Many Republicans in Congress are pushing for healthcare legislation that would be worse overall than the current Affordable Care Act, which is popularly known as Obamacare, though it’s notable how many Americans do not know that they are the same. The Affordable Care Act is quite flawed policy, but removing some of its most important provisions will leave millions more without health insurance. That means that thousands more will die every year, when a single-payer system of healthcare should have been implemented to prevent this long ago.
In the years before the Affordable Care Act (ACA) the uninsured population peaked at just over 50 million people. It fell sharply when the main provisions of the ACA took effect, falling to less than 28 million in recent quarters. However, in its effort to make America great again, the Republicans expect to raise the number of uninsured back above 50 million. Serious analysis of their plan shows that they have a good shot at meeting this goal.
While the Republicans are in principle keeping some of the provisions of the ACA that were responsible for lowering the number of uninsured, this effect will be temporary. In most cases the situation for most people not covered by their employers will be the same or worse than before the ACA took effect.
For example, the plan leaves in place the expansion of Medicaid through 2020. This should be long enough so that most currently serving Republican governors will not have to deal with the effect of the elimination of this provision. After 2020 people benefiting from the expansion will be allowed to remain on Medicaid, but new people will not be added. Since people tend to shift on and off Medicaid (something rarely understood by reporters who cover the ACA), after two or three years the vast majority of the people who benefited from the expansion will no longer be getting Medicaid. By 2025 the impact of the expansion on the number of the uninsured will be trivial.
The Republicans will be further helped in their plans to raise the uninsured population back above 50 million with their proposals for segmenting the market by encouraging healthy people to buy low cost catastrophic health care plans. The Republicans propose to raise caps on health savings accounts, which will give healthy people a strong incentive to buy plans with very high deductibles. As a result, plans that have lower deductibles will have a less healthy population and therefore be very expensive. This should make it more difficult for people with health conditions to afford insurance.
On net, it seems likely the Republican proposal will succeed in raising the number of uninsured above the pre-ACA level. Since this seems the likely outcome, it is reasonable to assume that it is the intention of the Republican designers of the bill.