Around 1 a.m., this morning, the Republican-controlled Senate took the first step toward repealing Obamacare, voting 51 to 48 on a budget resolution to begin on legislation to gut Obama’s signature achievement. One-by-one the Democrats stood up for the ACA, and one-by-one, they were drowned out by the GOP.
Al Franken, Elizabeth Warren among the parade of Democrats drowned out when defending Obamacare. pic.twitter.com/lkhcvxM0Tw— Dan Diamond (@ddiamond) January 12, 2017
One Republican, Rand Paul, voted against, saying that he wants a replacement plan in place before repeal.
This, of course, is just the first step in a long process, but Donald Trump signaled yesterday that Obamacare would be repealed on the same day that his Health and Human Services Secretary, Tom Price, is sworn in. After a few days in which it appeared that a few hesitant Republicans might hold up the repeal, Trump seemed to put it back on the fast track.
There still remains roadblocks for the Republicans, and without a replacement in place, they may not get the necessary votes, with Rand Paul, Tom Cotton, Susan Collins, and Lisa Murkowski expressing reservation.
A replacement plan will eventually be fashioned, but the GOP will need 60 votes to pass the replacement, meaning they will need at least 8 Democrats. Trump and the GOP think they can force the Democrats’ hand, but it will depend on what the replacement looks like. The replacement, however, is not likely to be nearly as good as the flawed Obamacare (and if it were, I’d want the Dems to vote for it anyway).
What’s the new plan likely to look like? Rand Paul’s alternate offers a rough outline of what to expect. The crux of it is this: The burden to pay for health insurance will switch from employer to employee through health savings accounts. Right now, health savings account allow us to put money into an account — tax free — to pay for healthcare costs. HSAs are great if you have the extra money to put aside, and you have one of those high-deductible plans where you’re going to end up paying out of pocket for a lot of your healthcare expenses anyway.
The Republican plan will expand those HSAs to cover health insurance premiums, as well as regular healthcare costs.
The big pro here is, because we’re paying for it ourselves, we’d get to choose our own health plans, which means in theory that we can choose our own doctors, etc., and it would be easier to maintain the same health plan if we lost or switched our jobs. The idea, anyway, is it would also increase competition among health insurance plans fighting for customers, which in theory would drive down the cost.
Moreover, the popular pre-existing conditions would be phased out, and the burden of covering poor people or those with pre-existing conditions would shift to the states, which is fine if you live in California, but not so fine if you live in a red or poor state.
It sounds great, right? We get to choose our own plans! They might be cheaper!
If you can already easily afford health insurance, and don’t plan to ever lose your job, and don’t have any pre-existing conditions or ever plan to develop any, it is great! Just enroll in a plan, put enough money aside into an HSA every month to pay for it, and stick with the same insurance plan for the next 30 or 40 years and you’re all set!
The reality, however, is this: A lot of employees who are not required to buy health insurance won’t. If you’re 25 and healthy, and you have the choice between paying $300 a month for something you don’t think you need or using that money to pay for food, gas, clothes, etc., you’re going to opt out of health insurance until you develop a pre-existing condition, but by then you’re f*cked, because no one will ever cover you.
Meanwhile, without the larger pool of young, healthy people, insurance premiums will go up across the board. Poor people, without the subsidies provided by Obamacare, won’t be able to afford health insurance, and they’re either forced to rely on Medicaid from the states that care about poor people, or they are shit out of luck. It will basically go back to the way it was before Obamacare — 20 million people will lose health insurance and people with pre-existing conditions will no longer be covered (that’s 52 million people, y’all). Only wealthy and middle-class people will be able to benefit from more portability (the ability to take your same health insurance with you from job to job). Millions of uninsured people will continue to get treatment through the ER, driving up the costs of medical care, which will be passed along to those with health insurance.
In other words, the Republican plan is a big fuck you to poor people and the uninsurable with pre-existing conditions (52 million people), but the GOP will tout that it gives the “people” more personal responsibility over their own lives and the ability to make their own health insurance decisions.
The plan, however, wouldn’t gain the necessary eight Democratic votes to pass it, which would ultimately mean no replacement, which means we would have neither Obamacare nor the shitty HSA alternative. The only good news here is that Republicans and Trump would be blamed for it, which is great if you care about politics more than you do about people.