The AHCA would neither repeal nor replace Obamacare

REUTERS/Carlos Barria
President Donald Trump hugging House Speaker Paul Ryan as he gathers with Congressional Republicans in the Rose Garden of the White House on Thursday.

The “American Health Care Act,” which I’ll keep calling Trump/Ryancare and which squeaked through the House yesterday, is a bit of a fraud. It neither repeals nor replaces The Affordable Care Act, which Republicans succeeded in dubbing Obamacare.

Instead, if it becomes law, it would leave most of Obamacare in place. How can you call that “repeal” or “replace?” It makes a few changes,  almost all of which are beneficial to rich people (who would stand to get a big tax cut) and health insurance companies, who would have increased flexibility to avoid insuring people on whom they stood to lose money. Many people — especially sick people and working poor people and especially sick poor people in red states — will lose coverage or have to pay more for it.

Personally, I am offended by the apparent need felt by House Republicans to rush it to final passage without allowing the Congressional Budget Office to score the bill. Presumably, the CBO will soon issue its report on how Trump/Ryancare is likely to affect costs and coverage. If the House Republicans (no Democrats voted for the bill) are proud of this accomplishment, they should stop lying about it (a start could be dropping the insultingly false “repeal and replace” gag) and allow the country to know what effects the CBO’s impartial number-crunchers think the law will cause.

On the CBO point: Republicans will say either that the CBO is biased against them (which is pretty ridiculous since the CBO works for the Republican-controlled Congress) or that the CBO projections often turn out to be wrong. The latter point is reasonable, if they add that no one can really project the long-term future impact of a bill like this with a high confidence of perfect accuracy.

The CBO has a solid reputation of honestly projecting these things as best as it can. It exists so Congress can have the benefit of a neutral, expert analysis before it votes. Rushing something this big, complicated and important through the House without the benefit of CBO’s analysis strikes me as an admission that the CBO report will be embarrassing to those who voted for it.

Since no one asked me, here’s a small very sensible (IMHO) suggestion: Both houses of Congress should have a rule preventing a vote on final passage of a bill of this magnitude and complexity without waiting for CBO analysis. Or else just shut the CBO down and use the savings to help some sick, poor people.

Of course, I’m making too much of the passage of the bill without a CBO score, because the analysis will be ready before the Senate votes, and there seems to be widespread agreement that Trump/Ryancare will not probably pass the Senate as written. It just stinks to not wait for a neutral expert analysis of the bill by the agency that the Congress created for that purpose.

By the way, have I mentioned recently that President Trump (who claims to be thrilled with Trump/Ryancare as it stands), said as a candidate his health care plan would cover everyone and the government would pay for it.

I’ve written about this before, and I know how rude it is to bring up what a candidate promised when he wanted everyone’s vote, but here’s a taste of what Trump said about his health care reform idea last September, after he was the nominee, in an interview with Scott Pelley on “60 Minutes”:

TRUMP: “Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, ‘No, no, the lower 25 percent that can’t afford private. But —’ ”

PELLEY: “Universal health care.”

TRUMP: “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

PELLEY: “The uninsured person is going to be taken care of. How? How?”

TRUMP: “They’re going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably —”

PELLEY: “Make a deal? Who pays for it?”

TRUMP: “— the government’s gonna pay for it. But we’re going to save so much money on the other side. But for the most it’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”

Finally, if you want some Left and Right instant analysis of the bill that passed yesterday, you could do worse than read the instant analyses from the liberal New Republic and the conservative Weekly Standard.

Brian Beutler’s piece in The New Republic is headlined, “The Republican Health Plan Is a Lethal Moral Obscenity.” So you can tell where he’s going.

Chris Deaton’s piece in The Weekly Standard, headlined “Republicans Shove Health Bill Across Finish Line,” is (as the headline implies) less enthusiastic in favor of Trump/RyanCare than is Beutler against it. You’ll learn a lot by reading both, so I’ll just shut up for now.

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Comments (12)

  1. Submitted by Neal Rovick on 05/05/2017 - 03:07 pm.

    Well, yesterday Trump (unwittingly ??): gave his support to Medicare for all–he told the Australian PM that Australia had far better health-care than the US (“We have a failing health care — I shouldn’t say this to our great gentleman and my friend from Australia,” Trump said, “because you have better health care than we do.”.

