What’s wrong with the AHCA

The American Health Care Act is one of the worst pieces of legislation I have ever reviewed in my time as a journalist.

Here’s why.

When I analyze a bill or proposal, one of the most important issues is alignment between a policy’s outcomes and its author’s claims. For example, does a balanced budget really balance the budget? Would minimum wage hikes really kill jobs? Readers can, from there, make up their own minds about what they want from public policy.

From that perspective the AHCA fails almost utterly.

The sponsors of this legislation have presented it as a way to reduce health care costs, expand coverage and stabilize the insurance marketplaces. It will accomplish none of those things.

Health care costs will likely go up. While young and healthy people will see their premiums decrease, almost everyone else will probably see price hikes coupled with reduced protection for out of pocket expenses. Further, without insurance, many Americans will return to using the emergency room for their medical needs. This is far more expensive than preventative and primary physician care.

Coverage will contract. The last time this legislation was scored, the CBO estimated that 24 million people would lose insurance. Given that the new AHCA takes away protections for pre-existing conditions, this number may well be higher in the latest version. We’ll find out next week.

Individual insurance markets will face two new points of potential instability. First, the AHCA weakens incentives for young, healthy people to get coverage, potentially skewing risk pools. Second, if future regulation allows health insurance sales across state lines, the AHCA’s changes will likely lead to a race to the bottom in terms of coverage and protections.

Nor does it repeal the individual mandate. Where under Obamacare not having insurance triggered an IRS penalty, under the AHCA it leads to massive premium hikes which could easily lock a sick or poor person out of the insurance marketplace indefinitely.

Both laws encourage people to get insurance by punishing those who don’t. Obamacare enforced its mandate financially, the AHCA does so by potentially withholding medical care.

This law is poorly written. It will not do what its sponsors claim. It won’t do anything even close. One of the only things that it will unambiguously accomplish is a $900 billion upper-end tax cut, which is not the platform on which its authors have sold the bill.

This is why it may be the worst piece of legislation I have ever reviewed.