Repeal and Replace Ironies Bite Like a Great White Shark

I realize that House Speaker Paul D. Ryan (R-Wisc.) is desperate to repeal the Affordable Care Act. What he has danced around with the grace of a baboon is why. Of all laws, this one is probably more Republican in nature than most because it originated long ago in the uber-conservative Heritage Foundation.

He’s offered the standard propaganda like it’s “collapsing.” That it’s in a “death spiral.” That it’s a “struggle” for Americans. Premiums are too high (of all excuses this one amuses me the most, Republicans for the last 3 decades haven’t given a good crap about something costing average Americans too much). I don’t buy the mandate sticking in his craw either. He was for it when it was a Republican plan and it works the same way all group insurance works. He says a “much, much better system” could be put in its place. Better, of course, means better for his big donors, but even that doesn’t make sense because the Hospital, doctor, and even insurance lobbies are for keeping AND enforcing the ACA.

Ryan made all these points, and more, during a town hall meeting aired by CNN. No one expected to hear anything new of course, but to Ryan, the appearance to care is important. But an explanation for Ryan’s haste to take action that could upend insurance coverage for more than 20 million Americans was never broached. It did underscore, however, that his description of and position on the law are based on misrepresentations and lies.

Objections to rushing into repeal — expressed even by Republican governors — haven’t slowed the rush on Capitol Hill. On Friday, the House approved a budget resolution that will begin the process of stripping away some ACA provisions; the Senate passed its own version earlier this week. Nine Republicans even opposed the measure, which otherwise passed along party-lines.

Here are some of the most glaring lies about the Affordable Care Act that came out of Ryan’s mouth during the CNN town hall:

  1. “The law is collapsing.” “We’ve got to rescue people from the collapsing of this law,” Ryan said. He didn’t specify what he means by “collapsing,” but by almost any measure of enrollment and cost this generalization has no basis in truth. Enrollment in private plans offered through the ACA exchanges for 2017 is running well ahead of the figure for 2016. Last year about 11 million new people signed up for exchange plans; this year the total is projected to be 12 million. That’s not counting enrollees under Medicaid expansion, who number about another 11 million.
  2. Premium increases. Ryan maintains that premium increases for ACA plans are unsupportable for American families. Even when I was Controller for huge corporations or law firms with huge payrolls, there wasn’t a year that went by that premiums didn’t increase as much or more as the ACA increases for 2017.  And that was when the group policies capped out insurance pay outs at one million dollars—a pittance for serious illnesses (i.e., cancer, MS, HIV)—that aren’t applicable under the ACA. Healthcare-for-profit gross margins increase insurance costs, the same way automobile insurance, life insurance or any other insurance increases as costs or risks rise, period.

A Republican audience member who had contracted cancer even spoke to Ryan’s dismay that, “Thanks to the Affordable Care Act, I’m standing here today alive,” he said. “I want to thank President Obama from the bottom of my heart, because I would be dead if not for him.”

But when the cancer survivor mentioned that he lived in Arizona, Ryan thought he had a “gotcha.” Pulling a note card from his pocket, he reeled off the premium increases for Arizona and a few other states for 2017. “Arizona — this year, the premium increases for people on Obamacare, 116%,” he said.

Of course, as Ryan knows full well, premiums and deductibles were rising before the ACA, and in many cases, the post-ACA increases are lower than before. As long as health-for-profit remains the only business in the country that won’t tell you ahead of time what the procedures, even procedures base lines, will cost the consumer, they can charge whatever they want,in order to pay CEOs, third-party pharmaceutical managers like ExpressScripts or CareMark, hospital administrators, etc. What he didn’t mention was that increases in many other states were much lower. Ohio and New Hampshire show 2% increases as opposed to Arizona’s 116%. Arizona’s problem is a state problem, not a federal problem as far as premiums go.

The average benchmark ACA plan premium for a 40-year-old in Phoenix, according to, was $207.00.

And if you think the increases are high, wait until no one but the wealthy can afford the premiums at all and a regular doctor visit, or an x-ray, or a monthly high blood pressure prescription will cost you as much as your ACA premium. Then there’s the return to Emergency Rooms having to treat cases of the flu which gets passed along to consumers.

  1. High-risk pools for preexisting conditions. Ryan understands that protection for people with preexisting medical histories is the most popular element of the Affordable Care Act. He told the town hall audience that the GOP has “a better way” to guarantee coverage for those people: high-risk pools. Separating those with expensive conditions from the overall insurance pool will make insurance cheaper for everyone else, he asserted. Since “8% of all the people under 65 have that kind of preexisting condition,” sequestering them would “dramatically lower the price for the other 92%.”