    But seriously, I really don’t think any of this really matters to him–he hasn’t bothered to study anything about health-care policy–all he knows is that certain things need to be done to move to tax cuts–because that is money to him and his family. Now THAT he understands. Anything else that needs to be traded away for personal advantage can and will be traded away. You can give away anything that has no value to you to get something of value for yourself.

    The art of the deal ? Say whatever it takes to get the deal.

    But the real meat of the money in this issue is the cuts to Medicaid–cutting the Medicaid program by $880 billion….AND, it would cut taxes by $883 billion.

    Yo, Sherlock…Notice any similarity between the Medicaid cut and the tax cut ??

  2. Submitted by Brett Adams on 05/06/2017 - 02:12 am.

    “Lyin’ Trump”

    Remember when he used that on Ted Cruz (who is admittedly deplorable)? He is the biggest bald-faced (and bald-headed) liar-in-chief we’ve ever had, since Nixon at least. Check Politifact & see…

  3. Submitted by Jeffrey McIntyre on 05/06/2017 - 06:49 am.


    It never was about Health Care…it was about $800b in tax cuts for the uber wealthy…because it just so hard to get by these days on mere millions.

  4. Submitted by Jim Roth on 05/06/2017 - 07:22 am.


    The flaws in the bill have been widely discussed. Trump brags that it makes coverage “available” to everyone, including those with preexisting conditions and poor and older Americans. For that matter unaffordable coverage was available before the Affordable Care Act was passed. The ACA has flaws but rather than fix them Republicans including Trump chose to politicize the need to ‘repeal Obamacare.” Some may argue that that’s smart politics. It may be in the sense that Trump managed to get elected with that and other hollow slogans. It’s not good policy. It’s a disaster as health care policy. It’s also obscene that Trump felt it necessary to have a party complete with beer and laughter and laudatory compliments about him when the bill is not only a disaster it’s also only part way to possibly becoming law. As we’ve seen Trump desperately needs attention and adulation and finds ways to define half measures as great successes that he deserves great credit for.

  5. Submitted by David LaPorte on 05/06/2017 - 07:40 am.

    The AHCA was never about health care

    The AHCA goal was never about improving healthcare. Healthcare really needs attention, since we spend more money on this sector of our economy than any other country, yet are ranked 36th by the World Health Organization and 50th by Bloomberg for outcomes. Unfortunately, the real goal of the AHCA was to save money so that the Republicans could fund windfall tax cuts for the wealthy.

    If their goal was to improve healthcare, the Republicans would have included the healthcare stakeholders in the development of the bill. But they never talked to the doctors, the hospitals, nurses, pharmaceutical companies, health insurance companies or any of their associations. They also ignored patient advocacy groups. When the Affordable Care Act (aka Obamacare) was developed, all of these interest groups were at the table.

    The AHCA has now been condemned by a list of healthcare organizations that is far too long to include in this comment. Highlights include the American Medical Association, the American Nurses Association, the American Hospital Association, the American Cancer Association, the American Association of Retired People and so many more. I can’t find a single organization with an interest in healthcare that supports it.

    There can be little doubt that the organizations that are condemning the AHCA have a deep commitment to healthcare. That’s why they exist. The same cannot be said of President Trump and the Republican members of the House of Representatives. Their actions, and the uniform condemnation by the healthcare community, makes a very strong case that healthcare was not their goal.

    We’ll see what happens in the Senate, where key Republicans have already said that the AHCA won’t be their starting point. However, while they may make cosmetic changes, I’m skeptical that they will prioritize healthcare when House Republicans and President Trump clearly did not.

  6. Submitted by Tom Christensen on 05/07/2017 - 10:22 am.

    Repeal, Replace, or NOT

    As the minority party the Republicans spent about seven years and over 70 tries to repeal and replace Obamacare. Now they have caught the car they were chasing and don’t have any idea what to do with it. They can’t even agree amongst themselves how to repeal and replace Obamacare. A logical person would think if they want to do something as drastic repealing and replacing Obamacare and they have had ample time to develop a rational plan, they would have a means of repealing and replacing. They don’t need any Democrats to get in their way to stop their efforts as their own members are doing a good job of obstructing by themselves. It turns out they should have spent the last seven years repairing their party and maybe even participating in democracy instead of just obstructing it. They are good with a two-letter word, NO, and poor at a three-letter word, YES. They are still the party of NO and they are currently in charge of the country in a way that should be any politicians delight. They have control of all the strings of government and they DON’T KNOW HOW TO LEAD.

