The effects of a repeal of ACA

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Reverse Robin Hood, class warfare.. The graph speaks for itself and even some Conservatives are alarmed..

There is no disputing that the GOP’s American Health Care Act cuts taxes that primarily benefit high earners, while reducing government health care assistance to the impoverished. This is how Democratic economic policy guru Gene Sperling has criticized the bill, and how several of my Vox colleagues have summarized it.

Avik Roy, a leading conservative health wonk, warned in a Forbes column on Thursday that the House bill “would price millions of lower-income Americans out of their coverage,” a result he warned could “damage the credibility of free-market health reforms for a generation.”

This analysis from the Tax Policy Center shows that shift vividly. (It’s from an early version of the bill, but experts think these broad effects aren’t likely to change much in revised estimates):
Tax Policy Center
That frame illustrates the difference between the policy environment today and the one that would exist if the AHCA passed. By its measure, the bill amounts to a reverse Robin Hood situation. The poor lose and the rich win.

Obamacare repeal is class warfare - Vox

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How typical..

Rep. Chris Collins (R-N.Y.), who says he did not read the House Republicans' healthcare bill before he voted for it, told a local paper he was unaware of the legislation's possibly devastating effect on his home state. “No,” Collins told The Buffalo News Thursday when asked if he was aware of the bill’s cuts to a health program serving 635,000 New Yorkers. “Explain that to me.”

GOP rep unaware of health bill’s impact on his state despite voting for it | TheHill

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Remarkable

New York Attorney General Eric Schneiderman (D) warned Congress on Friday that he would file a lawsuit to protect abortion rights if the Senate passes the House GOP's healthcare bill. In an interview with CNN's Erin Burnett, Schneiderman attacked the bill, called the American Health Care Act, as "bad public policy." "It doesn't protect people with pre-existing conditions, it will cost millions of people healthcare," he said.

New York AG: I'll sue if Senate passes ObamaCare repeal | TheHill

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The Republican AHCA will kill a lot of people. "Make Americans safe," how ironic.

But because Republicans wasted years before stitching and taping this vile bill together, most of them have no sense of its certain lethality...

The article repurposed the term “death panels” to describe a very real problem—not just that most experts believe uninsurance and mortality are linked, and reducing coverage will lead to preventable deaths, but that ending the compact would interfere directly with ongoing care.

If, for instance, you got an organ transplant thanks to a health plan you bought on an ACA exchange, or through the ACA’s Medicaid expansion, and rely on expensive immunosuppressant therapy to prevent your body from rejecting the new organ, House Republicans will vote today to maybe kill you.

Six years ago, before Obamacare’s coverage expansion went into effect, the number of people in that predicament, or a similar one, was surely tiny. But the ACA has extended coverage to millions of people since then. If Republicans weaken protections for people with pre-existing conditions, make their insurance unaffordable as this bill promises to do, the toll will be disastrously high.

The insularity of conservative thoughts blinds many Republicans to this logical certainty. Just as so many Republicans lack the empathy to support things like marriage equality or disability rights until their families need the protections, they can not see that violating the pre-existing conditions promise is grossly inhumane. And because Republican members of Congress are all insured—and, indeed, they selfishly exempted themselves from the pre-existing conditions rollback—it will never dawn on them. In many cases, the GOP’s moral intuition runs backwards. 

But that doesn’t mean Republicans don’t know what they’re doing in a broader sense. Though the CBO doesn’t forecast immediate mortality risks, it does estimate the global costs and consequences of legislation, and has already apprised Republicans that the AHCA would do widespread harm.

The changes Republicans have made to AHCA over the past several weeks have made the bill considerably more regressive and politically toxic, but have not altered its fundamental nature. The original AHCA failed amid a feeding frenzy over the CBO’s finding that the bill would strip insurance from millions of people within a year, and leave 24 million fewer people insured by the end of the decade, relative to current law..

All of the backroom dealing has tinkered around the edges of a House Republican consensus that it is good policy to finance a massive tax cut for the rich with savage cuts to Medicaid and to premium subsidies for working class people.

Recent amendments layer onto that consensus a new proposition that states should be able to allow insurance companies to price people with pre-existing conditions out of the insurance market, and sell people plans that don’t cover basic benefits like doctors visits and hospitalization. The Brookings Institution has persuasively argued that the AHCA would amount to near-wholesale elimination of Obamacare’s ban on discrimination against people with pre-existing conditions, and may even allow employers to hollow out employee health benefits.

The Republican Health Plan Is a Lethal Moral Obscenity | New Republic

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When a guy on Fox tries to insert a little reality on the healthcare law the Republicans just passed, he gets shouted down, see the video:

All Hell Breaks Loose When Someone On Fox Mentions What The GOP Health Care Bill Actually Does

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Here is Ryan, countering real objections like:

• Hundreds of billions of dollars are taken out of the system with their AHCA Obamacare replacement law and these go overwhelmingly to the rich.
  
