paul ryan

Please Explain the Health Care Replacement Plan

If you’re wondering what tf is going on with health care in this country and have no idea what any of the proposed changes mean because you actually don’t know what the Affordable Care Act (ObamaCare) was originally, and how that differs from the GOP replacement, the American Health Care Act, then welcome to the majority. Luckily, some of us poor sad souls majored in this in college and we are here to translate for you. Though if you have no basic knowledge of health insurance, pause, go read this, and then come back and we’ll continue.

Affordable Care Act

The Affordable Care Act was a piece of legislation that’s goal was to provide greater health security for Americans by implementing health insurance reform that expanded coverage. The act required that U.S. citizens and legal residents have qualifying health insurance and those without coverage would pay a tax penalty. It created state-based health benefit exchanges through which individuals could purchase coverage thus making health insurance more accessible. The act also required that employers with 50 or more full-time employees offer full coverage or be forced to pay tax penalties.

It proposed expansion of Medicaid to all non-Medicare eligible individuals under 65 years old with incomes up to 133% of the federal poverty level, which was optional for states who received federal financial support for the programs if they opted in. It prohibited insurance companies from ruling out coverage for individuals with pre-existing conditions (such as chronic illness like type I diabetes or even pregnancy) and allows children to remain on their parent’s plan as dependents through the age of 26. The plan certainly wasn’t perfect, but it did increase health insurance coverage and access, which is important and necessary.


American Health Care Act

Although it’s been repeatedly referred to as “dead on arrival” based on the resistance its received from medical associations and conservatives alike, the American Health Care Act introduced on March 6, 2017, still has a chance of becoming law. The major highlights of the plan are as about as well liked as Mondays. The plan proposes to repeal the insurance tax credits from Obamacare that were an adjustable rate based on an individual’s income, and replace them with a flat rate tax credit based solely on age.  Those under 30 years old would receive a $2,000 credit and those over the age of 60 would receive a $4,000 credit (and everyone else somewhere in between) across the board, regardless of income, etc. The issue with this is that the people who will be most affected are low-income individuals who will be receiving substantially less in credit, whereas higher income individuals may be receiving more.

To see how this affects you, checkout out this interactive map from the Kaiser Family Foundation- they also have great breakdowns and comparisons of all health care plans currently on the table.

The second major issue with the American Health Care Act is the proposed defederalizing of Medicaid. The plan suggests cutting $370 billion in federal funding for Medicaid which would force states to make up the costs individually. And when states aren’t able to make up the difference, it is expected that between 6-15 million individuals will LOSE health insurance coverage altogether. Meanwhile, if you’re in the ultra-wealthy 1% you could be seeing tax breaks up to $200,000, which is great because we all know that you being able to afford your second yacht is more important than allowing poor and disabled people in the United States access to health care which is only a basic human right, nbd.

health care

As a student of public health policy, this proposal is cringe-worthy, though I’d like to think that most decent Americans would agree. I mean, even Trump doesn’t want to put his name on the legislation and he puts his name on literally anything- regardless of quality (i.e. Trump University, Trump Steaks..)- so that says a lot. I’m not opposed to changing the ACA as it stands, but come on let’s find a solution, not just changing it for change sake.