Over the history of the United States, many health reforms have been proposed, but very few pass the bar to be implemented. Barrilleaux, & Rainey (2014) suggest that the rigidity of the health care system is the reason why it is hard to apply these health reforms. President Lyndon Johnson implemented the first-ever health care reform in 1965. The health insurance coverage, known as Medicare, covered both hospital and supplemental medical insurance for senior citizens. After much criticism for only targeting the rich, the legislation introduced Medicaid which focused on helping the poor.
Medicaid is run by both the Federal Government and the states. Over the years, many reforms have seen their way into the legislation, but very few have been passed. That was until 2010 when President Obama introduced a landmark health reform, the Affordable Care Act, commonly known as Obamacare. It is arguably the most critical health reform since the Medicare and Medicaid of 1965. Through Obamacare, more than 20 million Americans gained access to health care coverage. Evidently, since its implementation, the national uninsured rate has been at a historical low while the costs are rising at their lowest rate in over 50 years (Beland, Rocco, & Waddan, 2014)
Passing a health care reform has always been considered the highest achievement by any administration mostly because it results in increased number of people under a health insurance cover many of whom never had such access before (Barrilleaux, & Rainey, 2014). However, such a move should be free from partisan politics as it could have severe consequences on the health, well-being, and economic security of the American people. The step by the current Presidency to implement a new health reform is a callous and irresponsible move. A rushed move to repeal the Obamacare would be catastrophic to tens of millions of Americans.
Implication of Repealing the Obamacare Act
Less than two years since taking the office President Trump is determined to have his party repeal the Obamacare. The bill titled American Health Care Act is already in the Senate which has significantly increased the chances of being passed. This has raised concerns all across the country. Many people see the move as a rushed decision which is mostly motivated by politics, a battle between the Democrats and the Republicans. While it will likely change a lot before finally reaching the Presidents desk, it is clear on who stands to lose and who will gain if it is passed.
Before looking at the details of who and how different people will be affected, here are the proposals of the legislation. First, it calls for providing refundable tax credits depending on the persons age and income. Additionally, the bill will allow the states to waive protections to those with pre-existing medical conditions. It also enables the insurers to charge higher rates to older people. If the bill is passed, the enhanced federal match for Medicaid expansion planned to start in 2020 will be eliminated entirely. The Federal government supports the Medicaid by covering about one in every five American. The bill will withdraw this support leaving the Medicaid to be fully funded by the States. Finally, the bill seeks to lift the taxes on the wealthy, insurers, and the companies which were a requirement of the Obamacare Act (Carroll, 2017).
The Politics behind the Repealing of the Obamacare
The American Health Care Act failed its first vote In the Senate, in July. The Republicans in the Senate have made several changes and are yet again trying to pass the bill. This begs the question, why are the Senate Republicans so eager to repeal the Affordable Care Act despite all the reasons in the world not to? A Fox News article points out one of the reasons for the Republican obsession with the American Health Care Act. According to the report, the party is obligated to fulfill a campaign promise they made to the American people. Failure to deliver the pledge could have severe electoral consequences on the coming elections planned for the mid-next year.
The New York Times brings another twist to the matter. The newspaper published an article saying that the Republicans cannot give up on the bill that easily because their donors want it. Carroll (2017) agrees that this point makes sense. An anonymous Republican senator revealed that McConnell returning the law to the Senate shows the donors that they tried. Levinsohn et al. (2017) associate the slow fundraising of the party to the disappointment of the donor due to their lack of accomplishment. The Washington Post stated that recently, the senators had received open criticism from their supporters, friends, and donors over the repeal failure.
According to Capretta (2017), the pressure of the donors to Republicans is working on the repeal bill is garnering new votes. For instance, Dean Heller, a moderate senator known for his high opinion against the repeal efforts has suddenly switched to become a strong supporter of Graham-Cassidy. This move is reportedly after the senator had a meeting with two billionaire GOP donors in his state, Steve Wynn, and Sheldon Adelson.
Why Are the Donors Interested in The Bill?
Republican donors want the American Health Care Act to repeal the Obamacare. But why? The Obama Care Act has made health insurance affordable even to the needy American families. To achieve this, the bill has tax credits which defray the cost of health insurance. And when the lawmakers could not find the money to fund the subsidies, they did what Democrats are best known for, raising taxes on wealthy families (Liscio, & Stonecash, 2017).
