tax cuts; but at the same time, they also further limited one major reform regarding consumer driven health care, another issue that conservatives claimed they cared about, but current Republicans apparently don’t think is a priority; again, from Roy:

In the original bill, if you were eligible for a tax credit of $3,000, and you bought an insurance plan that cost $2,800, the remaining $200 would be deposited in a Health Savings Account under your name. That feature of the bill gave consumers an incentive to keep premiums down, because they would economically rewarded for doing so. But the Manager’s Amendment kills that provision, because pro-life groups were worried that such HSA deposits could be used to fund abortions.

So, in short, Republicans decreased patient choice because…they are afraid patients would make choices politicians won’t like. Sounds a lot like Democrats.

Here is another example of where this bill goes two steps backwards for every step forward. Republicans are for more ‘choice’, correct? But in the most recent change in the bill, they would diminish the free choice of Veterans. In the initial bill, Vets would have the choice to either participate in the Veterans Administration, or could opt out and participate in the free market insurance system under the AHCA. However, in the most recent re-write, they would be prohibited from using the insurance exchanges and subsidies if they were eligible for VA benefits.

I could go on and on about this bill, in never-ending detail. The questions from my initial post remain: do the Republicans even know why they are writing this bill? If their goal is more patient choice, great…I am on board. But please see above..their own amendments show that is not necessarily the case.Is their goal to make access to more cost efficient insurance models? Fine. But they don’t allow that to be the case either. So what are they trying to achieve? Is this simply all about politics?

In short, this bill removes major portions of Obamacare, but replaces them with new regulations and rules that could be in many ways every bit as costly and cumbersome as its predecessor, without actually improving health in this country. That, to me, is the definition of failure.

President Trump, Speaker Ryan and others are making the political argument that this must be done now, or never. I don’t agree with that either, and past history is a good landmark in showing why they are wrong. Go back to the chronological history  ACA debate of 2009-2010, and you will see the debate was fraught with failures, starts and stops, and even moments when it appeared the process was on life support. And yet, the process continued. The GOP could continue this debate in much the same manner, if they have the political will to do so.

One final point; if you accept this bill as is, this plan virtually guarantees a decades long struggle around health care at the Federal level. Sure, the GOP will repeal some of the mandates, and most of the taxes. But the next time Democrats come to power, who here believes it won’t take them long to reverse course? Trump and company are guaranteeing that Obamacare, in some manner or form, is the law of the land for the foreseeable future, except we will have varying degrees of taxation, subsidies, and regulation dictating funding depending on which party rules the White House and Congress. That is a horrible situation for this country to be in, and this may be the one scenario in which the GOP could be building a regime that is actually worse than maintaining Obamacare…imagine that.

Republicans should go back to the drawing board. This plan is not worthy of passage in the House. Furthermore, everyone knows this plan is D.O.A. in the Senate.  There is at this point zero chance it gets 50 votes. It is always possible they could pay off enough Senators to get to 50 votes, but that is the same kind of corrupt bargain that Democrats used to get the ACA passed in the first place. Republicans should decide among themselves what their goals for reform really are, and build a plan around one singular philosophy. Pick one; any one.  Simply tinkering with Federal regulations and mandates as they are currently trying to do is not enough.

I am not alone at all in my dissatisfaction. FreedomWorks today came out against the AHCA, and is asking its followers to ask their Representatives to vote against the bill. The Freedom Caucus and Heritage Foundation, among others, have leaned the same way. I tend to agree with all of them.

In short, I see no reason to vote for this bill at this time. Patience and steadfastness is required at this time. Conservatives should hold to their beliefs, and fight for the greater good. The House should reject this bill, and try again.