The primary aim of any large-scale government program is not to save money. Social Security does not aim to reduce the deficit. The military does not turn a profit. The same is true — or, at least, should be true — of any federal health care policy. These policies should not first and foremost function as tax breaks for those who need them least. Instead, like any good social policy, health care reform should come from a place of concern and empathy. It should orient itself towards humanity, towards bettering and saving lives. It should assist not just those who have the least among us, but all of us.
The American Health Care Act loses sight of this.
The Congressional Budget Office, a nonpartisan agency within the legislative branch tasked with providing estimates on the effect of proposed legislation, recently released numbers on the AHCA. 14 million individuals will lose health insurance within two years. That number will rise to 24 million by 2026.
Through 2019, health care premiums will soar — they’re predicted to be as much as 20 percent higher than they are under current federal law. That number will start to decrease by 2020, but only because the sickest Americans will have their insurance coverage dropped altogether.
The AHCA rolls back Medicaid expansion, one of the most successful facets of the Affordable Care Act. The ACA established a matching program, in which the federal government provided a certain amount of funding for each dollar a state provided for Medicaid. To replace this, the House Republicans’ bill provides capped subsidies per enrollee, resulting in much less federal support for each state’s expansion program.
This matching system allowed for individual states to meaningfully expand Medicaid. Several traditionally red states that swung hard for Trump implemented Medicaid expansion, enabling poorer states like Kentucky, West Virginia and Arkansas to save thousands of lives. Eight of the states that expanded Medicaid have “trigger” laws on the books, which will automatically undo any Medicaid expansion if federal funding is cut. Within these eight states alone, the AHCA will cause over 3 million Americans to lose insurance. Because of this, four Republican governors issued a joint statement condemning the AHCA.
Beyond rolling back Medicaid expansion, irreparably harming the lives of millions of citizens, the AHCA provides unnecessary tax breaks for the richest Americans. This bill is essentially a $200 billion tax cut for the nation’s top 2 percent — totally disconnected from health care. The tax cut particularly harms the “white working class” that gave Republicans their near-universal federal power. It is not populism. It is not the will of the voters. It is Congressional Republicans pushing through a reckless ideology that was a key contributor to the Bush administration’s failures and wealth inequality.
Defenders of this so-called “replacement” bill will claim it provides choice. House Speaker Paul Ryan (R-Wis.) and other Ayn Rand-obsessed sycophants in the House majority repeat their favorite buzzwords endlessly: access, freedom, liberty. These are misleading. There is no choice if someone cannot afford care. And with rising premiums, that is sure to be the case.
As President Trump so aptly pointed out the other week, health care reform is hard. And the ACA is not perfect. Premiums are too high, and it is does not provide complete coverage for every single American. But its flaws are not that it provides too much, but too little. The ACA is essentially modified RomneyCare, the Republican Party’s one-time “conservative” answer to the much more expansive health care proposals Hillary Rodham Clinton put forward in the 1990s. It is the most conservative health care policy available that simultaneously provides coverage and is functional. To go to the right of the ACA means gutting coverage, which is precisely the effect of the AHCA.
The wealthiest, most powerful democracy in history can afford to provide coverage for its sick and its healthy. It can afford to provide coverage for its young, and its middle-aged, and its elderly. The choice to do otherwise is not only imprudent, but has lost focus of what Americans owe to each other as human beings. Government can and should be a force for good. In health care policy, where the stakes are so high and the effects are so deeply felt, this force for good is absolutely necessary. The AHCA is not the answer.
ARI GOLDFINE is a College sophomore and the vice president of Penn Dems.
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