After vowing for years to “repeal and replace” the 2010 Affordable Care Act, Senate Republicans return to Washington on Monday to try to force through an unpopular replacement plan.
Majority Leader Mitch McConnell of Kentucky is the architect of that plan, which would hurt hundreds of thousands of his constituents.
How unpopular is McConnell’s plan? A USA Today/Suffolk University poll shows only 12 percent of Americans support it, while 53 percent say Congress should leave the Affordable Care Act alone or fix its problems.
Even a Fox News poll showed that only 27 percent of Americans support McConnell’s Better Care Reconciliation Act, while 54 percent oppose it. An earlier Fox poll found people also didn’t like the House Republicans’ plan, called the American Health Care Act. Forty percent approve, 54 percent disapprove.
The Republican base is more supportive. Fox News found 51 percent of Republicans like the Senate bill and 75 percent like the House bill. But that’s no surprise. GOP politicians and right-wing media have spent years demonizing the Affordable Care Act, which they dubbed Obamacare, even though it was a conservative solution built around the idea of making it more affordable for people to buy insurance from for-profit companies.
By denouncing this market-based approach as socialism, Republicans painted themselves into a corner. Their alternatives mostly take insurance away from people — 23 million under the House plan, 22 million under the Senate plan, according to the non-partisan Congressional Budget Office.
The Republican plans also reduce patient protections and raise premium costs and out-of-pocket expenses for older and sicker Americans. They would reduce premiums for some younger, healthier people, mostly by allowing them to buy policies with fewer benefits.
Because no Democrats support the GOP repeal-and-replace plans, McConnell can afford to lose only three Republican votes. A dozen GOP senators have expressed opposition to or reservations about the bill without changes. That includes Kentucky’s Rand Paul, who, as usual, is hanging with the libertarian fringe.
Insurance industry reaction to the GOP approach has been mixed. But virtually every group representing health care professionals opposes it, including the American Medical Association, the American Nurses Association, the American Hospital Association and the American Public Health Association. That speaks volumes.
The Senate Republicans’ plan would reduce spending on Medicaid, the federal-state system that insures the poorest 20 percent of Americans, by $772 billion over a decade. Many Medicaid recipients are “working poor” people whose low-wage jobs increasingly do not come with insurance. Medicaid also pays for the care of two-thirds of the elderly people in nursing homes because they have exhausted savings. So, just as businesses are forcing more middle-class people to rely on Medicaid, Republicans want to slash it.
Kentucky has a lot at stake here: Hundreds of thousands of Kentuckians would lose insurance and the state would lose thousands of jobs and billions of dollars in federal health care assistance.
The Urban Institute estimates 541,000 fewer Kentuckians would have insurance by 2022 under the Senate plan. The Center for American Progress estimates the number at 231,400 by 2026. Either estimate would be catastrophic. About 473,000 Kentuckians got insurance coverage for the first time under Obamacare’s Medicaid expansion, reducing the state’s uninsured rate from 21 percent to 6 percent. GOP plans would reverse that.
The Senate Republicans’ plan would hit Kentucky harder than any other state, with a 58.5 percent or $6.26 billion reduction in federal health care assistance, the Urban Institute estimates.
Kentucky would lose 32,100 jobs by 2026 under the Senate Republican plan and 16,500 under the House Republican plan, according to studies by the Commonwealth Fund and George Washington University. More than half of those jobs would be in health care businesses, and the rest from reduced economic activity caused by less health-care spending. Many of those lost jobs would be in small towns where every job counts.
Studies also estimate that Kentucky hospitals would be hurt because they would legally have to provide more free care to poor people who show up in their emergency rooms. Under the Affordable Care Act, hospitals’ uncompensated care fell by 67 percent from 2012 to 2015.
McConnell and other Republican leaders say fiscal responsibility demands that the federal government spend less money caring for poor, sick and elderly people. Yet, they also want to cut more than $540 billion in Obamacare taxes paid by the nation’s wealthiest people. Well, of course. Rich people need tax cuts more than poor people need health care.
The Affordable Care Act has done a lot of good, but it has problems that need fixing. The Republican plans wouldn’t fix those problems; they would make them worse, especially for Kentucky’s poorest and most vulnerable citizens. Kentuckians should demand that their representatives in Congress do better.