Don’t Be Fooled by Republican Rhetoric about the Affordable Care Act: Gutting the Law is Still Going Strong

In the first week of February, you probably heard that Trump said that repealing the ACA might not happen until next year and that Republicans now say that they want to “repair” or “rebuild” the Affordable Care Act rather than repeal and replace it. Don’t be fooled. Whatever r-word Republicans use to describe what they plan to do with the ACA, whether it’s repeal, replace, repair, rebuild, it all means the same thing. They want to gut and do away with the ACA, and have no consensus replacement plan. Nor do any of the plans they’re currently floating provide anywhere near the level of comprehensive and affordable benefits written into the ACA, and they know it.

While Republicans are currently working to distract us with their constantly morphing healthcare rhetoric, jamming through Cabinet hearings and confirmation votes, and the daily blitzkrieg that is evidently now American political life, they’re quietly working away behind the scenes to dismantle the ACA via reconciliation. Remember that? For a quick recap, reconciliation allows Republicans to avoid a filibuster by Democrats because Congress can pass such bills addressing budgetary matters with only a simple majority (51 votes). Republicans have a 2-vote margin here, since they hold 52 Senate seats and also have Mike Pence in their back pocket should the need arise.

Bottom line: Republicans are still pushing reconciliation legislation that sneaks in provisions destroying the financial scaffolding of the ACA that are critical for it to function. Simply put, without the individual and employer mandates, as well as the tax that folks who choose not to purchase coverage need to pay, there just isn’t enough money to support the ACA’s most popular provisions: ensuring that people with preexisting conditions have affordable and quality healthcare, and that children can stay on their parents’ plans until they turn 26. You need healthy people in the market to balance costs, as even this non-economist knows. This means that Republican assertions that they’ll keep these two popular provisions in any kind of working order are, to quote former Vice President Joe Biden, a bunch of malarkey. It also means that the reconciliation legislation that Republicans are working on under the radar presents the greatest current threat to the ACA, since Republicans have the ability to undo the core of the law via reconciliation and slowly chip away at the rest of the ACA over time. ACA repeal may not look like a single dramatic repeal bill, but rather a slow and agonizing process as Republicans gradually suck the life out of the landmark healthcare law that benefits and has saved the lives of millions of Americans.

It’s looking like Republicans want the reconciliation bill ready to go by March 1st, which coincides with Paul Ryan’s announcement that he wants repeal complete by the end of the first quarter, which is the end of March. And they’ve been working with the Congressional Budget Office (CBO) to try to make this happen. But the process isn’t without its bumps in the road. Last month, the CBO asserted that repealing the ACA will cause 18 million people to lose their health insurance just in the first year and 32 million over the next decade, and premiums to spike across the board. Other estimates suggest that repeal will result in more annual deaths than those caused by gun violence.

Notwithstanding this, and even notwithstanding concerns from Republican governors whose states have benefited from the ACA’s Medicaid expansions, top conservative Republicans want to quicken the pace. Senator Mike Lee is vociferously eager to repeal the ACA before replacing it, never mind the devastating chaos this would cause for millions of Americans who would lose their health insurance with no way to replace it, not to mention the damage it would do to our economy and the widespread unemployment it would cause. In fact, Lee is so determined to get rid of the ACA that he specifically opposes waiting for a replacement before repeal. The uber-conservative House Freedom Caucus agrees. They, in fact, called for a voteon a 2015 repeal bill that’s becoming more and more concerning each day, given that none other than Tom Price — Trump’s Secretary of Health and Human Services nominee who should concern us all and is up for his confirmation vote today — proposed and championed it. Conservative Republicans are clearly becoming restless and want a hearing on this bill as soon as next week. Should they succeed in repealing large swaths of the ACA, they will manufacture a healthcare crisis and hope to use it put Democrats in a no-win position. With Price on target to become the HHS Secretary, he will have significant sway over the shape of US healthcare policy, which would be all the more the case should Republicans coalesce around his 2015 bill as they did before.

So about that bill. I’m sure there will be more to come over the next weeks, but here are some highlights of Price’s 2015 Empowering Patients Act (a misnomer that anticipated alternative facts before alternative facts were a thing.) The law sets up Health Savings Accounts (HSAs), which actually emerged as moneymakers for insurance companies back in the 90s. They’re just dandy if you’re wealthy, but not so much if you’re everyone else, whether you’re not super rich or you have a preexisting condition or disability that requires constant expensive care. It also returns us to the days of high-risk pools, which are basically groupings of people with the highest healthcare costs, so particularly seniors and people with chronic illnesses and disabilities. Spoiler alert: we’ve tried them before, and they don’t work because of underfunding. They just don’t. Logically, throwing all the people who most need healthcare into one pool will result in exponential healthcare costs for all involved. And for those folks with preexisting conditions and disabilities — if you couldn’t maintain continuous coverage because you lost your job or couldn’t work because of illness, then insurance companies could deny you coverage. (Also, about preexisting conditions — remember the days when surviving domestic abuse counted as a preexisting condition and thus a reason insurance companies could deny you coverage? That was egregious, and I don’t think any of us want to go back there.) Of course, the government would provide a modicum of financial support for folks to purchase what would become increasingly pricey (Price-y, even?) healthcare, but those tax credits would correlate with age, not with financial need, because that makes sense, apparently.

And for all Republicans’ talk about “fiscal responsibility,” the CBO says otherwise. In January, it analyzed Tom Price’s 2015 Empowering Patients Act as the most likely option to repeal and replace the ACA, and estimated that not only would it cause 32 million people lose their health insurance, it would also double premiums. So much for affordable. Similar to current budget reconciliation legislation aiming to repeal as much of the ACA as possible, Price’s bill also got rid of the ACA’s financial framework and support for its Medicaid expansion. What does this mean? Healthy people, and probably insurers, would flee the insurance market and costs would rise exponentially for sick and older people. By 2026, approximately 75% of the population could live in a location where no insurer offered individual coverage.

So what can we do? Arguably the two best resources open to those of us who want to protect the ACA and healthcare equity in this country are education and making sure that our representatives hear our voices loud and clear. The New York Times recently published an article indicating that a third of Americans don’t know that the ACA and Obamacare are the same, while Vox explained that just over half of Americans are unaware that repealing the ACA also repeals its Medicaid expansion. Call your representatives daily and urge them to protect the Affordable Care Act. If you can tell them a personal story, that’s even better, since they arm themselves with our stories when they debate and thus hold Republicans personally accountable to each person who will suffer from dismantling and/or repealing the ACA. Call them so frequently that you get to know staffers well enough that they could theoretically repeat your stories back to you. Should you be deterred from calling because of social anxiety, here are some tips to help. If you go to your representatives’ town halls, ask questions about Medicaid expansion, clarifying that the ACA and Obamacare are the same, how reconciliation will impact the ACA and the folks who need it to survive, how whatever replacement plan currently in the press will actually provide affordable and quality coverage to folks with preexisting conditions, and so on, to get them on the record explaining the truth of the matter. Write letters to the editor of your local paper explaining why you support the Affordable Care Act, like this one here. Get involved with Organizing for Action’s efforts to save the ACA by sharing its materials on social media, attending an event, or joining a webinar.

And make sure your friends, colleagues, family, social media followers, random people you meet on the street (though of course always use caution when talking with strangers, as we learned in kindergarten) all understand that yes, the ACA is the same as Obamacare, and yes, repealing the ACA will also repeal the Medicaid expansion. Above all, do not let the Republicans brush reconciliation under the bed. It’s real, it’s happening, and we need to organize and push back now.