• Coverage of pre-existing conditions are softened as the guarantee disappears if people have a coverage gap (which happen frequently through unemployment or other mishap), states opting out of the guarantee, or insurance companies hiking premiums which they are allowed to do under the new AHCA.
  

What do we get as answers? Theoretical stuff like one-size-doesn't-fit-all and setting states free from the Federal government (by giving them less money)..

In an interview on "This Week," Stephanopoulos first asked the speaker why the AHCA, House Republicans' replacement for President Barack Obama's Affordable Care Act, allowed states to opt out of mandating that insurers not raise insurance costs for Americans with preexisting conditions.

"Even if you used all $138 billion that you all put in for high-risk pools, that would still cover only a fraction of those with preexisting conditions," Stephanopoulos said.

Ryan defended a provision in the bill that barred insurers for charging more for preexisting conditions as long as individuals did not have a lapse in their health insurance coverage, arguing that "you can't say for healthcare in America one size fits all." "Under this bill, no matter what, you cannot be denied coverage if you have a preexisting condition," Ryan said. "And under this bill, you cannot only not be denied coverage."

"But you can charge people more," Stephanopoulos interjected. "Let me finish my point," Ryan said. "You can't charge people more if they keep continuous coverage. The key of having a continuous coverage provision is to make sure that people stay covered and they move from one plan to the next if they want to. It's kind of like waiting until your house is on fire to then buy your homeowner's insurance. You want to make sure that people stay covered to keep the cost down."

Stephanopoulos also pressed the speaker to answer critics who asserted that the bill unfairly benefited the wealthy by rolling back the taxes on high income earners that helped fund the Affordable Care Act, the law better known as Obamacare. The ABC anchor said the AHCA cuts $900 million in taxes for individuals who earn over $200,000 annually, while also cutting $1 trillion in subsidies for Medicaid.

"Most of benefits go to millionaires," Stephanopoulos said. Ryan characterized the bill as a "a rescue operation," touting hypothetical benefits of block-granting Medicaid, which gives states a lump sum rather than a per-person amount. "We're giving states the ability to run their own Medicaid program," Ryan said, arguing that block-granting Medicaid was "hardly draconian." "So, you don't think anyone will be hurt when you're taking $880 billion out of the system?" Stephanopoulos asked. "No I don't, because I think the micro-management of Medicaid by the federal government," Ryan replied.

Paul Ryan grilled on AHCA, healthcare bill - Business Insider

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Another abstract defense that means nothing.. 

Health and Human Services Secretary Tom Price on Sunday said that Medicaid would be "more responsive" to its users under the GOP healthcare legislation. During an appearance on CNN’s “State of the Union,” Price argued that patients, families and doctors would win under the Republican plan. He refused to say the legislation would cut Medicaid, saying the Congressional Budget Office (CBO) generated its analysis off the ObamaCare baseline. “Remember that there are no cuts to the Medicaid program. They’re increases in spending,” Price told Tapper. The GOP bill, called the American Health Care Act, repeals the Medicaid expansion implemented under ObamaCare and cuts hundreds of millions of dollars from the program, according to the CBO. When asked by Tapper if premiums and deductibles will decrease under the new plan, Price said “absolutely.”

Price: Medicaid will be more 'responsive' under GOP plan | TheHill

How can it become more responsive when hundreds of billions are sucked out of it?

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Even John Kasich ridicules the plan

Ohio Gov. John Kasich ® mocked House Republicans’ ObamaCare repeal bill, saying its plan to establish high-risk pools for people with pre-existing conditions is “ridiculous.” “The business of these [high]-risk pools, they are not funded,  $8 billion dollars is not enough to fund,” Kasich said on CNN’s “State of the Union,” Sunday morning, laughing. “It’s ridiculous.” Kasich said states wouldn’t have an incentive to move to a high-risk pool system and would instead stay in the healthcare exchange. “There would be no reason to move to a high-risk pool, because a high-risk pool is not funded,” he said. Kasich also pushed for more authority for governors over pharmaceutical and insurance companies to help drive down costs..

Kasich: Republicans' plan for high-risk pools 'ridiculous' | TheHill

The other idea is actually more relevant, more authority over pharma and insurance companies.

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And, of course, there are reasons why these defenses of Trumpcare are so abstract (see above):

As they take their victory lap for passing a bill that would repeal and replace much of the Affordable Care Act, President Trump and congressional Republicans have been largely silent about one of the most remarkable aspects of what their legislation would do: take a step toward dismantling a vast government entitlement program, something that has never been accomplished in the modern era.

Fighting the expansion of the so-called welfare state is a fundamental premise of the American conservative movement. But as tens of millions of Americans have come to rely on coverage under the 2010 health law, Republicans have learned the political risks of being seen as taking a hatchet to the program, however imperfect it may be. So conservatives have now cast aside their high-minded arguments of political principle, replacing them with dense discussions of policy.

