The So-Called 'Fiscally Conservative' Plan

The Affordable Care Act: Repeal and Replace

In this ongoing segment, Glasgow-based columnists Michael Burns and Alec Carmichael have agreed to square off on issues of national and international significance. Less a debate format than an opportunity to feature in-depth discussion, "Side by Side" will feature structured analysis of current events complete with fact-checking, editorial support and, when necessary, informal arbitration. To suggest a topic for our duo, write to [email protected].

When I think about government waste, I often think about the fact that thousands of government employees often perform redundant and unnecessary works that often bear little fruit for the American taxpayer.

The repeal and replace mantra of the so called “fiscally conservative” Republican Party has the same problem. In essence, the politicians on the hill hired aides to work behind closed doors to draft and construct a replacement plan that either will not pass or will cost Americans more in the long run. That being the same party that cried foul that a website went over budget, but that supports a plan, which according to the non-partisan Congressional Budget Office, will cost 14 million people their insurance next year and 24 million their insurance 10 years from now, so much for, “I want every American to have health insurance.”

The true cost to the “fiscally conservative” is what this is going to cost America in the long run. According to the CBO report, the non-partisan one, the cost of premiums will go up by 15 to 20 percent for single policy holders who are not covered by employers. This would likely affect most of Northeast Montana’s self-employed or ranchers and farmers. That 20 percent is on top of how much they went up under the Affordable Care Act. Why does that make sense? If the largest complaint against Obamacare was that premiums went up dramatically, why risk a further increase? It truly is not good policy.

In another great irony, the Republican plan hurts the older generations more than the younger, again singling out a group dedicated to their party. The Trump-Ryan Care plan would hurt the older generations by allowing companies to charge them five times more for coverage than younger Americans. This means that the millennial generation wins out as the baby boomer generation eats the difference (maybe that will make up for social security says the cynic). But I digress.

The highlight of the bill, according to the fiscally responsible, is that it seems to reduce federal deficits by $337 billion over ten years. This would come from reducing Medicaid expansion and by ending subsidies for lower-income families. In essence, the only thing the new care act would do that the old system didn’t was... oh wait I can’t think of anything. This is not a replacement. This is a repeal and hope for the best. It doesn’t increase coverage for the uninsured, help needy families, expand Medicare or Medicaid to seniors, and it doesn’t reform America’s troubled and inflated health care system. It is a shell put in front of Americans to act as a replacement for the now widening in popularity Affordable Care Act. But again I digress.

The real plan, as the Republican Party knows full well, is to present something that looks good to the constituents of the repeal and replace mantra, while not actually passing anything. Then next election the Republicans can say they tried, but that obstructionists prevented them from being successful. The populists who don’t see through the veil may still side with the Trump Party, but many will again defect and find another place to put their support.

It sounded better to call the system broken during the election than to offer up that some of it works and some of it needs tweaking. Fixing is the logical step towards solvency and in reality now has a much better chance of occurring than repeal and replace does.

What we could do is allow insurance commissions to control premium hikes, much like utility price hikes are controlled currently. If the hike doesn’t serve a purpose then does it actually need to occur? Not likely, but as insurance companies have demonstrated it is easier to charge people whatever they want for something they are forced to buy anyway. Therefore, if the commerce is forced for the people than the pricing also needs to be controlled by the government. Otherwise, companies will continue to take advantage of the lack of options people have.

Furthermore, reducing subsidies and Medicaid and Medicare will not solve the money problem just the deficit. The $337 billion in savings will again fall on hospitals who now still have to purchase healthcare for their employees, but cannot deny services to patients in need. Meaning many small and rural hospitals will again see an increase in financial aid and bad debts, which coupled with more expense, could spell trouble for small remote hospitals such as the ones in Northeast Montana.

Another consideration would be the loss in productivity. Health insurance means prevention as much as it does treatment. For every employee who falls ill and cannot work it costs employers productivity, employees in wages and the government in taxes. The revenue is not neutral it just gets laid off on other people.

The fact is, repeal and replace was a great chant at campaign rallies (I am really enjoying the Trump rallies for 2020 by the way), but it is terrible policy. We need to fix the broken premiums, reform prescription and hospital care pricing and take on the challenges the ACA actually presents, which relate to affordability, not access. The Republican plan blows affordability out of the water and takes accessibility off the table. It is simply not a replacement. It is just a repeal.