March 8, 2017
By Steven Wishnia
Washington, DC - For the labor unions representing America’s health-care workers, the House Republican bill to replace Obamacare, released this week, went over about as well as a new strain of norovirus.
National Nurses United executive director RoseAnn DeMoro called it a “house of horrors,” while American Federation of Teachers President Randi Weingarten said it was “about as cruel as it gets.”
“This isn’t a health-care plan—it’s a massive giveaway to insurance companies and those at the top, while it hits America’s families with a triple whammy of less coverage, higher costs, and more taxes,” Weingarten said in a statement.
The bill is called the American Health Care Act. Its key provisions include repealing the Affordable Care Act’s mandate that everyone buy health insurance and replacing its direct subsidies to help people afford insurance with tax credits—$2,000 a year for people under 30, $4,000 for those over 60, It would also phase out Medicaid as a program that pays virtually all health costs for people who receive the benefits. Instead, it would give states a flat amount each year for Medicaid.
While the bill would repeal Obamacare’s tax penalty for people who don’t buy health insurance, it would let insurance companies charge people 30% more if they’d gone for more than two months without coverage. It would also let Obamacare’s minimums for what policies have to cover expire in 2020; reduce funding for federal public-health programs, including vaccination; and eliminate funding for Planned Parenthood.
The Service Employees International Union summarized it on Twitter as “#Trumpcare bill means massive cuts to Medicaid, rationing care & paying over $1,500 more for less care. #NotAPlan.”
That $1,500 figure is conservative, based on the analysis by the liberal news site Vox the SEIU cited. By 2020, Vox estimated, the bill would increase costs for the average enrollee by $2,409. The impact “would be particularly severe for older individuals” and the poor, it added. For people aged 55 to 64, costs would increase by more than $5,000 a year if the bill went into effect now, and by almost $7,000 in 2020. For a single person earning less than $30,000 a year, less than 2½ times the federal poverty line, costs would go up by almost $3,000, and by more than $4,000 in 2020.
“We can all agree that the American health-care system must be improved,” Communications Workers of America President Chris Shelton said in a statement. “This isn’t a health-care plan, it’s a shameful handout to corporations paid for by working families who will pay more for less coverage, and by those Americans who will be left with no health-care coverage at all.” Insurance companies could charge workers age 50 and older five times as much as younger workers, he added, while people who make more than $774,000 a year, insurance company CEOs, and insurance, drug, and medical-device companies would all get tax breaks.
The bill was released without any Congressional Budget Office projections of its costs and effects. In January, a CBO analysis of a similar House Republican measure from 2015 estimated that it would increase the number of people without health insurance by 27 million after it was in full effect. It also projected that insurance premiums for individual policies would go up by at least 20% almost immediately, and would “about double” within 10 years.
“Though this bill has been kept secret, and congressional leadership has failed to provide lawmakers and the public with a CBO score for their legislation, we already know that it will leave millions without coverage,” AFSCME President Lee Saunders said in a statement. “But the questions remain—how many will lose their coverage, and at what cost to jobs, local economies, and state budgets? No vote should occur on this legislation until those questions are sufficiently answered.”
House Speaker Paul Ryan “wants to jam through TrumpCare without any analysis of the new burdens on the middle class or a full accounting of how many millions of Americans will lose their health care,” said UNITE HERE President D. Taylor. “Lawmakers and the public will be left to guess the costs and effects.” He singled out its “ridiculous giveaways—like a tax break for health-care corporations that pay executives more than $500,000 a year.”
“Whoever you voted for in November, no one voted for dropped coverage, worse benefits at higher costs, and a huge tax on middle-class health benefits,” he concluded. “That’s exactly what TrumpCare does.”
The bill would also keep Obamacare’s so-called “Cadillac tax,” a 40% excise tax on employer-sponsored health-insurance plans that cost more than $10,200 for individuals and $27,500 for families, but delay its introduction from 2020 to 2025. a Last year, Ryan proposed taxing “the most generous plans” as income. Either scheme, North America's Building Trades Unions President Sean McGarvey wrote in a Feb. 1 letter to Congressional leaders, would “impose a significant burden on the 177 million Americans who receive health care through employment-based health plans,” as well as on the employers who provide them.
There are legitimate criticisms of the Affordable Care Act, RoseAnn DeMoro wrote on the CommonDreams Web site Mar. 7, notably the 28 million people still uninsured and “its abject failure to limit escalating out-of-pocket costs.” But the GOP plan, she said, “fetishizes a market-based health-care fundamentalism that saw the U.S. plummet in a wide array of health-care barometers, including infant mortality and life-expectancy rates and people skipping needed care due to cost.”
“Nurses know there is only one real fix to our broken, dysfunctional, profit-focused health-care system—an improved Medicare-for-all system, much as the rest of the developed world assures health care for its people,” she concluded. National Nurses United’s California affiliate, the California Nurses Association, is sponsoring a bill that would create a state-run single-payer system, and its New York chapter is backing a similar bill in the state legislature.