There’s a new rule in American politics: Whichever party owns health care will come to regret it.
Seven years ago, Barack Obama’s Democrats passed a health-insurance law that promised to cover almost everyone and make medical care more affordable. Best of all, Obama said, the new plan wouldn’t inconvenience anybody, except the high-income folks who got hit with a tax increase.
“If you like your health care plan, you can keep your health care plan,” he pledged. Big mistake.
Obama succeeded in his basic aims, but he couldn’t keep all his promises, especially that one.
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Ever since, whenever anything’s gone wrong in the health sector – whenever prices rose, or an insurance company dropped a line of business – Republicans have had an easy target: Obamacare.
As we all know, the same Republicans who said Obamacare was fatally flawed swore they would replace it with a better, cheaper system – just as soon as they regained power. Now they have, and just like Obama, they’ve overpromised.
“We’re going to have insurance for everybody,” President Trump said in January. People “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better,” with “much lower deductibles.”
But the health-care bill House Republicans unveiled on Monday can’t keep all those promises. It doesn’t even pretend to.
And in a telling mirror image, Democrats immediately dubbed the new plan “Trumpcare.”
From now on, you can depend on them to hang that label on any part of the American health system that isn’t working, just as Republicans did with Obamacare.
The Republican bill would undo much of Obama’s expansion of insurance coverage, especially for low-income people.
It provides much lower subsidies, on average, for people who buy health coverage on the individual market. The cuts are deep for people just above the poverty line, individuals earning between $15,000 and $30,000 a year.
The bill ends Obama’s expansion of Medicaid, the insurance program for very low-income people, three years from now. At that point, the GOP bill would change the funding formula for Medicaid, making it easier to cut the program’s expenditures in future years.
Not everyone will suffer: The GOP bill includes a nice tax cut for the wealthy, canceling the taxes they paid to support Obamacare.
And it preserves the most broadly popular parts in the Obamacare law: the ban on insurance companies refusing coverage to anyone with a preexisting condition, the ban on lifetime benefit limits and the rule allowing parents to keep children on their plans up to age 26.
The bill does not seek universal coverage. Republicans say their goal is universal “access,” but this bill doesn’t provide subsidies big enough to make that practical.
The bill rewards some Republican constituencies: High-income taxpayers get a tax cut, businesses are freed from coverage requirements, middle-income older voters get bigger subsidies. But it does that by reducing subsidies for low-income people, including low-income workers.
The inevitable result is that fewer people will buy health insurance – and many of those will opt for cheaper, bare-bones insurance policies with high deductibles (not the “lower deductibles” Trump promised).
Don’t take me at my word. Here’s what Robert Laszewski, a nonpartisan insurance expert (and flinty critic of Obamacare) wrote on Tuesday: “It won’t work.”
Obamacare’s flaw, he wrote, was that it took care of the poorest people but gave a raw deal to middle-income workers who couldn’t afford its premiums. That was because the Democrats who passed it took care of their political base first and didn’t have enough money left to subsidize everyone.
“Now the Republicans are making the same mistake: taking care of their base and giving the Democratic base a lousy deal,” Laszewski wrote.
“What good will it do a person making $15,000 a year to get a credit only large enough to buy a plan with a $3,000 or $5,000 deductible?” he asked.
“Half the country will hate it – just a different half.”
Or listen to Avik Roy, a Republican health-care scholar, who has argued that his party should be more generous to the poor. The House bill suggests that the GOP has a “stubborn desire to make health insurance unaffordable for millions of Americans, and trap millions more in poverty,” he wrote.
In short, the GOP would replace one flawed plan with another and transfer most of the pain from high-income taxpayers and middle-income insurance-buyers to low-income families. Democrats won’t let voters forget that.
If the bill passes, millions of people will discover that their Obamacare subsidies have been reduced and their health insurance is less affordable – and Democrats will blame Trumpcare.
Millions who have coverage now will lose it. There will be heart-rending stories about people who had insurance but couldn’t afford to keep it – only to contract a life-threatening illness. Democrats will blame Trumpcare.
Health costs will go up; they always do. Democrats will blame Trumpcare.
Insurance forms will still be infuriating, and insurance companies will still hassle their customers. Democrats will blame Trumpcare.
And Trump’s fatal promise – “We’re going to have insurance for everybody” – will be repeated by his opponents as often as Obama’s.
They broke it. They’ll own it.
Doyle McManus is a columnist for the Los Angeles Times. Readers may email him at firstname.lastname@example.org.