    GOP Representative Raul Labrador, from Idaho stated Saturday, at his town hall meeting, “nobody dies from not having health care.” You can see how ill-informed and desperate the GOP is getting if they are willing to make such preposterous statements to his own constituents.

    Quoting Arizona Republican Rep. Andy Biggs on Saturday “He’s ‘bewildered’ by fellow House Republicans not keeping their promises on health care. The GOP just passed a bill and they’re claiming it’s a repeal, but it’s not a repeal. They’re sending it to the Senate knowing it’s going to be changed. The bill did not receive full support from House GOP members. We’ve basically enshrined the features of ObamaCare,” said Biggs. “This is going to be very difficult to walk back from.”

    The Washington politicians have spent the last 40 years trying to divide up the country for their benefit. Red state, Blues states, Liberal, Conservative, tea party, freedom caucus, log cabin republicans, progressives, libertarians, etc., etc. They have attained their goal and now they once again don’t know what to do about it. We are no longer the United States of America, we are the Divided States of America. Many in the GOP claim their religion guides them, but their politics go contrary to their religion. Nothing as complicated as healthcare gets passed without fixes. According to President Trump “Who knew it was this complicated?”, apparently most rational people know that. Sure, Obamacare needs fixes. The Democrats have stated that and so have the Republicans. The only way it will get fixed is by stopping the poison pill politics and by working together. Good luck with that old-fashioned idea. Welcome to TRUMPCARE!

  7. Submitted by joe smith on 05/07/2017 - 01:30 pm.

    Repeal it or replace it, who cares,

    just change it!!! I could care less what they call it, who comes up with the ideas, how many GOP or Dems vote for it, just get something that works for working Americans! Those who work for a company that covers their insurance, have seen higher deductibles, less choice of doctors and too many changes in healthcare to ever establish a relationship with their family doctor. Those who pay for their own insurance have seen skyrocketing premiums, higher deductibles, fewer by half the choices in coverage (in many counties no choice), couldn’t keep their Doc and in many cases forced to leave coverage by willing to pay penalty. Obamacare is broken, something needs to change!!

    I hear that the new plan will put a work requirement on Medicaid, thank goodness!! Medicaid is for disabled, our poorest families with kids and those that are under 65 and can’t take care of themselves. It was never intended for able bodied folks who choose not to work!! Medicare is partially paid for (to the tune of 3% of workers salaries! half paid by employee and half by employer) by working folks to take care of retired seniors. This BS that older folks and the poor won’t be covered has never been the case!! Just repeated talking points by the Left to scare folks. BTW, the Jimmy Kimmels story while heart breaking, was totally off the mark when saying a baby born to a poor family would be left to die. Every hospital in country would do what it took to try and save a newborn.

    Nobody who dealt with insurance at any in depth level, thought Obamacare would work. It was just a stepping stone to single payer. With the ACA we were a half step away from single payer, (that is why the Liberal elite, big Govt folks are howling over its demise). if it goes back to competition in the market, buying across state lines, having actual standards for Medicaid, $50 dollar plans with high deductibles for 25-45 year olds (who use very little healthcare) allow groups to buy together, we will once again be a full step away from single payer Govt run healthcare. Where is the outrage from the left over our soldiers,actually dying while waiting for healthcare, from the VA?? An actual single payer system!

    • Submitted by Neal Rovick on 05/08/2017 - 09:16 am.

      Joe, if you think that by going back to pre-ACA days, you’ll have better coverage for lower cost, you are mistaken. Costs have been continuously rising all that while and there is every indication that the under AHCA costs for the people who actually need care will be higher.

      After all, if it is likely you won’t need insurance, you won’t buy it–meaning the costs for those who do need insurance will be higher because there is a smaller pool paying for it.

      And it clearly states now older people will pay up to 5 times the younger population (rather than 3 times, under the ACA)–not much of a mystery there which way prices for the older insurance buyers will go.

