But does it really? Partisans—supporters and critics—hold different views
U.S. Congressional House Speaker Paul Ryan, R-Wis., held a match to the legislative log pile that is “Obamacare” by unveiling “A Better Way: Our Vision for a Confident America,” a 37-page Republican plan offered in hopes of fatally igniting the Affordable Care Act (ACA).1 Whether it will catch fire and flare is yet to be determined. But partisans are already either fanning the spark with long-winded praise or throwing wet spitballs of complaints in hopes of extinguishing any heat.
There’s a conventional wisdom that Republicans deplore the ACA (also known as Obamacare) as much for its partisan beginnings as for its unwieldy size and implementation. Failed appeal attempts have been numerous and persistent since the 2010 passage of the landmark healthcare legislation.
What Is ‘A Better Way’?
The Republican plan is built on five major principles, with supporting documentation. They are excerpted here:
“1. Repeal Obamacare. The law… was filled with special interest handouts, budget gimmicks, and tax increases. Nonpartisan analysts warned the law’s mandates and regulations would lead to higher premiums and reduced access to care. Budget experts cautioned that the law’s cuts to entitlement programs were unsustainable, while health professionals worried about declining quality of care. Six years later, it is clear these warnings have become reality, and the American public is bearing the consequences. This law cannot be fixed. Its knot of regulations, taxes, and mandates cannot be untangled. We need a clean start…”
“2. Provide all Americans with more choices, lower costs, and greater flexibility. The nation’s healthcare system is too bureaucratic and too expensive… Insurance companies should be competing against each other to offer the most affordable, highest-quality options for consumers… Choice, portability, innovation, and transparency are essential elements of successful reform, and for too long they have been absent in healthcare.”
“3. Protect our nation’s most vulnerable. Patients with pre-existing conditions, loved ones struggling with complex medical needs, and other vulnerable Americans should have access to high-quality and affordable coverage options. Obamacare’s solution was to force millions of people onto Medicaid… We reject this approach. Instead, we believe states and individuals should have better tools, resources, and flexibility to find solutions that fit their unique needs.”
“4. Spur innovation in healthcare. From new procedures to advanced, life-saving devices and therapies, the U.S. has always been at the forefront of medical discoveries. Unfortunately, we cannot say the same for our policies. Today, it costs $2 billion and takes 14 years to get a new drug through the byzantine clearance process at the Food and Drug Administration. Obamacare made the problem worse by levying a new tax on medical devices, driving out jobs, and slowing the development of new … products that could help cure patients in need. Last year, the House passed the 21st Century Cures Act, which would… support advancements in cures and treatments. Our plan builds on that …”
“5. “Protect and preserve Medicare. “More than 50 million seniors and individuals with disabilities rely on Medicare for access to healthcare. Millions more are counting on Medicare to provide health security when they reach retirement. Unfortunately, the program is unsustainable and will fail current and future Americans without significant reforms. The problem is driven by demographics, cost growth, and outdated payment systems that encourage overuse of health services… Obamacare raided more than $800 billion from the program and … used the funds to finance the law’s open-ended expansion of entitlements. Republicans fundamentally reject this idea. Medicare must be protected … and strengthened …”
The document offers hellfire condemnation of Obamacare, stating the ACA “… has proven unaffordable, unworkable and intrusive…” It claims Americans with job-based healthcare coverage face higher premiums and higher deductibles. It further notes, “The nonpartisan Congressional Budget Office (CBO) has said that premiums in the individual market ‘are projected to grow somewhat more quickly over the next few years because of factors related to the ACA.’ And an analysis by the Heritage Foundation found three of Obamacare’s most costly insurance regulations—age-rating restrictions, benefit mandates, and minimum actuarial value requirements—‘collectively increased premiums for younger adults by 44%, and for preretirement-age adults by 7%, relative to the previously available least-expensive plans.’”
The GOP document claims insurers have struggled to conform with Obamacare mandates and regulations and, as a result, have canceled some policy options, leaving consumers with plans offering narrower networks and fewer providers. “On average, Obamacare plans have 42% fewer oncologists and 32% fewer primary-care physicians,” according to “A Better Way.”
