When Republicans released their long-awaited health care replacement plan, much of their sales pitch featured words like “choices,” “options” and “access.”
“What matters is that we’re lowering the cost of health care and giving people access to affordable health care plans,” said House Speaker Paul Ryan, R-Wis., when asked whether the GOP plan would cover fewer people.
“Insurance is not really the end goal here,” said Office of Budget and Management director Mick Mulvaney, in an interview with NBC. “We’re choosing instead to look at what we think is more important to ordinary people: can they afford to go to the doctor.”
House Oversight Committee Chairman Jason Chaffetz cast the proposal in even starker terms: “Americans have choices and they’ve got to make a choice and so maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest it in their own health care,” the Utah Republican said, in an interview with CNN. “They’ve got to make those decisions themselves.”
The GOP rhetoric underscores a striking difference in how the two parties approach the potent politics of health care, long one of the country’s thorniest policy problems.
The Affordable Care Act, the signature domestic achievement of former President Barack Obama, aimed to use government funds to cover as many people as possible with health insurance.
Income-based subsidies helped millions pay for premiums and an infusion of federal funds expanded state Medicaid rolls. Those who went without insurance were subjected to tax penalties — an unpopular provision that quickly became a political liability for Democrats.
But Republicans don’t believe the government should provide billions of dollars in subsidies for people to buy insurance as they seek to scale back the role of government in health care.
Now that they control Congress and the White House, they’ve set a goal of “universal access.” That means everyone would get a chance to buy some form of insurance — but they wouldn’t necessarily get it.
Their plan would provide age-based and income-based tax credits that could be used to buy any state-licensed health plan. There would be no tax penalties for the uninsured, though insurance premiums could increase by 30 percent for those who let their policies lapse.
The credits, which range from $2,000 to $4,000 would not cover as much of the cost of premiums as the current subsidies for many people, particularly older Americans.
The GOP rhetoric makes sense politically, says Robert Blendon, a Harvard University expert on public attitudes about health care.
“They’re offering the idea that you’ll be able to acquire an insurance plan that’s more affordable and more flexible than what you have. But it’s not going to come with a subsidy,” he said. “Otherwise, it would look like they’re just trying to get rid of a plan that covers millions of people.”
Critics say what’s being lost is actual coverage and benefits.
Since the law passed, about 22 million people have gained coverage through Medicaid and by buying private health insurance on government-sponsored markets that offer plans with subsidized premiums. The national uninsured rate is below 9 percent, a historic low.
Republicans are moving forward with their plan without any official estimates from the Congressional Budget office of how many people would gain or lose insurance. They hope to pass the legislation before lawmakers leave for the congressional recess in early April.
But a preliminary analysis released on Tuesday from ratings agency Standard & Poor’s found that about 6 to 10 million people will lose health insurance if the bill passes.