      As for Medicaid costs: 42% of the spending is for disabled disabled, 21% are aged and 21% are children and only 15% are non-disabled adults (national average).

      Among the non-disabled adult population, 63% of the families have at least one job, and 14% of the families have a part-time job. 23% of the households have no job. Many of the households covered by Medicaid are single-parent households.

      The Heritage Foundation says a work requirement is pointless:


      Under the proposed policy, governors would be given the option of requiring able-bodied adults without dependent children enrolled in Medicaid to hold a job, perform community service, or undertake training as a condition of receiving Medicaid services.

      While the idea of requiring work, training, or other constructive activity in exchange for benefits is sound in principle, there are numerous reasons why this policy would prove ineffective. Moreover, there are better ways to promote work in the context of the health care reform debate.

      First, the proposed policy is optional; most governors will just ignore it. Second, work requirements for medical services would be almost impossible to administer and enforce. Making cash assistance or food stamps contingent on work participation is one issue, denying medical care to sick, poor people is another matter. If enacted, “work requirements” in Medicaid would certainly be symbolic rather than substantial.

      In reality, it is difficult to get eligible able-bodied adults without dependent children to enroll in Medicaid. After all, they do not need to enroll in the program to receive free medical care. They know that if they get sick and walk into a clinic or emergency room they will get enrolled in Medicaid prospectively or receive treatment pro bono.

      A work requirement would just make it less likely for able-bodied adults without dependent children, known as ABAWDs, to register for the program. The work requirement would reduce Medicaid enrollments, but Medicaid costs might well go up because the eligible ABAWDs would go to the emergency room rather than receive routine care elsewhere.

      (end quote)

      • Submitted by Tim Smith on 05/09/2017 - 05:16 pm.


        Document your sources on Medicaid, perhaps what percentage of enrolleess are disabled vs not? One would imagine the disabled are higher cost per enrollee, but arent children n the non disabled a much higher percentage of those enrolled?

  8. Submitted by joe smith on 05/09/2017 - 12:32 pm.

    Neal, how can say the costs won’t

    go down for folks when now under the ACA a 26 year old has to buy a bronze plan for $850 monthly premiums with a $10,000 deductible when he needs a $50 a month premium with $10,000 deductible? Would the price of cars go down on average if everyone who drove was forced to buy BMW’s or the car of your choice? You say only 15 % of Medicaid goes to adults, if you were talking about 15% of 100 bucks no biggy, you are talking about 15% of tens of billions of dollars… That is huge!! Only in Govt and those who believe in their control, is billions of dollars no big deal!! Seniors use 3-5 times more healthcare than younger folks do, that is why their coverage will cost more (plus they will get higher tax credits to cover that increase in new bill), Is that hard to understand?? The person with 6 car wrecks pays more for insurance than the driver with no accidents, is that unusual?? What I hear from the left is a cry for single payer. All I ask is that look at the VA (Govt single payer) and ask is that what you want for YOUR healthcare?

    • Submitted by Neal Rovick on 05/09/2017 - 02:06 pm.

      Do the math, Joe…$ 545

      Do the math, Joe…

      $ 545 billion in total medicaid spending x .15 (proportion of non-disabled, non-elderly adults) x .23 (non-working adults) is $ 18 billion dollars. Within that $ 18 billion there’s a whole range of people, from the unemployed, or single mothers down to the derelict destitute who will never work. In the end though, who would you bar from the hospitals and emergency rooms ?

      And while you may believe that the VA is a hellhole put to shame by the private sector:


      The American Customer Satisfaction Index for 2013 shows that the VA health network, which serves more than 8 million veterans, achieved marks equal to or better than those in the private sector.

      The health system earned overall satisfaction indexes of 84 for inpatient care and 82 for outpatient services, while the U.S. hospital industry earned scores of 80 and 83 in those categories, respectively.

      (end quote)

  9. Submitted by joe smith on 05/10/2017 - 09:39 am.

    First of all NO ONE in America is turned

    away from an emergency room! That is just plain false, they admit everyone who enters the ER. 2nd, if 15% of Medicaid recipients are not disabled or the extremely poor (reason for work requirement) that is 70 BILLION more tax payers are shelling out a year…. Chump change to the left but real tax dollars for tax payers!!!

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