Lemme lay some education down on y’all.
The Republicans have sworn to repeal and replace the existing Romneycare system. However, what the end result of that effort looks like is very unclear. There are competing Republican ideas from leaders in the House, Senate, and the incoming White House. It is way too early to make an accurate prediction as to what repeal and replace will look like. We can, however, make some educated guesses based existing plan drafts.
One of the most detailed repeal and replace plan at present comes from Speaker of the House Paul Ryan. Paul Ryan’s “A Better Way” details reform of Romneycare that one might assume, ab argumentum, is representative of an ultimate repeal and replace end point. “A Better Way” details a plan that would maintain guaranteed issued and has means by which insurance plans and insurance purchasers can spread risk to lessen the cost consequences of guaranteed issue. Given that the Ryan plan forces insurers to maintain guaranteed issue, it can hardly be said that the plan denies people health coverage.
Other Republican plans also preserve guaranteed issue. Tom Price’s plan, which is a bit more legislation ready than Ryan’s, mandates guaranteed issue for those individuals who have maintained coverage. Trump has not yet released a plan but he has indicated that his plan will have a guaranteed issue provision. In short, the regulations on the insurance industry that Republican leadership are proposing will force insurers to issue coverage to those parties who, say ten or twenty years ago, could not find accessible coverage. Other Republicans will likely propose only repealing Romneycare and not providing a reform-based replacement, but those Republicans are not demonstrative of leadership or of Republicans as a whole.
The Republican plans, as most of them stand, would increase coverage for individuals when contrasted with the insurance market of ten years ago. However, the Republican plans, as purposed, will not achieve the stated goals of reducing insurance costs because they are fundamentally flawed economically. Ryan’s plan, as purposed, is not a viable long-term means to provide and pay for reasonably-priced health insurance of Americans. Prices will jump under Republican plans, but the Republicans wouldn’t admit that. Then again, Obama’s ACA was (and is) also fundamentally flawed such that it was itself non-viable in the long term, and it resulted in price jumps as well.
In short, the Republican plans as proposed do not involve forcing people to choice between death and begging at a charity. The plans conceive of means by which people can purchase insurance at a reasonable price despite any pre-existing conditions. That said, the promises made by the Republicans in terms of reducing healthcare costs will not be realized, just as Obama’s promises of reducing healthcare costs were not.
No, see, here's the problem - the Ryan plan, the Tom Price plan, all GOP replacement plans that I have seen involve using so-called high risk pools to offer coverage to people with pre-existing conditions. High risk pools are not a new idea - 34 states had high risk pools at the time the ACA passed. They suffered from many, many problems, the most glaring of which is that the premiums were extremely high, and the plans offered had high deductibles and covered little before the deductible ran out. On top of that, the plans also had lifetime maximums. AND, worst of all - these pools and the really crappy insurance available through them were subsidized by the federal government. Across all 34 state high risk pools, maximum enrollment was 200,000 people because the plans were generally far too expensive for most people to buy, even with the feds kicking in substantial subsidies to the pools.
Guaranteed issue is completely meaningless if people can't afford the policies. Nominal "health insurance" is likewise meaningless if the policy doesn't cover anything. Also, premising guaranteed issue on continuous coverage is totally meaningless if you don't prohibit insurers from tossing people off their plans - a huge gap that I don't think any of these replacement plans really addresses - and is also going to lead to people who hit lifetime maximums being uninsurable, just as they were before the ACA.
If you strip away the minimum coverage requirements, and stick people with pre-existing conditions into high-risk pools, they are going to mostly end up uninsured. We know this because this has been tried before. These plans do not improve on the insurance market of 10 years ago, they
are the market of 10 years ago. If high risk pools were a workable method of extending health insurance to people with pre-existing conditions, there never would have been a need to replace that system with the ACA. So don't be fooled - these plans by and large do NOT provide accessible coverage.
Then you have the issue of the Medicaid expansion, which is where the majority of the newly insured got their coverage. The Republican plans want to block grant Medicaid to the states, but say nothing about how much they want to pay, if they will make any kind of coverage requirements, or really do anything to ensure that people currently covered under the expansion - or even under pre-expansion Medicaid - will continue to be covered.
In short, these plans are structured to functionally deny coverage to many, if not most, of the people who received coverage under the ACA. They also leave Congress free to decrease funding of high-risk pools and/or Medicaid at any time, which I don't think I need to tell you is a disaster waiting to happen.
You know how you know this is all BS designed to deny people coverage? The fundamental things they are proposing are what the ACA is already doing - there is functionally little difference between using tax dollars to subsidize insurance for high-risk enrollees, and placing high risk enrollees into the general insurance pools, and spreading the cost around to all of the enrollees. Whether I pay an extra $100/month for insurance, or $1200 of my yearly tax dollars are used to subsidize a high risk pool, the outcome is the same. The only difference is under the high risk pool scenario, Congress retains the power to fund the pools, or not. So ask yourself - why do they want that power? Specifically, Republicans, why do they want that power? It ought to be self-evident.