What It Proposes
The GOP plan makes a variety of generalized proposals for change and improvement to American healthcare coverage. An executive summary declares “A Better Way” to be a “step by step plan to give every American access to quality, affordable healthcare.”2 The plan proposes:
- More choices for coverage and lower costs, by way of portable health insurance, expanded patient-centric care, preservation of employer-based insurance, insurance sales across state lines, allowing small businesses and individuals to band together for group buying power, support of wellness programs and enacting medical liability reform
- Protections: for pre-existing conditions, against sudden policy cancellation, for young adult dependents (until age 26) on parents’ policies and more
- Better cures and treatments via strengthening of the NIH, decreased barriers to research collaboration, acceleration of drug discovery and development, advancement of personalized medicine and improved use of electronic records
- Protection of Medicare by improving Medicare’s fiscal status.
Short on Details
The framework has merit, and purports to maintain some of the more popular aspects of Obamacare (such as coverage for pre-existing care). Yet critics are quick to point out that the devil is in the details—and the details are not clear.
After Ryan introduced the plan, ABC News reported, “The plan relies on individual tax credits to allow people to buy coverage from private insurers, and includes other largely familiar GOP ideas such as medical liability reform and expanding access to health savings accounts. It proposes putting $25 billion behind high-risk pools for people with pre-existing conditions and for others, and transforming the federal-state Medicaid program for the poor by turning it into state block grants or individual per-capita allotments to hold down spending. But [it]falls far short of a full-scale replacement proposal for ‘Obamacare’ and leaves key questions unanswered, including the size of the tax credits, the overall price tag of the plan, and how many people would be covered. Republican aides said it’s intended as an overall roadmap showing how the GOP would approach undoing and replacing Obama’s health law with a Republican in the White House, and specific legislative details would be answered as the actual bills are written next year.”3
A June 22 commentary in The Washington Post noted, “Despite what Ryan says, the plan doesn’t actually maintain the prohibition on denials of coverage for preexisting conditions … the single most popular element of the ACA. It does so only if you maintain continuous coverage, beginning with a special one-time open enrollment. If you don’t … insurers can once again deny you because of your medical history, just like in the bad old days. And his answer for people with costly medical conditions is high-risk pools, which are just about the worst way possible to provide insurance (they segregate the costliest patients together, making coverage impossibly expensive).”4
The Post further argued that repeal of the ACA would mean “… reopening the ‘doughnut hole’ in Medicare prescription drug coverage, and moving Medicare back to the fee-for-service model the ACA has successfully begun a move away from, taking away subsidies from small businesses, taking away funding for community health centers, bringing back cost-sharing (i.e. you paying money) for preventive care, shutting down all the pilot programs the law created to test new ways of delivering and paying for care, and a hundred other things that are going to cause enormous problems for hospitals, doctors and patients.”
Forbes also weighed in, stating “Ryan’s proposal is mostly a collection of old GOP ideas that have gone nowhere. Whether it gives Republican candidates a talking point beyond ‘repeal Obamacare’ remains to be seen. But it is little more than a starting point for negotiations should lawmakers want to talk about ways to improve the Affordable Care Act in 2017.”5
Healthcare will be one of the most important discussions in the upcoming run for the presidency. Whether this new take on healthcare coverage helps or hurts the GOP candidate — presumably Donald Trump, whose own healthcare plan was notably devoid of specifics—is a point of interest to both parties.
It may ultimately be up to American voters to determine whether ACA is repealed, reformed, reborn or replaced. Right now, it’s anyone’s guess, with a definitive answer likely to emerge after the November general election.
- U.S. House Republicans. A better way: our vision for a confident America. June 22, 2016. http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf
- U.S. House Republicans. A better way: snapshot. June 22, 2016. http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-Snapshot.pdf
- Werner, E. House Republicans offer proposals for health care changes. ABC News. June 22, 2016. http://abcnews.go.com/Health/wireStory/house-republicans-offering-proposals-health-care-40035713
- Waldman, P. Paul Ryan unveils plan to set fire to the American health-care system. The Washington Post. June 22, 2016. www.washingtonpost.com/blogs/plum-line/wp/2016/06/22/paul-ryan-unveils-plan-to-set-fire-to-the-american-health-care-system/
- Gleckman, H. What Paul Ryan’s latest health proposal would mean for seniors. Forbes. June 22, 2016. www.forbes.com/sites/howardgleckman/2016/06/22/what-paul-ryans-latest-health-proposal-would-mean-for-seniors/#17d044115f39