Where Do Democrats And Republicans Stand On The Issue Of Healthcare
The chasm between the parties approach to providing healthcare to Americans couldnt be more vast. Simply put, Democrats have had some form of healthcare reform on their agenda for nearly a century. Republicans not so much. They feel that the status quo is just fine. At the core is a philosophical disagreement about the role of government. Democrats believe that government should be responsible for the people in some ways, and Republicans believe that the less government, the better. In the current climate, this boils down to Democrats wanting to retain, improve, and expand the ACA, and Republicans working overtime to repeal it with no replacement.
The Republican Healthcare Plan Isn’t Actually A Healthcare Plan
After six years of vague talk about a conservative alternative to the Affordable Care Act, House Republicans on Tuesday finally laid out the replacement for a repealed health law — a package of proposals that they said would slow the growth of health spending and relax federal rules for health insurance. In finally presenting one, Speaker Paul D. Ryan of Wisconsin and his Republican team did not provide a cost estimate or legislative language. But they did issue a 20,000-word plan that provides the most extensive description of their health care alternative to date.
New York TimesHuffington Post
The plan, which isn’t legislation and is more like a mission statement, lacks the level of detail that would enable a full analysis, but one thing is clear: If put in place, it would almost surely mean fewer people with health insurance, fewer people getting financial assistance for their premiums or out-of-pocket costs, and fewer consumer protections than the ACA provides. It’s difficult to be certain, because the proposal, which House Speaker Paul Ryan will talk up at the American Enterprise Institute in Washington on Wednesday, lacks crucial information, like estimates of its costs and effects on how many people will have health coverage. The document weighs in at 37 pages, which includes the cover, three full pages about how terrible Obamacare is, and two blank sheets.
Better Care Reconciliation Act
- expansion adults
- other adults
The law would set a target spending amount for states based on spending during a past two-year period that the state chose. The amount allotted to a state would increase each year by the medical component of the consumer price index plus 1 percentage point until 2025, then would increase by the CPI each year thereafter. Beginning in 2020, states that spent more than the targeted amount on their Medicaid programs in any given year would receive a reduced amount of funding the following year.
Planned ParenthoodThe bill would suspend federal funding to community health centers that provide family planning, reproductive health, and related medical services and that also provide abortions. This would include the nonprofit organization Planned Parenthood. The funding would be suspended for one year.
WaiversThe Senate bill would retain but amend the ACA’s 1332 waiver program, which allowed states to obtain waivers to opt out of or amend the ACA’s provisions, including, but not limited to, the essential health benefits, the health insurance exchanges, the individual and employer mandates, and the premium tax credits. The government could only grant waivers if state plans met the following conditions:
- provided coverage that was at least as comprehensive
- provided coverage that was at least as affordable
- provided coverage to at least a comparable number of residents
- did not increase the federal deficit
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Universal Coverage Vs Market
Democrats generally continue to support the Affordable Care Act , but would like to fix its flaws and generally improve the law. Democrats want to empower states to use innovation waivers to create their own approaches to healthcare reform that are as good asor better thanthe current system. Many Democrats also support fixing the ACA’s “family glitch” by basing affordability calculations for employer-sponsored coverage on family premiums rather than employee-only premiums, and most also support expanding premium subsidies to higher income ranges in order to soften the subsidy cliff.
But increasingly, Democrats are also getting behind the idea of a transition to some sort of universal coverage system. All of the Democrats who ran for the 2020 presidential nomination were in favor of universal coverage, although they had differing opinions on whether we should transition entirely to a single-payer system or use a combination of government-run and private health coverage .
Biden’s healthcare proposal also calls for an end to surprise balance billing, premium-free coverage under the public option for people who are caught in the Medicaid coverage gap , and allowing Medicare to negotiate prices with drug companies.
The Republican Party has not rolled out a new healthcare platform for 2020, and is instead utilizing the same platform they had in 2016. So in general, their approach can be expected to be the same as it has been for the past several years.
Republicans Have A Health Plan Finally
The House Republican Study Committee has come out with a viable plan.
For the past ten years Republicans in Congress have been largely AWOL on health care.
If memory serves, there has never been a hearing to showcase the victims of Obamacare. Nor has there been a hearing to show how sensible reforms could make the lives of those victims better.
When it came to legislation, the GOP only had two ideas: either abolish Obamacare entirely or toss it to the states. Neither approach actually solved a health care problem. They just allowed Republicans in Washington to wash their hands of the issue and pass the problems along to someone else.
The House Republican Study Committee has accepted the challenge and delivered. In a 68-page document, it identifies the worse problems in our health care system and shows how they can be solved.
The proposals are bold, impactful and easy to understand. Here is a quick summary.
Personal and portable health insurance. In an ideal world, if people like the insurance they get from an employer, they would be able to take it with them from job to job and in and out of the labor market. Under the Obama administration, this practice was not only illegal, employers who bought individually owned insurance for their employees faced huge fines.
