Today the U.S. House barely passed a bill to repeal and replace the Affordable Care Act (ACA).
“I’ve resisted referring to any ACA-replacement bill as TrumpCare since it is House Speaker Paul Ryan who pushed for it,” said Frank Knapp Jr., President and CEO of the South Carolina Small Business Chamber of Commerce. “But President Trump also pushed for this bill and signed off on it. So there is no other better name for it than TrumpCare.”
Should the Senate pass this version of TrumpCare, here are the losers:
- Small businesses. Small business owners know that an employee with health insurance is a healthier employee and a more productive employee. And small business owners who want to offer group health insurance want it to be affordable. TrumpCare will result in more uninsured workers by shrinking Medicaid (most Medicaid recipients work for small businesses), not requiring personal responsibility for having health insurance (the mandate would remain but not enforced) and eliminating tax credits to small businesses that offer group health insurance to help make it affordable.
- States that expanded Medicaid. TrumpCare will stop giving states money for the millions they have added to their Medicaid program. That means the states will have to pick up the tab or take away the health insurance. Either way the Medicaid expansion states, many of which are red states, will need more tax dollars. The reason is that these states have been replacing state dollars with federal dollars for healthcare services for prisoners and people in mental health facilities.
- States that didn’t expand Medicaid. South Carolina and 18 other states refused to expand Medicaid so they have not had at least the benefit of several years of lower healthcare costs and healthier citizens. But these states will now have less federal dollars per low income person to provide health insurance. They will either have to put up more state dollars or cut back healthcare services. The result will be less healthy populations that in the end will mean higher medical costs of the uninsured with the bill footed by hospitals and eventually by those with insurance.
- Legislators in red states. Republicans in Congress will be kicking the hard and unpopular decisions down to their GOP-controlled state legislatures. States would make the decisions on whether to eliminate the essential health benefits which are part of every health insurance policy under the ACA. The public has grown to expect their health insurance to cover emergency room visits, maternity care and colonoscopies. The public also expects not to be turned down or charged higher premiums for having pre-existing conditions. TrumpCare puts all the burden on state legislatures to decide if those benefits are still available to their citizens.
- People with pre-existing health conditions. For all the bluster of the namesake of TrumpCare about protecting people with pre-existing conditions, the bill does not do it. TrumpCare would give every state the opportunity to allow insurers to once again charge higher premiums to people with pre-existing conditions. But the states would have to set up high-risk pools that the feds promise to subsidize to keep the insurance “affordable”. TrumpCare would set aside $8 billion over 5 years for these high-risk pools, nowhere near what the experts say is needed to make health insurance in these pools affordable for the millions that would be forced into them. South Carolina had a subsidized high-risk health insurance pool before the ACA. Only 2,500 people could afford the premiums that were three times the average premium
“The good news is that the U.S. Senate will not agree to TrumpCare in its present form,” said Knapp. “But this is an exclamation point on the need for the public and small business owners to wake up to the threat of having millions more uninsured Americans and all the negative consequences for them and all of us.”