Healthcare is broken in the United States. Regardless of what side of the aisle you're on, the evidence is overwhelming that something needs to change.
“We are spending nearly 1 in 5 dollars in the economy on healthcare. That’s far more than any other developed country on Earth and we do this without any demonstrably better healthcare outcomes,” said Dr. Robert Hartwig, a finance professor at the Darla Moore School of Business and one of the nation’s top authorities on the Affordable Care Act (ACA).
On May 4, House Republicans narrowly passed their plan to try and combat these issues by a vote of 217-213. Twenty Republicans along with all 193 Democrats voted “No.” One Republican abstained.
Their bill, titled the Affordable Healthcare Act (AHCA), has now moved on to the Senate where it was renamed the Better Care Reconciliation Act of 2017 (BCRA). BCRA is currently facing heavy resistance from Democrats and factions within the Republican party. This has forced Senate Majority Leader Mitch McConnell to postpone a vote on the bill until after Congress’s July 4 recess.
The goal of the BCRA is to repeal and replace the ACA and to reduce the burden of healthcare costs on the federal government. Republicans believe the ACA has driven up costs, people have lost access to the doctors of their choice and that there is too much government involvement in healthcare, Hartwig said. Republicans typically favor a private sector-oriented healthcare system over a heavily regulated federal government system although the degree to which government should participate is still a hot topic within the party.
The BCRA seeks to scale back the Medicaid expansion from the ACA and ultimately, the thought is that it would lower the cost of insurance for some individuals. The plan does not claim to lower the costs of providing healthcare in the United States; however, it claims to provide more options for insurance than are currently available. For example, a person could purchase a less expensive policy that may not be as comprehensive as what is currently required under the ACA but can provide a more individualized insurance plan to each person. More extensive policies could also be purchased, much like they were before the ACA. This bill also removes the financial mandate to purchase insurance under the ACA.
The BCRA keeps a few of the popular ACA benefits while getting rid of many others. Under the BCRA, people under the age of 26 will still be allowed to stay on their parent’s insurance and “insurers would still be required to provide coverage to any applicant, and they would not be able to vary premiums to reflect enrollees’ health status or to limit coverage of preexisting medical conditions,” the Congressional Budget Office’s (CBO) report said.
“We’re talking about going back to the funding system that existed prior to the Affordable Care Act and then increasing the funds available to Medicaid on a per capita basis by an amount tied to the consumer price index,” Hartwig said.
The CBO, a nonpartisan committee tasked with providing economic analyses of congressional bills, estimated that the bill would reduce the federal deficit by $321 billion over a decade. This CBO report also estimated that 22 million more people would be uninsured by 2026 and that Medicaid would have 15 million less people enrolled by 2026.
"There are some Republican senators who believe the replacement bill does not go far enough in terms of scaling back the ACA and there are others that believe it goes too far," Hartwig said. McConnell has had such difficulty in passing this bill through the Senate because “each time [McConnell] tries to placate one faction of his party, he winds up losing the support of the other faction,” said Hartwig.
Another reason the Republicans are facing such heated opposition on this bill is that “the ACA has been the law of the land for seven years now. Its main components have been enforced for three or four years, people have begun to grow used to it and once an entitlement is established, it is very difficult, if not impossible to ever put that genie back in the bottle,” Hartwig said.