The New Republican Healthcare Plan


The new republican plans for health care sure sounds like “just die quickly, and quietly” Well, as we expected, once the Republicans captured the White House (well, in 29 days now), their first order of business will be to repeal the ACA.

They have been talking about repealing it and replacing it for 6 years now, bloviating at every opportunity, and doing fuck-all in the House with 54 attempts to repeal or defund portions of the ACA (or the pejorative “Obamacare”) so this isn’t a surprise.

However, some of the rhetoric coming out of the Paul Ryan camp is interesting. Suddenly, instead of shutting it down on day 1, they are talking about repealing and delaying for 2 – 3 years until they can devise a “replacement” for it. Yeah, that sounds do-able.

Of course, they are talking half hearted ideas to replace, like tax incentives for HSA accounts. As if those near the poverty line can afford to sock away enough in a tax free account. Oh, and they often don’t make enough to pay taxes, so this really sounds like a give-away for the wealthy. As a single point of reference, having hit the magic “five-oh”, I had to have a colonoscopy as a screening for colo-rectal cancer. The total bill, for this preventative procedure: $19,000 dollars. That is more than 3 years of contributions to my HSA maxed out each year. Clearly, the HSA isn’t the cornucopia for low to moderate income people, those who were/are the key beneficiaries of the ACA.

Or the concept of selling insurance across state lines to foster “competition.” Of course, that really doesn’t work, because for there to be a network it takes significant effort for an insurance company to build relationships with doctors and hospitals. This has been a favorite of Republicans for as long as I can remember (at least 30 years), and is just smokescreen. Competition requires some power in the consumers, that means transparency of prices, and offer, neither that is the current status quo in healthcare.

Or, returning to the system of high-risk pools that were the norm in the way back time. Of course, they were poorly funded, and the waiting list in some states was as long as 6 years. Some 2% of policies were high risk, but the estimates were that between 20% and 60% of the prime work age American population had pre-existing conditions that would have pushed them to the high risk pools. Clearly, that was a flawed strategy, and a poor substitute for a large pool of coverage to spread the actuarial risks.

The truth is, for all their bellyaching, the Republicans haven’t put together a credible healthcare alternative to the ACA in their near 7 years of trying.

One thing is certain, the health insurance companies, and the major hospital chains will be (or already are) lobbying hard for there to be small tweaks to the ACA. They clearly do not want to go back to the old way. The ACA, even with its flaws, is a significant improvement over what was, and if the retrograde GOP Governors wouldn’t fight it, the experience in many states would be significantly improved.

Regardless of what they do, the Republicans will own the aftermath. I predict that a pretty large cohort of the voters who came together to elect Herr Drumpf will be shocked in how their access to quality healthcare will be curtailed.

Their plan sure sounds like “just die quickly, and preferably quietly.”


Poking around the Kaiser Family Foundation is a great place to find neutral research on healthcare, and health policy. Certainly better and more balanced than the so called reports from the partisan think-tanks (Heritage, AEI, etc).

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