The Not-So-Happy Ending to the Search for the Secret Republican Healthcare Plan, or Republicans Should Put It Back in the Basement and Pretend It Doesn’t Exist.

So now we know the gist and then some of what’s in the secret Republican healthcare plan, which some lovingly dubbed the “basement bill,” that Steny Hoyer and Rand Paul led a quest to find last week. If you’re in need of hilarity with an edge of snark and desperation, go on Twitter and search the hashtag #NoSecretPlan. Bottom line: we’d all be in a far better place if that bill, the American Health Care Act, remained in the basement and never saw the light of day.

Here’s what we know so far. It undoes the individual mandate, which is the financial scaffolding of the Affordable Care Act. Requiring everyone to buy health insurance helps spread money around so that way senior citizens, people with preexisting conditions and disabilities, and children up to age 26, can afford health care. Think about it this way. Setting aside the common-sense fact that everyone should have health insurance, because disease and injury don’t discriminate whom they hit based on age — a fact to which I can personally attest, as I was diagnosed with my first chronic disease when I was a young child — consider this reality. Your purchasing health insurance is exactly what allows your grandparents to afford their health care. Your neighbor who lives with Crohn’s disease to afford her health care. Your friend’s mom who lives with endometriosis to afford her health care. Your grocery clerk working a minimum-wage job to afford his health care. So it’s not just about you — it’s about all of us. We all win. You get health care, which everyone should have, and you help your friends, family, and neighbors afford health care that they desperately need.

PSA: The individual mandate isn’t an effort at government overreach. It’s an effort to make sure there’s enough to go around. Take it away, and there simply aren’t the funds to ensure that you, your friends, your family, and your community can all afford health care. It’s gotten a bad rap, but when you look at it this way, it’s actually empowering. You are helping other people, many of whom could never afford health care before, still more of whom would die or suffer more than you can imagine if they didn’t have health care, receive critical medical treatment. That’s what the individual mandate does. So when fewer people pay in, that means prices spike for everyone, and that most hurts the people who depend upon health care: the chronically ill, the disabled, and seniors.

Put it another way: there’s a fundamental difference between affordability and accessibility of health care coverage. The Affordable Care Act, although it’s imperfect and we need to improve it, took dramatic steps forward in making health insurance affordable. Republicans’ American Health Care Plan makes insurance accessible, meaning that technically all people could buy it because insurers can’t flat-out deny people coverage because of health status, age, gender, or any other reason, but it does not make insurance affordable. And this leaves many people with chronic conditions who regularly deal with exceptionally high medical bills in almost the same position as they would be in if insurers were permitted to refuse them coverage. Before the ACA, these folks often couldn’t acquire health insurance because insurers wouldn’t sell to them; now many of them won’t be able to acquire health insurance because they won’t be able to pay for it.

But wait! you may say. Republicans are keeping the ban on insurers discriminating against people with preexisting conditions, so we’re all good! Well…not so much. For starters, people with preexisting conditions have to maintain continuous coverage, or insurers could exponentially jack up their premiums, which for many people amounts virtually to the same thing as insurers refusing to sell to them at all. That break in coverage cannot exceed 63 days. And it’s well within the realm of reality to lose your health care coverage. What happens if you lose your job? What happens if you age out of your parents’ plans and your state doesn’t provide you a way to maintain insurance? What happens if you get coverage through your parents and you need to move? What happens if you have to take a leave from work or school and your health insurance is discontinued? What happens if you’re unable to pay for a period of time due to unanticipated financial hardship? These are only a smattering of ways people could lose their health insurance. Perhaps Republicans will come up with answers to some of these questions, but as of now, they have yet to publicize them.

