Supporters of the American Health Care Act (AHCA) claim an unparalleled victory, a promise fulfilled, and a cure for our failing health care system. Detractors see the end of the world: “thousands will die” from lack of health insurance.
Let’s all step back from the ledge, take a deep cleansing breath, eschew the hyperbole, and consider six facts followed by a suggestion.
Fact #1: Nothing has happened, nothing at all. Despite the shock and awe, regardless of proclamations of “insurance for everybody” on the one hand or doomsday on the other, the AHCA has not impacted the health care of a single American in any way, shape, or form. If you had insurance yesterday, you will still have it tomorrow, and the premiums won’t change next month. If you have a doctor now, that provider will still care for you next weekend.
Fact #2: The Senate is likely to change the bill that the House just passed: they may totally revise it; and they could even pass nothing at all. No one knows what the Senate will do. Sen. Susan Collins, R-Maine, says they will “start from scratch,” meaning a blank slate. Average Americans don’t know what to worry about or even if we need to worry. We are anxious because the future of health care is unknown and that is frightening, particularly as the care of our health is critical to all of us, literally.
Fact #3: The ACA created twelve new taxes such as the Medical Device Tax, an Earned Income tax, the Cadillac tax, and the Medicine Cabinet tax. Four previously existing taxes were increased, including the Biofuel tax and the Medicare Payroll tax. The AHCA rolls back virtually all of these taxes. There is a good chance that the Senate will leave the rollbacks in place. That translates to more take home pay, more money in your wallet, and probably more job opportunities.
Fact #4: The AHCA eliminates some ACA mandates, such as individual and employer penalties. The bulk of the ACA regulatory and administrative apparatus remains intact and untouched. This is unfortunate as that expanded bureaucracy was the main reason why the ACA caused the cost of insurance to skyrocket instead of plummeting as promised.
The amended AHCA adds to the size and complexity of the health care bureaucracy with its tax credits and insurance bailouts. Most observers doubt that the Senate will reduce the size of the health care bureaucracy but, again, no one knows for sure. Let’s see what they do before we push the panic button.
Fact #5: The Congressional Budget Office released an assessment of the projected effects of the original AHCA bill on March 9, 2017. They have not scored the amended AHCA passed on May 4, which is quite different from the original. The AHCA score from March 9 is irrelevant. We have no idea how much the amended AHCA will cost, how it will effect insurance coverage, and most important by far, what the Senate’s final version will do to our access to health care.
Fact #6: The AHCA bill that the Senate will take up expends many additional billions of dollars to stabilize insurance markets and to create high-risk pools. Though such spending contributes further to national debt, with the vehement rhetoric about insurers refusing to sell insurance and the need to cover for pre-existing conditions, it is doubtful that the Senate will reduce what the House wants to spend.
They might even increase the bailouts to encourage sellers to return to the market. Whether insurance carriers who stopped selling insurance — UnitedHealth, Humana, Anthem Blue Cross and Aetna, to name a few — will come back into the market remains unclear.
While we wait, there is something we can do, indeed, something we must do.
Both the public and especially the media need to stop the vitriol, tone down the bombast, convert hysteria into tranquillity, and let the senators do their work in peace. They need an atmosphere of calm, collegial problem-solving rather than embattled legislators hunkered down in bunkers on two sides of a political battlefield.
If the Senators are forced to approach health care defensively due to ad hominem attacks, constrained by party dicta, and consumed with tactical concerns over midterm elections, they will be unable to craft a bill that puts health care in its proper perspective: access to timely care first and foremost, with everything else secondary: cost, coverage, national spending, and lastly, politics.
- Waldman, who holds both M.D. and MBA degrees, is Emeritus Professor of Pediatrics, Pathology and Decision Science, and Director of the Center for Health Care Policy at the Texas Public Policy Foundation. He is the author of “The Cancer in the American Healthcare System” and can be reached at [email protected].