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Less Ambition In Other Key Policy Areas
The two behemoths of federal health policy, Medicare for senior citizens and many disabled, and Medicaid for low-income households of every variety, are far less the reform target of Republicans and conservatives than they used to be. An essential reason for this is that both programs, with little controversy, have become increasingly privatized. Former House Speaker Paul Ryans vision of privatizing both programs is happening and fast. Today, about half of all Medicaid spending goes to private Medicaid managed care organizations, most of them for-profit. Trends now project that by 2023 a majority of Medicares senior and disabled enrollees will get their coverage via Medicare Advantage , the private insurance option dominated by massive for-profit insurers such as UnitedHealthcare.
The penetration of commercial insurance into both programs is a double-edged sword for conservatives because these for-profit insurer giants oppose conservative policy proposals that would threaten their revenues, such as the Trump Administrations unsuccessful 2017 proposal to repeal the ACA and provide Medicaid financing to states in block grants rather than reimbursements. It is more challenging for Republicans to delegitimize a program that is privately administered and championed by for-profit organizations. Ironically, todays coverage advocates have powerful, wealthy allies to oppose cuts that could harm Medicaid and Medicare enrollees.
Securing Reproductive Health Rights And Justice
Democrats are committed to protecting and advancing reproductive health, rights, and justice. We believe unequivocally, like the majority of Americans, that every woman should be able to access high-quality reproductive health care services, including safe and legal abortion. We will repeal the Title X domestic gag rule and restore federal funding for Planned Parenthood, which provides vital preventive and reproductive health care for millions of people, especially low-income people, and people of color, and LGBTQ+ people, including in underserved areas.
Democrats oppose and will fight to overturn federal and state laws that create barriers to reproductive health and rights. We will repeal the Hyde Amendment, and protect and codify the right to reproductive freedom. We condemn acts of violence, harassment, and intimidation of reproductive health providers, patients, and staff. We will address the discrimination and barriers that inhibit meaningful access to reproductive health care services, including those based on gender, sexual orientation, gender identity, race, income, disability, geography, and other factors. Democrats oppose restrictions on medication abortion care that are inconsistent with the most recent medical and scientific evidence and that do not protect public health.
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Gop Needs New Health Care Target Obamacare Survives Again
WASHINGTON The Supreme Courts latest rejection of a Republican effort to dismantle Obamacare signals anew that the GOP must look beyond repealing the law if it wants to hone the nations health care problems into a winning political issue.
Thursdays 7-2 ruling was the third time the court has rebuffed major GOP challenges to former President Barack Obamas prized health care overhaul. Stingingly for Republicans, the decision emerged from a bench dominated 6-3 by conservative-leaning justices, including three appointed by President Donald Trump.
Those high court setbacks have been atop dozens of failed Republican repeal attempts in Congress. Most spectacularly, Sen. John McCain, R-Ariz., flashed a thumbs-down that doomed Trumps drive to erase the law in 2017.
Along with the publics gradual but decisive acceptance of the statute, the court rulings and legislative defeats underscore that the law, passed in 2010 despite overwhelming GOP opposition, is probably safe. And it spotlights a remarkable progression of the measure from a political liability that cost Democrats House control just months after enactment to a widely accepted bedrock of the medical system, delivering care to what the government says is more than 30 million people.
The Affordable Care Act remains the law of the land, President Joe Biden said, using the statutes more formal name, after the court ruled that Texas and other GOP-led states had no right to bring their lawsuit to federal court.
Taxation And Income Inequality
The current law established two taxes on high-income individuals , via a 0.9% Medicare payroll surtax on earnings over that threshold and a 3.8% tax on net investment income. The latter tax is steeply progressive, with the top 1% paying 90% of the tax, as investment income is highly concentrated with the wealthy. The ACA also established a penalty tax for individuals without adequate insurance, an excise tax on employers with 50 or more workers who offer insufficient coverage, annual fees on health insurance providers, and the “Cadillac tax” on generous employer-sponsored health plans. Combined with subsidies that primarily benefit low-income households, the law significantly reduced income inequality after taxes and transfers.
The Center on Budget and Policy Priorities reported that “The House bill would represent the largest transfer in modern U.S. history from low- and moderate-income people to the very wealthy.” CBPP also wrote: “Millionaires would gain roughly $40 billion in tax cuts annually…roughly equivalent to the $38 billion that 32 million households in poverty would lose from cuts to their tax credits and Medicaid.”
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Trump Tries To Sell Republican Health Care Plan To Conservatives
DAVID GREENE, HOST:
Democrats have been lining up against a Republican plan to replace the Affordable Care Act, and that’s not a surprise. But Republican resistance to House Speaker Paul Ryan’s proposal has even the White House taken aback. In our studios this morning is David Urban, a prominent GOP lobbyist in Washington. He was a senior adviser to President Trump during the campaign, and he was been credited with delivering the key state of Pennsylvania to the president. David Urban, good morning.
