A point of clarification for Reps. Erik Paulsen, Tom Emmer and Jason Lewis, the three Minnesota Republican U.S. House members who voted for their party's health reform plan: When you vowed on the campaign trail to repeal the Affordable Care Act, the expectation was that the replacement plan would improve upon former President Obama's signature health care law.
But for the second time now, one of the nation's most authoritative voices has confirmed that the GOP's American Health Care Act (AHCA) would be a disastrous step backward when it comes to cost and quality coverage, particularly for older and sicker Americans. There's no honor in keeping a promise to repeal the Obama law, which is how Lewis and others have defended their AHCA support, when the replacement would gut Medicaid, a safety-net program for children and the elderly, and would leave millions more Americans without health insurance.
On Wednesday, the nonpartisan Congressional Budget Office (CBO) released its second analysis of the AHCA. Just like the agency's first report, released before the House hastily revised and passed the bill on May 4, the second assessment is fair and brutal.
The revised AHCA, which included compromises to garner broader support for House passage, only minimally improved upon the original version of the bill. The CBO concluded that the changes would result in 23 million fewer Americans having coverage by the middle of the next decade compared with the Obama law. The original AHCA would have left 24 million Americans without coverage in the same time frame.
The revised bill also didn't score as well when it came to balancing the federal government's books. It would reduce the federal deficit over the 2017-to-2026 period by $119 billion — $32 billion less than the savings booked from the original bill.
The CBO deserves credit for taking direct aim at claims that the bill would save consumers money and provide robust protections for those with pre-existing medical conditions. The reality is that younger and healthier people might save money. But the trade-offs for helping this demographic group are painful, as the report makes abundantly clear.
Older people, such as retirees who aren't old enough for Medicare, would generally pay far more and get substantially less aid to cover their monthly premiums. Savings for the able-bodied would rely on shunting those with high-cost medical needs into underfunded, government-run "high-risk pool" insurance. Many would be unable to afford their premiums in these new programs. Minnesota had a high-risk pool before the Obama reforms, and it was unaffordable for many consumers.
It was irresponsible for House Republicans to vote on the revised AHCA before the CBO had a chance to rework its analysis. The Senate, where the bill heads next, should not repeat the same mistake. It is troubling that, so far, the Senate has done much of its early work on health care reform behind closed doors.
In particular, the proposed $834 billion in cuts to Medicaid, which pays for the bulk of long-term care for the elderly and disabled, must be done in the open, particularly when most of the savings are eaten up by tax cuts. Medicaid also covers at least 30 million children.
Republican rhetoric for years has magnified the flaws of the Affordable Care Act. The Obama reforms clearly need improvement. But the CBO has made it clear twice now that enacting only Republican reforms would make things worse.
It's time to acknowledge that neither party has all the answers and to move forward with bipartisan solutions. It reflects poorly on political leadership that few Americans expect that to happen.
