As Brit living in America, it is difficult to express the horror I feel when watching politicians play political football with people's health care. While there are fierce debates as to how to fund the NHS, the notion that someone could not get health care because they couldn't afford it is completely and utterly alien to me. You can walk in to any hospital in the UK and get exactly the same world class health care as everyone else does without any insurance, without filling out forms, and without any proof you can pay for it. You can get all lifesaving drugs for under $10/month (and not pay that if you can't afford it), and never, ever have to worry about going bankrupt due to expensive medical care bills. You get treated, you go home and that's about it.
While Obamacare isn't perfect, it did a lot to ease the perpetual anxiety the majority of Americans feel about their health care. With the Affordable Care Act, Americans could finally get insurance if they had a pre-existing condition. Millions of poor people left uninsured by the supposed wonders of free market capitalism were able to get quality insurance for their families. The ACA expanded Medicaid, allowed the young to stay on their parents health care plans for longer, and emphasized pre-emptive care to bring down costs in the long term.
Then, Americans elected Donald Trump into office, a man who ran primarily on kicking out immigrants and wrecking Obamacare without any plan to replace it. After multiple cack-handed attempts to repeal and replace Obama's signature piece of legislation with ludicrously badly crafted plans, it appeared Trump and the GOP's attempts to return health care to the dark ages were finally over. It was a humiliating defeat on many levels and Obamacare remained the law of the land. That was until this week when the GOP crawled out of the cave it retreated into and put forward yet another plan to replace Obamacare that would, by all accounts, be far worse than any of the other idiotic versions before it. Reported Vox's Sarah Kliff:
While other Republican plans essentially create a poorly funded version of the Affordable Care Act, Graham-Cassidy blows it up. The bill offered by Republican Sens. Lindsey Graham and Bill Cassidy takes money from states that did a good job getting residents covered under Obamacare and gives it to states that did not. It eliminates an expansion of the Medicaid program that covers millions of Americans in favor of block grants. States aren’t required to use the money to get people covered or to help subsidize low- and middle-income earners, as Obamacare does now.
Plus, the bill includes other drastic changes that appeared in some previous bills. Insurers in the private marketplace would be allowed to discriminate against people with preexisting conditions, for example. And it would eliminate the individual mandate as other bills would have, but this time there is no replacement. Most analysts agree that would inject chaos into the individual market.
The New Yorker's John Cassidy was equally as scathing, essentially calling it a cynical move to pass more tax cuts for the rich:
It [the Graham-Cassidy bill] would roll back the Affordable Care Act’s expansion of Medicaid, which has enabled about fourteen million Americans to obtain health-care coverage. Then it would subject the rest of Medicaid to substantial cuts by converting it to a block-grant program. By targeting the low-paid, the sick, and the infirm, the legislation would create hundreds of billions of dollars in budget savings; these could then be applied to Republican tax cuts aimed primarily at rich households and corporations.
The bill isn’t just a smash-and-grab raid on the poor and nearly poor, though. It would also undermine the insurance exchanges set up under the A.C.A., by stripping away the subsidies for the purchase of policies, abolishing the employer and individual mandates, getting rid of the lifetime caps on health-care outlays, and allowing insurers to force people with preëxisting conditions to pay more.
The passage of this bill is far from certain, but it is still a serious threat to Obamacare if the Democrats and the public do not pull out all the stops to prevent the GOP from ramming it through. Lindsey Graham and Bill Cassidy's plan for a new health care system is to destroy the best parts of Obamacare and replace it with nothing. They want a free market system run by insurance companies with no government interference, no standards, and no protections for consumers. As Kliff points out, this bill goes much further than previous GOP attempts to keep costs down for consumers by basically eliminating the individual mandate and replacing it with nothing:
Other Republican bills recognized they needed to replace the individual mandate with something to encourage enrollment among the healthy. The American Health Care Act in the House had a surcharge for those who have a break in coverage. BCRA had a six-month waiting period for anyone who has a break in coverage but then wanted to re-enter the market.
Graham-Cassidy has ... nothing. The individual mandate and subsidies would disappear, but the mandate to cover everybody would stick around. Any health economist will tell you that this is a dysfunctional market: Premiums would spike as only the sickest people enroll, ultimately leading to a death spiral.
When you look at the details of the bill, it immediately becomes apparent that it isn't a real replacement plan at all. It would be catastrophic for the poor, hugely damaging to the middle classes and anyone with a pre-existing condition, and a huge benefit to the rich. Yet it is still regarded as a viable Obamacare replacement by the GOP and could well become the law of the land. Trump has already stated he will sign it should enough Senators get behind it, and with only Sen. Rand Paul publicly stating he won't support it, Obamacare is in serious trouble again.
Is it time to panic? Absolutely.