GOP healthcare plan is Obamacare, but with a little extra spite

The GOP’s much derided healthcare plan is pretty revealing about their priorities. They grudgingly accept that people expect the right to get healthcare, and that government has to help, but they’ve just got to throw in some hate and spite to make it palatable.

The GOP doesn’t like programs that help poor people

The GOP kept subsidies to help people buy healthcare, but they made them age dependent rather than income dependent (and made them tax credits, because spending is not spending if it’s a tax credit). That means many poor people won’t be able to afford healthcare. It’s more “fair” to richer people that they get an equal subsidy, but the point of Obamacare wasn’t to hand out free money, it was to ensure coverage. This no longer does that.

…especially what they see as a handout for the poor

The most cruel part of this bill, and the one that is the most quintessentially republican, is the Medicaid cuts. They’re block granting the aid, which they claim gives states control over the money to “innovate as they see fit” but in reality just caps the aid so that future enrollment stalls as the population grows. It’s a way to cut the program without having to take blame for cutting it.

And of course tax cuts for the rich

Is there anything more stereotypically republican than cutting aid to the poor so you can give the rich a tax cut? Supposedly this will lower the revenue baseline which will help them with their other tax cuts down the road. That makes it worse, not better, in my opinion.

Getting rid of pre-existing condition protections and basic coverage requirements

These were the big concessions to the Freedom Caucus, which thought the bill was just too generous without them. Now states can opt-out of these provisions. We’ve certainly seen that conservative governors are not above throwing their citizens under the bus for politics. But the bigger threat is that insurance companies in less competitive markets will tell these states that they’ll pull out unless these provisions are nixed.

The republican spin machine is in full force on this front, saying it gives local control rather than your government forcing you to decide what to buy. It’s a passable talking point if you’re a Fox News addict, and that’s the point of it: just give the loyalists something to buy into and parrot. But it’s a bit like saying that auto insurance won’t cover you for rear-end collisions because we don’t want you to have to pay for that type of coverage if you don’t want to. This takes us back to the days when people would buy health insurance and after they have a heart attack: “oh look, it doesn’t cover ambulance rides or inpatient surgery.”

This is where the pettiness gets real

The funny thing is, none of the stuff we’ve talked about so far has anything to do with the two key problems with Obamacare. 1) is the unpopular individual mandate. This is addressed by charging 30% more for one year if you have a gap in insurance. I don’t think this will be enough personally to get people to act, so it will be interesting to see how this plays out. But at least it’s an honest attempt to address the individual mandate.

2) is making sure insurers don’t pull out because it’s unprofitable. This is primarily caused by two things. Not enough young healthy people are joining, and the government isn’t providing they payments it promised to help offset these uncertainties. The GOP is letting insurers charge older sicker patients more (offsetting the age based tax credits). This is a legitimate policy fix, even if it’s one I disagree with strongly.

The thing is, the GOP could have done these last two things, and NONE of the other stuff and still fixed the problems with Obamacare. Everything else is just GOP wish list stuff. This is who we have voted into office.

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