A Republican Principle Is Shed in the Fight on Health Care - The New York Times

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Four big lies at the heart of Trumpcare, from The New Republic:

We’re Not Kicking Millions Off Of Medicaid

HHS Secretary Tom Price says the $880B cuts to Medicaid will "absolutely not" result in millions losing coverage https://t.co/s2QDMsFjEh
— CNN Politics (@CNNPolitics) May 7, 2017

AHCA cuts Medicaid spending by hundreds of billions of dollars. A Congressional Budget Office analysis of an earlier version of the bill found that AHCA would reduce Medicaid rolls by five million people within a year, and 14 million people over 10 years. The Medicaid provisions have not changed since the publication of that impact estimate. This is the most consequential, black-is-white lie of the four, because it violates Donald Trump’s repeated campaign promise not to cut Medicaid and because of the degree of contempt it shows for millions of poor people. And House Speaker Paul Ryan echoed it on Sunday.

We’re Not Screwing Over Sick People

.@SpeakerRyan tells @GStephanopoulos: "Under this bill, no matter what, you cannot be denied coverage if you have a pre-existing condition." pic.twitter.com/m7vXnDpuYR
— This Week (@ThisWeekABC) May 7, 2017

Ryan also claimed AHCA has “multiple layers of protections for people with pre-existing conditions,” when the truth is that the AHCA creates multiple hoops for people with pre-existing conditions to jump through in order to avoid massive price discrimination—and no guarantees that any insurance available on the market will be affordable to them, or provide them adequate coverage. 

When Ryan says “you cannot be denied” he is hiding behind the technical fact that the AHCA continues to prohibit insurance companies from rejecting sick patients outright—a provision they kept precisely so they could make this misleading claim. But the Affordable Care Act’s pre-existing protections consist of two interlocking provisions: the “guaranteed issue” provision that ended the insurance company practice of telling sick patients to look elsewhere; and “community rating,” which pools risk across large geographic regions so that everyone in the same region of the same age pays the same premiums, for the same plans. Trumpcare ends the latter promise by allowing states to waive the community rating protection.

If sick people in those states experience a lapse in coverage (through job losses or other hardships) they will be subjected to underwriting—the process by which insurance companies make people disclose their health histories, so that they can charge people with illness more money. Sick people who could not afford market coverage would be able to enter underfunded “high risk pools” in those states, where coverage has historically been extremely poor. 

But even those who maintained continuous coverage would be susceptible to extreme price shocks. The AHCA encourages healthy people to forego coverage until they’re sick, or to choose underwritten health plans, in order to avoid the risk pooled market where they’d be cross-subsidizing sick people. What Ryan would call the first “layer of protection” for the sick actually has a hole in it that nearly all sick people in waiver states will fall through.

Because of this, House Majority Whip Steve Scalise felt he had to go on MSNBC Friday and dishonestly claim everyone with pre-existing conditions who currently has coverage will remain insured under the GOP plan.

We Didn’t End-Run the CBO At All!

While we're setting the record straight: AHCA was posted online a month ago, went through 4 committees, & has been scored by CBO -- twice.
— AshLee Strong (@AshLeeStrong) May 6, 2017

Strong’s boss, Paul Ryan, repeated this basic claim on ABC’s This Week, and called claims to the contrary “a bogus attack from the left.”
Horseshit.

The Congressional Budget Office estimates they are referring to were of versions of the bill that could not pass the House. Though they didn’t radically alter the basic structure of the bill, the changes Republicans have made to it since then were significant enough to make the bill acceptable to House Republicans. They include the provisions allowing states to waive both basic benefit requirements, so that insurance companies can sell junk plans, and community rating, so that insurance companies can price-gouge sick people.

House Republicans intentionally rushed their vote, and beat the CBO to the punch, to escape scrutiny for the implications of these changes. The prior estimates famously found the AHCA would kick 14 million people off their plans within a year, and leave 24 million extra people uninsured 10 years from now, relative to current law. Forthcoming estimates may not change those topline numbers much, but they will tell us a lot about how sick people will fare, and about whether the AHCA would put the federal government on the hook to subsidize scam health plans that cover basically nothing.

Health Insurance Doesn’t Save Lives Anyhow

Congressman Labrador: "Nobody dies because they don't have access to healthcare." #idpol
— Shannon Moudy (@ShannonMoudyTV) May 5, 2017

Experts debate just how strongly having insurance correlates with mortality, but most believe tens of thousands of deaths each year are attributable to uninsurance. That’s a tiny fraction of the tens of millions of people who lack health insurance, but a catastrophically high number in absolute terms.

Conservatives cite uncertainty around the precise numbers to make sophistic claims, like the one Raul Labrador made on Friday, but this is not one of those instances where the counterintuitive argument is the correct one. People without insurance put off doctors visits, and stop taking expensive medicines, all the time. In some of these cases, such as undiagnosed cancer or worsening heart disease, the consequence of the delay is death.