Whew, that’s a lot of lies are packed into this tired old argument. Ryan, as Republicans do, got his figure of “8% of Americans that suffer from conditions that would relegate them to a high-risk pool” pulled from somewhere, but I bet it stinks in there and it’s never seen sunshine.

It grossly undervalues the truth.  The Department of Health and Human Services estimated in 2011 that 50 million to 129 million Americans under 65, or 19% to 50%, had some kind of preexisting condition and up to 20% of them were uninsurable before the ACA. The ratio rose sharply with age, so that as many as 86% of those aged 55 to 64 were at risk of being denied insurance because of their medical condition. In 2012-2014, FamiliesUSA estimated that nearly 25% of all Americans under 65 could be denied coverage without the ACA protections.

And it’s not as if America’s experience with state high-risk pools hasn’t been tried before with universally grim results. Before the ACA, 35 states had such arrangements. They were persistently underfunded and for enrollees they were expensive, with deductibles as high as $10,000 and premiums as high as double those for healthy individuals. Every one of them excluded coverage for as long as the first year, even though paying premiums, for the very conditions that made their users uninsurable on the open market.

Economist Harold Pollack calculated in 2010 that if a nationwide pool covered only 4 million people with a history of emphysema, stroke, cancer or a heart condition, it would cost more than $24 billion a year even with the waiting periods, etc., above.

  1. The “death spiral.”At the town hall, Ryan reiterated the baseless claim that because more unhealthy people are buying Obamacare plans and “healthy people [are] not buying it,” rates are “skyrocketing,” driving more healthy people away and leaving costly unhealthy customers in the pool in a vicious cycle.

The Council of Economic Advisers reported this month that Ryan’s claim is bullshit. Premium increases have had neither an adverse effect on enrollments in the individual market nor the risk pool. Enrollment is rising, and signups of people in the 18-34 age range — the most desirable because most healthy category, have remained steady at about 28% of total enrollment. And it directly contradicts Ryan’s claim that “younger, healthier people [are] just going without insurance.”

Come on, we all know why the GOP wants to repeal ACA…because doing so would be a huge tax cut for the wealthy for pete’s sake. The rest is just hogwash.

So, Repeal Doesn’t Make Sense, What About Replacement?

Of course the main reason the Republican Party is having such a hard time with the replacement part of “repeal and replace” is that Obamacare is virtually the same privatized mandate plan the GOP pushed for going back to President Richard Nixon—National Health Strategy in 1971 then again in 1974.

Then the GOP revived its privatized mandate plan again in 1993 with  Bob Dole helping to propose the Health Equity and Access Reform Today act or HEART as the alternative to the proposed single-payer plan Health Security Act of 1993 — commonly known as “Hillarycare“ — and then again when then-Gov. Mitt Romney proposed — and succeeded in implementing — the Patient Protection and Affordable Care Act of 2006 in Massachusetts.

President Barack Obama — as a compromise to have basic health reform passed — used this same GOP blueprint with one significant change: adding a public option alongside the GOP’s privatized mandate plan (basically, Obama proposed adding an option to join a form of Medicare).

Eventually the public option was stripped out of the 2010 ACA bill in further compromise to attract bipartisan support for the bill, leaving in its place the very plan that the GOP wanted and pushed for decades. But of course the ACA still did not receive a single vote from the Republican Party.

As a result, the GOP’s repeal and replace position backs it into a helluva corner if voters would take the time to digest it. It has no real replacement plan because the ACA is essentially the privatized mandate it has pursued for so many years. The only possible alternative to a 40-year-old GOP plan would be reverting to the old system, leaving millions of people without full coverage or Emergency Room health care.

Rand Paul and others try to make a case for HSAs (Health Savings Accounts) which of course only benefits people that CAN save any earnings in pre-tax dollars while continuing to pay for healthcare. The only people who can afford this type of “replacement” are wealthy individuals of course.

Even those with coverage — like through their employers — could then once again have a cap on lifesaving treatments, such as those for cancer, and thereby reinstating the privatized insurance “death panels” deciding the profitability of patient treatment versus probable patient outcomes.

Presumably, America would go back to being ranked 47th in the world in patient health outcomes, (including such third world countries like Nigeria where running water is only partially available) before ACA as reported by the World Health Organization.

So the real reason for “repeal and replace” has only one logical explanation. It’s GOP-given name, Obamacare. The ironies bite like a “Great White” don’t they?

Congratulations Republican and Trump voters; you wanted communism and a Putin puppet so that only the wealthy and well connected comrades benefit from government? You’re about to get your wish and more in 3 days.

Do svidaniya i udachi.

Harvey Gold