On the other hand, Republicans are known for their dislike of the idea of more taxes from the wealthy. They dislike this idea so much that in 2011, they would have forced the country into defaulting on its national debt rather than agree to overturn the high-end tax cuts by George W. Bush (Carroll, 2017). In 2012, the Republicans maintained their position of not letting President Obama extend the Bush tax cuts for everyone unless he continued the tax cuts for the wealthy people only.
Subsidizing the health costs of the poor and working-class Americans is expensive, and while the Democrats and their supporters and donors are for the strategy of the rich paying for it, the Republicans, mainly their donors are not, and they will not barge.
A Possible Compromise
The Affordable Care Act also has its flaws which the American Care Act seeks to fix. However, the Democrats, though they accept some of the flaws would rather have the bill amended rather than carrying out a new reform. Senate Majority Leader Mitch McConnell had warned of a scenario which could bring bipartisan between the two parties. Capretta, (2017) agrees that such a strategy would result in the best health reform in America yet. The insurance markets reform is the best point to start the negotiations between the two parties on the bill (Oberlander, 2017). Such a compromise on the insurance would either lower the premiums or stabilize the insurance markets. More than 41, 000 Americans in over 60 counties are at the risk of having no insurance options while much more could see their monthly health insurance premiums increase from next year.
The Democrats are now more than ever more willing to allow states to be more flexible in structuring their insurance exchanges after admitting that Obamacare has its weaknesses. Levinsohn et al. (2017) hint that they are willing to allow the insurers to dictate how much to charge the older and sicker policyholders and maybe modify the strictness of essential health benefit requirements. On this issue, both parties seem to agree on several healthy policy solutions. The bill should include a massive reinsurance program that will offset the costs of the sickest people. Sen. Lindsey Graham proposed that those who have any of the five most expensive health conditions be put in a federally managed risk pool. This will ensure that the healthy Americans do not need to subsidize their insurance covers.
The mandates and essential health benefits is another aspect of the bill that causes a rift between the two parties. On this matter, Liscio, & Stonecash, (2017) observe that Democrats are willing to negotiate as long as the Republicans back off the proposals to have the Medicare spending reduced in the future. Affordable Care Acts individual and employer mandates are unpopular to most, even the Democrats (Blase, 2011). The new legislation as passed by the House allows the insurers to charge higher penalties of 30% to those who fail to maintain continuous coverage. The pending Senate version seeks to impose a six-month waiting period for individuals who may want to re-enter the insurance market.
One issue still to be known is whether the Democrats will accept the widening of the existing age bands. When many of the senators are asked this question, they say it is premature as they are focusing on market stabilization first before they dwell on this matter as Carroll, (2017) reports. The American population is watching closely if the two parties will have a deal that both will confidently accept. So far, the Democrats are expressing their frustrations as the other side is apparently not making enough effort to come to the table with them.
The policymakers should focus on progressing the Affordable Care Act by implementing the Health Insurance Marketplace policies that make the market more stable. The efforts to have negotiations is a move in the right direction by the lawmakers. The challenges of delivery systems, federal financial assistance for new enrollees should be at the center of the proposed reforms. Additionally, establishing a public plan option for the areas that lack individual market competition and trying to reduce the cost of prescribed drugs are apart of the areas the reforms address. The bipartisan efforts in this health reform are a sign that it is possible to achieve positive change to one of the most complex challenges facing the country.
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Blase, B. (2011). Obamacare and the Employer Mandate: Cutting Jobs and Wages. The Heritage Foundation: Leadership for America.
Burgin, E., & Bereznyak, J. (2013, July). Compromising partisans: Assessing compromise in health care reform. In The Forum (Vol. 11, No. 2, pp. 209-241).
Capretta, J. C. (2017). Building a Broader Consensus for Health Reform. JAMA, 317(22), 2273-2274.
Carroll, A. E. (2017). A Look at Republican Plans for Repealing and Replacing Obamacare. Jama, 317(4), 348-349.
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Jones, D. K., Bradley, K. W., & Oberlander, J. (2014). Pascal's Wager: health insurance exchanges, Obamacare, and the Republican dilemma. Journal of Health Politics, Policy and Law, 39(1), 97-137.
Jost, T. (2016). Day one and beyond: what Trumps election means for the ACA. Health Affairs Blog, 9.
Levinsohn, E., Weisenthal, K., Wang, P., Shahu, A., Meizlish, M., Robledo-Gil, T., & Berk-Krauss, J. (2017). No time for silence: An urgent need for political activism among the medical community. Academic medicine, 92(9), 1231-1233.
Liscio, R. E., & Stonecash, J. M. (2017). Parties, Public Policy Differences, and Impact. New Directions in American Political Parties, 251.
Oberlander, J. (20...
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