Transport yourself back to 2009. Obviously, the Great Recession was the biggest concern on everyone’s mind, but there was another serious and growing problem: the cost of health care, and consequently health insurance, was spiraling out of control. ACA was the Democrats’ response to this situation.
ACA had two purposes. The first was to reduce the rate of increase of unit costs by creating a variety of experimental cost control mechanisms. The second was to make health insurance more widely available through a system based on community rating, government subsidies funded primarily by taxes on the wealthy, and the individual mandate.
Did it work? Not entirely. The Medicaid expansion was crippled by a Supreme Court decision. Young and healthy people did not enter the market in the numbers predicted by the Obama Administration. It was difficult to make the system work in poor rural areas with relatively few providers. And yet, overall, you would have to say that ACA was a success, because the percentage of uninsured fell to a record low, and the cost curve was bent, if not broken. Medicare, for example, is in much better financial shape today than was expected ten years ago.
Today, the GOP proposes to replace ACA with AHCA. How do the two stack up?
Obamacare vs. Nobamacare
Wealth shift Rich to poor Poor to rich
Cost control Pilot programs Demand suppression by price
Uninsured Big decrease Big increase
Beneficiaries Poor and sick Healthy and wealthy
And the winner is . . . What do you think? People who could already afford insurance, or who don’t need it, are the only ones who stand to gain from AHCA. Even many of the GOP House members who voted for the bill don’t like it. But hey, it makes Trump look like a winner and facilitates a larger, permanent tax cut for the rich, and that’s what really matters!