DAVID URBAN: Well, good morning to you. Thank you, David.
GREENE: Well, thanks for coming in. So is the president having some trouble here keeping his party unified?
URBAN: No, no, David. Look, I think, you don’t have to have unanimity to have unity.
URBAN: And I think the party’s united behind wanting to fix the Affordable Care Act, Obamacare, and the president – you know, the party is united behind that.
GREENE: Are they really united?
GREENE: I mean, we have some more centrist Republicans who are very concerned about what they see as rolling back the expansion of Medicaid. We have some more conservative Republicans who are saying this feels like Obamacare 2.0. How is that unity?
URBAN: Well, again, you don’t have to have unanimity to have unity, right?
GREENE: Yeah, but explain the metaphor here.
GREENE: You’re telling Americans not to pay attention to this debate.
URBAN: Absolutely. Stakes are very high on this.
Thank You For Sharing
Everything old is new againat least when its a Republican plan to do away with the Affordable Care Act.
Fierce Healthcare reports that a new health care plan produced by the Republican Study Committeea group of 145 House Republicanslooks an awful lot like the American Health Care Act, which Republicans passed in 2017 when they still held the House majority. And the AHCA was actually a big motivator behind voters handing a loss of their majority to House Republicans.
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Obamacare V Republican Plan Compared
Republican politicians have campaigned on repealing President Barack Obama’s healthcare reforms pretty much since they were enacted in 2010.
Now, with a governing majority, they’ve had to come up with a replacement plan – a task that has proved much more challenging than they may have imagined.
The latest bill, crafted by Republican Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, provides considerable discretion to individual states to craft their own healthcare systems, with financial support from the federal government.
Here’s a look at some key differences between the existing law, informally known as Obamacare, and the Graham-Cassidy legislation. It is unlikely there will be government numbers on the impact before the bill comes to a vote.
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There has been a good deal of talk lately about how Republicans want to eliminate the Affordable Care Act, which would revoke the protection for those with preexisting conditions that ACA created for the first time in U.S. history. Spurred to action by the moral urgency of terrifying poll numbers, Republicans have responded Nuh-uh and insisted that they have a plan to protect the thing that is already protected by law, and that is threatened only by Republicans themselves.
Democrats counter that this plan is a phantom, a fantasy, something President Trump and other Republicans keep promising but never deliver. Its as though the GOP says, We have a plan to make car theft illegal! while its members go around smashing peoples car windows.
On a purely factual basis, the Democrats are absolutely correct. But its also the case that Republicans do have a plan of a sort, to be explained below.
First, lets note just how desperate Republicans are to deny that theyve been trying to destroy the ACA from the moment it was passed in 2010. Here, for instance, is a new soft-focus ad from Texas Sen. John Cornyn:
The Cornyn preexisting conditions TV spot has arrived Cornyn was lead figure in ’17 Obamacare repeal push he counters he cosponsored ’19 Protect Act, which has been criticized for not doing enough to provide same ACA protections
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Access To Affordable Health Insurance For All Americans
The House GOP plan ensures access to health insurance for all Americans in much the same way the ACA does, by retaining employer-based coverage and providing a refundable tax credit to households without an offer of a job-based plan. Under this formulation, there is no reason why anyone in the United States who wants health insurance would be forced to go without it.
While the House plan, by necessity, has a structure that is similar to the ACA in this regard, with a large employer-based insurance system and tax credits for those outside of it, the plans are very different in their details.
Tax Preference For Employer Coverage Is Retained, With Upper Limit To Replace Cadillac Tax
For Those Not Offered Employer Coverage, Refundable Tax Credits That Vary By Age But Not Income
Persons who are not offered employer coverage would be eligible for a refundable federal tax credit to help them purchase health insurance. This is also similar to what is provided in the ACA, but the GOP plans credits are markedly different in important respects. First, the credit would be available to anyone without an offer of coverage by an employer, and would not be reduced for people as their wages and incomes rise. This means middle-class families without an employer plan would get financial assistance for the purchase of health insurance.
Third, there are no federal benefit mandates restricting the use of the credits. The credits can be used to purchase any state-approved insurance plan.
Protecting Native American Health
Native American tribes have for too long been forced to cope with insufficient access to health care and mental health services, nutrition services, and modern infrastructure. Democrats are committed to pursuing environmental justice and climate justice, including for Indigenous peoples and communities, and will invest significant new resources in clean water and wastewater infrastructure, clean energy generation and distribution, and sustainable and regenerative agriculture. And we will make mandatory and work toward full funding for the Indian Health Service as part of our commitment to pursuing strong nation-to-nation relationships and honoring the United States trust obligations to Native American communities.
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