For the last two weeks, House Republicans have been rolling out their repeal and replacement plan for Obamacare. First and foremost, Obamacare intended to decrease the number of uninsured people in the US from around 15% of the population, or about 45 million people, to a much smaller number. By most accounts, about 10-15 million Americans ultimately gained health insurance as a result of Obamacare, far less than hoped for, but a significant number nonetheless. Two questions regarding the proposed bill that must be answered are will it maintain or decrease the number of uninsured Americans and will the result of the bill improve the quality of healthcare for those citizens?
The Obamacare insurance subsidies with the individual mandate provided a mechanism for an increased number of insured patients. Most of these patients were lower income individuals and families. Because there were limited choices in the individual marketplace, and a required benefits package, patients that did not qualify for subsidies paid high premiums and higher deductibles for their required health insurance. For these patients, healthcare premiums were very expensive, and services were mostly paid for out of pocket because deductibles were so high. Obamacare was broken for people in this group.
In the proposed GOP Healthcare bill, tax credits determined by age and geography substitute for the income related subsidies in Obamacare. The individual mandate is no longer present, so the beneficiaries of this plan are mostly older individuals from rural areas. The estimate by the Congressional Budget Office (CBO) is that if the bill passed as currently constructed, 24 million people would be left uninsured over the next 10 years. In addition, the CBO estimates that premiums would go up, however, there would be a substantial decrease to the federal budget deficit over the next 10 years.
This brings us back to the two important questions. The answer to the first is that if the American Health Care Act passed as constructed, it would increase the number of uninsured, and intuitively, the expectation would be a decreased level of care for those uninsured patients. The second question regarding quality of health care is more difficult to quantify, but it is becoming abundantly clear that the House Republicans are more interested in decreasing the federal deficit than improving the health of the American people.