Of course, Republicans also want to replace subsidies with tax credits that would be adjusted more according to age rather than income. Income will be taken into account to a minor extent, but age will function as the primary factor determining how much support you get, because Republicans think that accommodating the amount of financial assistance you receive for healthcare to your income is just too much government intervention. Given that government intervention is basically the GOP’s bogeyman (how ironic, given the party’s preoccupation with decisions that should be between a woman and her doctor), this hardly comes as a shock. What does all this mean? It means that you pretty much have to be able to pay up front for your health insurance. Even though those tax credits are advanceable, they’re nowhere near the amount of financial assistance the vast majority of people will need to be able to purchase insurance. And if you don’t pay taxes because of your low income, then this really doesn’t help you. Meanwhile, the wealthy, pharmaceutical companies, and insurers get a massive tax cut. I thought that Republicans were supposed to be the party with fiscal know-how? I’ll pause for a moment until you stop laughing hysterically (or crying, whichever one is more your style). This also means that a 25-year-old single mom working a couple of minimum-wage jobs will receive less financial support than a 60-year-old man with a substantial income…because obviously that makes sense? And it means that credits will only amount to a drop in the bucket, rendering healthcare financially out of reach for many.

On to Medicaid. The Affordable Care Act significantly expanded Medicaid, covering millions more people by rendering eligible people below 138% of the poverty line. Get ready to say goodbye not only to the Medicaid expansion, but to Medicaid as we know it, because by 2020, the bill freezes federal spending on Medicaid to apply only to those people enrolled in it at that point. That’s it. You can’t get on the Medicaid expansion unless you do so by 2020. That’s the cutoff date. And funding will be reduced at that point anyway, and Medicaid will ultimately be phased out. This will also harm hospital funding, which means that hospitals will begin to hemorrhage money. And don’t think that states are off the hook: they’ll have to make up the difference that the federal government doesn’t cover. Welcome to a return to the days of going to the ER for routine medical treatment. And while we’re discussing funding for Medicaid, AHCA proposes other changes too, like switching to a per capita cap. States would get a fixed amount of money from the federal government to pay for enrollees, rather than the current open-ended system of covering enrollees’ medical bills. Because clearly it’s entirely possible to predict how much someone will need to spend on medical bills in a given year, right? People always choose when dire illnesses and expensive surgeries and treatments are most convenient for their schedules and bank accounts. And we completely have control over when public health crises and natural disasters arise. That’s what planners are for, right?

And last but not least, let’s take a look at finances again for a moment. Insurers have significant leeway in how much they charge older Americans. They can charge them five times as much as they charge young people. Now remember the whole tax credit thing? How much do you think a tax credit is really going to help an older American facing exorbitant premiums? And how much do you think a tax credit is really going to help a younger American living just above the poverty line? However, if you’re a well-to-do adult, then you’ll be just fine. Clearly this is the population that needs the most help? Apparently?

Basically, what all this accomplishes is the exact opposite of the ACA. The ACA encouraged healthy people to purchase insurance and therefore sought to ensure that there’s enough money for all people, regardless of their age and health status, to afford health care. The AHCA actually penalizes people for signing up for health care, in that if they lose coverage for a period of time, they have to pay more, incentivizing them to remain without insurance and thereby driving up the prices for those who desperately need it. And even if you have a job, that job doesn’t have to provide you with health insurance anymore. While ACA wanted you to have health care, the GOP version…not so much. And of course no Republican healthcare plan would be complete without defunding Planned Parenthood. AHCA defunds Planned Parenthood for a year, unless the women’s health organization agrees to stop providing abortions, which helps literally no one. Defunding Planned Parenthood won’t end abortions as a fact of life. It will, however, end safe and legal abortions for many women, impelling them to resort to the dangerous back-alley and coat-hanger type of procedures we hoped were long gone. And here’s your reminder that no federal money pays for abortions, thanks to the Hyde amendment. So what this actually means in practice is that women and men who receive their health care coverage through Medicaid and other governmental programs won’t be able to seek any kind of care at all at Planned Parenthood. Not cancer screenings, not preventive care, not family planning. Nothing.

What do you really need to know about the Republican plan to “replace” the Affordable Care Act? One: it’s no replacement. Two: it’s going to hurt a lot of people. Three: can we please put it back in the basement and make sure it never comes out?