Before the U.S. Congress goes about its promised exercise of repealing the Affordable Care Act without much thought as to what would take its place, folks in these parts may want to review the hard truths behind what would be left in the wake of such a salute to political dogma.
First, let’s be clear about this: The political zealots on the far right – led by House Speaker Paul Ryan, R-Wis., and Vice President-elect Mike Pence of Indiana – are using a budgetary measure (“reconciliation”) to change national policy. This is not a stand-alone piece of legislation that would do away with the ACA in total, but rather a budgetary gimmick that chips away at the foundations of the law that, sooner rather than later, would allow the ACA to crumble.
This is not a move to attend to your health care needs here in Central Appalachia; it’s about scoring political points. It is a game and it is reprehensible when you pause to consider the collateral damage.
Second, the Republican leaders do not have a replacement plan and, in effect, are telling citizens to “Trust us.”
Good luck with that one.
Republicans, who have spent a good deal of time voting to repeal Obamacare, have had six years to come up with an alternative plan – and have nothing in hand. And now they are asking for our trust that they will get the job done – in short order.
The cynicism is, of course, that they want to erase any policy thumbprints of the Obama administration, regardless of its impact. That’s their plan. Let’s be clear: This is not about your access to quality health care.
In an appearance this week, Ryan did not offer up any facts. Just politicized opinion, a campaign stump speech. “This law has failed. Americans are struggling. The law is failing while we speak. … Things are only getting worse under Obamacare. … The health care system has been ruined – dismantled – under Obamacare.”
Fortunately for us, and unfortunately for Ryan – who, by the way, has a very nice health insurance plan provided by taxpayers – there’s plenty of proof in numbers that says Obamacare, while not perfect, has worked as intended.
For instance:
● The overall uninsured rate in the U.S. has come down precipitously since Obamacare was put in place. The decline in uninsured rates was especially pronounced among lower-income Americans.
● The average growth in per-enrollee spending by private health plans has fallen from 5 percent in 2000-2010, to 1.5 percent in 2010-2015.
● The rate of spending on hospital and physician services and prescription drugs has slowed.
● Medicare, which has instituted numerous cost-control initiatives under the Affordable Care Act, has seen an overall decline in spending per enrollee.
● Enrollment in the ACA grew to 12 million, up by about 1 million from 2015.
● More than 85 percent of all enrollees are entitled to subsidies, which limits and in some cases cancels out higher premiums.
● As noted in a story by Register-Herald reporter Wendy Holdren, uncompensated care costs at hospitals has fallen sharply in Medicaid expansion states, like West Virginia. That, alone, keeps smaller, rural hospitals open, providing health care to some of our nation’s most marginalized citizens.
Even more specific to West Virginia:
● The Urban Institute projects that 184,000 state residents would lose healthcare coverage in 2019 under an ACA repeal.
● West Virginia would stand to lose billions in federal funding with the repeal of the ACA. Yes, billions, with a capital B – a loss that would threaten the state’s healthcare infrastructure.
● According to a nonpartisan report from The Commonwealth Fund, the Mountain State stands to lose 16,000 jobs in 2019 if portions of the ACA are repealed.
Jobs, jobs, jobs, right?
Obamacare is not perfect. Few things in life are. Especially troubling has been the increased cost of premiums for households that have crossed the threshold at which subsidies are eliminated. But that, without repealing the law, can be fixed – if our elected representatives were serious about national health care policy.
We might even warm to a replacement plan – if only we knew what that was.
But by all appearance, our congressional leaders could not care less. They are in this only for themselves.
