Today’s political landscape is more polarized than ever before. The age-old tradition of compromise and “reaching across the aisle” seems to be more and more unlikely. Nonetheless, there has been no issue more polarizing than healthcare. It is a policy that has traditionally created a rift between the Republican and Democratic parties since its inception in the 1960s. With a majority in both Houses of Congress, the Republicans look to overturn Obamacare as their first priority. Congressman Tom Price's (R-G.A.)'s introduced the Empowering Patients First Act in 2015, legislation that will completely overturn Obamacare. Recently, Senator Rand Paul (R-Ky.) unveiled the first page of the Republican alternative to Obamacare.
It is essential to know what this new system will entail, in theory and in practice:
1. Provide grants to states to insure high-risk patients. High-risk patients include individuals who are more prone to be sick, including those with pre-existing conditions and those aged 50 and older. These grants will act as a safety net for the population. However, the grants that Republicans plan to dole out amount to only 3 billion dollars over the next few years, an amount that will barely begin to cover the costs of these patients’ health care services.
2. Institute the policy of “continuous coverage.” Most Republicans agree with Democrats on the positives of insurance companies covering people with pre-existing conditions without charging them extensively more. With the repealing of Obamacare, insurance companies will charge these individuals more. Only if individuals have maintained continuous coverage for 18 months before purchasing a new policy, will they be covered. Otherwise, individuals could be charged up to 150% on their next premiums. If you forget to pay your bill or if your insurance company “loses” your paperwork, you'll be temporarily transferred to a high-cost sick pool.
3. Expand the usage of health savings accounts. Health savings accounts (HSAs) are medical savings accounts available to those citizens covered under a high-deductible health plan (high deductibles, low premiums). Price recommends that individuals currently covered by a government provided health program should contribute to their insurance plans through health savings accounts. Proponents of this policy argue that it will hold consumers to be more responsible when seeking healthcare services. Opponents argue that while it might decrease the growth of health care costs, it will worsen health care outcomes.
4. Tax credits and subsidies will be reduced. Currently, individuals whose incomes range from 100% to 400% of the federal poverty level, receive subsidies to help them pay for their insurance packages. Under the EPFA, tax credits will be linked to age rather than income. In addition, these tax credits are comparatively modest, ranging from $1200 for those aged 18-30 to $3000 for those above age 50. In an age of rising premiums, these tax credits would do little to cover the baseline costs for many insurance packages, especially in rural regions in the country where only one option is available in the online insurance marketplace.
5. Repeal expanded Medicaid coverage. Currently, Medicaid expansion has been implemented to cover individuals up to 138% of the federal poverty level. It fills in the coverage gap between individuals whose income is too high to qualify them for Medicaid but too low to purchase a healthcare plan on the exchange market. This policy has provided health insurance to millions more of Americans, created jobs in the healthcare industry, and thus providing customers with more efficient healthcare. However, the costs of the expansion were unprecedented. Many critics aim to create a plan that requires those in the coverage gap to contribute towards their insurance plans. While 19 states are not adopting these expansion provisions, approximately 21.3 million Americans are covered under this expansion (in 32 states and the District of Columbia). By repealing these provisions without a replaceable coverage plan, Republicans will leave 21.3 million Americans in limbo, forced to fend for themselves on the open market.
6. Allow individuals to buy health insurance across state lines. Under Price’s replacement plan, health insurance companies that are licensed to sell insurance across state borders will be able to sell policies across state borders as well, just like any other insurance product. This will allow for consumers to find healthcare plans that best fit their financial needs, especially in rural locations where often, only one health insurance plan is available.
7. Worsen conditions for the elderly. While Price’s new insurance markets will provide lower premiums to the young, they will charge higher premiums to the elderly due to the latter group being more prone to receiving more costly health care services. Under the Affordable Care Act, an insurance company cannot charge an elderly customer 3 times more than they charge a young customer. Under Price’s plan, however, this would no longer hold true. The repealing of the Affordable Care Act without a tenable model of healthcare will potentially allow insurance companies to exploit their customers-their enrollees as well as healthcare professionals.
Ultimately, despite being the country with the largest expenditures on healthcare, our health outcomes do not prove themselves to be similarly higher. Building a sustainable model for healthcare requires bipartisan support, something quite unlikely in this age of political polarization. Many doctors view medicine as a calling, and healthcare as a way to get from point A to point B. It is a humanistic field, stabilized and deeply ingrained in the patient-doctor relationship. However, the pressures of healthcare have caused this relationship to falter. In order to preserve their intentions, today, more than ever before, it is essential that doctors get involved in the politics of medicine. They must express their voices and opinions - whether it be through lobbying efforts or local outreach - before healthcare, the entire structure which underlies their and their patients’ lives, is revolutionized, for better or for worse.