The AHCA: A Modest Republican Proposal

In 1729 English satirist Jonathan Swift published his essay ‘A Modest Proposal’, which suggested solving problems of overpopulation and poverty by selling the children of the poor for meat. This was a solution to a problem that certainly existed at the time that made everything much, much worse, and everyone laughed and clapped each other on the back at how brilliant a satirical point it was.

Yesterday the House Republicans gave us the 2017 version, except they weren’t joking.

The AHCA was passed by a narrow margin of 217 to 213, with a number of Republican defectors, though not enough to stop the bill from passing to the next phase, the Senate.

There is already talk that the Senate will not even begin to consider the bill. That’s good, but that is beside the point. This bill should have been so toxic that it never should have seen the light of day. They took a bill that failed to even get enough votes on the House floor to be considered, made it worse, and then somehow passed it.

There is no point pretending that Obamacare has no problems. It does, and they have been well documented. Deductibles are too high, there have been problems keeping the doctor you want, and insurers have been dropping out of exchanges left and right. Uncertainty about its future also risks making predictions of its demise a self-fulfilling prophecy.

But to think that this omnishambles of a bill that has been put forward to replace it is the solution is the true successor to Swift’s biting satire.

Beyond the mere fact that everything the Republicans said about Obamacare — that it was rushed through, that it didn’t have a CBO score, that it wasn’t debated properly, that we didn’t know how it would affect the economy — was truer for their own bill than it ever was for the ACA, let’s take a look at some of the consequences of this bill, shall we?

(All CBO score estimates are based on the bill before amendments, because, as I mentioned, the Republicans didn’t even bother to wait for the new bill to be scored)

- It is going to cut $880 billion dollars from Medicaid over the next ten years, taking money away from the poorest Americans and freeing it up for a tax cut aimed at the rich.

- It will create dramatically underfunded high risk pools that will force people with pre-existing conditions out of the market, even if the coverage is technically ‘available’. There are plenty of million dollar houses ‘available’, I just can’t afford to live in them. See how that works?

- Allows rape, domestic violence, postpartum depression and C-sections to be considered as pre-existing conditions, putting at risk your chance for affordable health insurance.

- Allows yearly and lifetime caps on an individual’s insurance spending, including for plans provided by employers.

- It is likely to increase deductibles

- Ultimately up to 24 million of the poorest Americans could end up losing their health insurance because they can no longer afford to pay for it, or because they will lose their access to Medicaid.

So, in short, people are going to lose their health insurance, and they are going to die. The poorest, most vulnerable Americans are going to stop being able to pay for their health insurance, and they are going to suffer what they must until they eventually die. But hey, at least those of us that don’t die, those of us who are lucky to be young and healthy enough to not have pre-existing conditions, might end up paying a little more on our deductibles, right? The shame of this decision should hang over Republican lawmakers evermore, but they seem genuinely proud of what they have achieved.

So I’d invite them to go ahead, tell me how this bill is better than Obamacare, and how it fixes any of the problems that we are currently seeing with the ACA that, by the way, is historically popular. Perhaps we can discuss it at my next dinner party, over a side of baby rib and a nice warm glass of peasant blood?

This story was originally published on Tremr