BY ATANAS SPASOV

Amidst the latest rumblings from the White House, the introduction and passage of the American Health Care Act (AHCA) nearly two months ago is a distant memory. The Republican bill that set out to repeal what they deemed as “undesirable” aspects of Obamacare has devolved into purely indefensible legislation that is the epitome of a last-ditch attempt to scrap Obamacare. Whereas Obamacare took months to pass, between negotiations and calls for transparency, the AHCA took all of thirteen days and definitely shows it. There was little time to debate the bill or hold hearings and, to top it off, no report from the Congressional Budget Office (CBO) with the estimated cost and coverage impact, which makes this bill the definition of legislative malpractice.

The CBO’s review of the plan was published only after the vote to pass the House of Representatives went through. In summary, it found that an additional 24 million people would be uninsured by 2026, with medium term premiums expected to be 15 to 20 percent higher than under the Affordable Care Act. There is little that can be done to spin the announcement positively. The parts of the bill that work in favor of the GOP are that the AHCA is set to reduce the deficit by more than $337 billion over a decade and, as such, exceeds the $2 billion reduction threshold to classify it as a budget bill. It can thus be passed through the process of budget reconciliation rather than as normal legislation, needing only 50 votes to pass the Senate.

The obvious downside for the GOP is that staggering number: 24 million. It is difficult to conceive of any legislation passed in the last century that negatively affects so many people. As such, it can be expected that a decent amount of Republican senators will abandon it and prevent its passing – notably Susan Collins (R-ME) and Mike Lee (R-UT). It would only take the two of them to halt the Senate vote. The House, however, is a different story. Because of its size and more representational nature, the views of its members tend to be far less moderate than senators. As such, any bill that hopes to clear both hurdles will have to be restrained from its chamber of origin.

This indicates that the Senate will undoubtedly write its own bill, hopefully one that is moderate enough to appeal to centerline conservatives and does less damage. In an ideal situation, the Senate would set out to fix some of the glaring problems of Obamacare: the lack of subsidies in states that expanded Medicaid, uneven expansions at that, in addition to the lack of price caps or the negotiation of prices. Ultimately, the AHCA will pass in some form, as it is unlikely that Republicans will back down from a tax and entitlement cut, no matter how unpopular.  

Those who stand to lose the most from the passage of this bill are low-income households on Medicaid and low-income seniors who will suffer impossibly high premiums – both of whom are most likely to vote Democratic. The 2016 election was, in part, a referendum in the repeal of Obamacare, and most voters knew what they were voting for when Trump won the presidency. The expected removal of the mandate will make the AHCA popular with the healthy “I’ve got mine” crowd, even if they are shaken down for a penalty towards non-continuous coverage. Republicans can gamble on the fact that healthy people keep that way.  

It is not necessarily Trump voters that will be the most affected. The president’s real base tends to skew towards upper-middle income conservatives who are better off than most Americans, with household incomes around $72,000 in comparison to the American median of $56,000. For many of them, the Obamacare mandate has penalized them for being healthy. Citizens who depended on the Affordable Care Act already vote Democrat, knowing what was on the line with a repeal.

With the analysis still operating in the early states, we will have to wait and see what other details come out. One can estimate that the GOP will come out with a plausible rebuttal, such as that the CBO is overstating coverage losses because they do not equate the tax credits to full or partial coverage. Unfortunately for Republicans, that argument simply cannot resonate in the face of the headline: 24 million to be uninsured under GOP’s replacement plan.