Republican health care plan lacks care for the vulnerable

Vermont's independent senator Bernie Sanders minced no words when describing the American Health Care Act being proposed by Republicans in Congress and strongly supported by the president.

"The reality is that Donald Trump and Paul Ryan's bill is not a health care plan. It's a massive transfer of wealth from the middle class to the wealthiest people in America. It must be defeated," Sanders declared in a statement on Monday.

Some might dismiss this as Sanders' typical firebrand rhetoric, but Vermont's Republican Governor Phil Scott also has misgivings about the plan working its way through Congress at warp speed.

"At first blush, this appears it would have a detrimental effect on Vermont, " Scott told reporters at a briefing on Friday. "We take this seriously."

A report from the Congressional Budget Office released on Monday states that 14 million Americans would lose coverage next year under House Republican legislation remaking the nation's health care system, and the number would balloon to 24 million by 2026.

On the plus side, the budget office said the GOP measure would reduce federal deficits by $337 billion over the coming decade. But that's largely because it would cut the federal-state Medicaid program for low-income Americans and eliminate subsidies that Obama's Affordable Care Act provides to millions of people who buy coverage. It would phase out Obama's expansion of Medicaid to 11 million additional low earners, cap federal spending for the entire program, repeal taxes the statute imposes and halt federal payments to Planned Parenthood for a year. Though average premiums are ultimately expected to fall, that would vary for people of different ages because compared to Obama's law Republicans would let older people be charged more.

Another major difference is the tax credits. The Republican plan still offers tax credits, which is why many conservatives opposite it, but they're structured differently. The biggest losers under the change would be older Americans with low incomes who live in high-cost areas, according to an analysis by the Kaiser Family Foundation. Those are the people who benefited most from Obamacare. For some — younger people with higher incomes who live in areas where the cost of health insurance is low — the new tax credit system will be more generous.

The Republican plan would also be a boon for insurance companies and their executives. As noted by CNN Money, there's a hefty tax break for heath insurance companies under the Republican plan that could translate into higher pay for top executives. The bill would roll back a provision of the 2010 Obamacare law that placed a $500,000 limit on deductions for each executive's compensation, according to a summary from the staff of the House Ways and Means committee. Five major insurers paid their CEO's $73 million in 2015, the most recent year for which pay has been reported. Only $2.5 million of that was deductible under Obamacare tax laws. But more than $70 million of that would be deductible under the proposed Republican legislation.

"Throwing 24 million Americans off of health insurance, raising premiums for older low-income Americans, defunding Planned Parenthood and giving $275 billion in tax breaks to the top 2 percent is a disgusting and immoral proposal," Sanders said in his statement.

Here in Vermont, top health care officials say the Republican plan could cost the state's Medicaid program up to $200 million in federal funds in 2020. If that happens, the state could be forced to lower Medicaid payments to doctors and hospitals, reduce benefits for Medicaid patients, and cut other health programs that receive Medicaid funding. Officials are also concerned it could increase the gap between people eligible for Medicaid and those who can afford insurance, resulting in more people without health coverage.

"We have done a good job of closing that gap. We now have one of the lowest uninsured rates in the country, and looking at this we have concerns this will march us back," Mary Kate Mohlman, Vermont director of Health Care Reform, told reporters.

The defunding of Planned Parenthood is also a sticking point for the state. About $2.5 million of that $200 million is federal money that the Vermont Medicaid program would have paid to Planned Parenthood when Vermonters go to a clinic for reproductive services such as cancer screenings and wellness visits.

"Women's health care is a priority for the governor," Vermont Human Services Secretary Al Gobeille told reporters at the briefing. "This bill as proposed doesn't help that. That's a problem for us The question becomes, `What does the state do about that?' and that's unclear at this time, but I believe it's a priority."

Sanders and Scott are right - this bill would have a detrimental effect and must be defeated, but more significantly, for the past six years, Republicans have tried more than 50 times to repeal the Affordable Care Act. Rather than spending those six years working on a replacement plan, or revisions to ACA, they bloviated and heaped scorn upon a program that was enacted without their support (even though it was originally proposed by the Heritage Foundation, a conservative think tank).

If Republicans really cared about the cost of health care in America and had compassion for the uninsured and underinsured, they could have had an adequate plan of their own ready on Day One of the new administration. Instead, they showed their true colors. This wasn't about caring for the most vulnerable in our country; it was about rebuking the previous president and rewarding their donors. They should be ashamed.


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