The Affordable Care Act (ACA) was the most significant piece of social legislation to be enacted into law since the passage of Medicare and Medicaid in 1965. Since the implementation of the ACA in October 2013, 17 million formerly uninsured Americans have obtained insurance coverage and the uninsured rate has dropped from 18% of the population to an all time low of just 9%. A poll conducted by the non-partisan Commonwealth Fund in June 2015 found that 81 percent those enrolled in ObamaCare plans are satisfied with their health insurance.
When the ACA passed in 2010, then GOP House leader John Boehner predicted the ACA would cause “Armageddon” and “ruin our country.” In 2013, Ben Sasse made the absurd prediction that the implementation of the ACA would cause America to “cease to exist.” It’s pretty obvious that those apocalyptic predictions of doom and gloom turned out to be very wrong since the U.S. economy has created over 200,000 jobs per month for nearly three years.
Despite the obvious success of the ACA (or maybe because of it), the GOP has been promising for over six years to come up with a consensus GOP replacement plan and to hold an up or down vote on it. On June 17, 2009, then-Rep. Roy Blunt (R-Mo.) promised that: “I guarantee you we will provide you with a bill.” Subsequently, on October 27, 2009, then-Minority Whip Eric Cantor (R-Va.) told reporters that the official Republican version of Obama Care was just “weeks away.”
Even though prominent Republicans made these bold promises, the GOP still didn’t have an ACA replacement plan over four years later which prompted Cantor to make another promise on January 30, 2014: “This year, we will rally around an alternative to Obama Care and pass it on the floor of the House.”
Earlier this month, new House Speaker Paul Ryan (R-Wis.) once again promised to introduce the long over due replacement plan for Obama Care sometime in 2016. “There are many things to do, but most urgent is to repeal and replace ObamaCare,” Ryan said. “We think this problem is so urgent that, next year, we are going to unveil a plan to replace every word of ObamaCare.”
What has been little noticed by Nebraska voters and the Nebraska press is that Jeff Fortenberry, Adrian Smith and Ben Sasse have actually proposed ACA replacement plans. These elected representatives have made little or no mention of their plans. Why is that?
Representatives Fortenberry and Smith are long time members of the Republican Study Committee – a group of ultra conservative GOP House members. Earlier this year, Fortenberry and Smith’s group actually offered up an ACA replacement plan that would kick millions of people off their insurance policies and increase insurance costs for many Americans.
According to the Center on Budget and Policy Priorities, the Fortenberry/Smith plan would would repeal all of ACA, end the tax break for employer-sponsored insurance, bring back pre-existing condition clauses and create a new tax deduction for health insurance.
These so-called “reforms” would add millions to the ranks of the uninsured. As a starting point, the 100% repeal of the ACA would immediately cancel 17 million insurance policies and bring back pre-existing condition clauses. That would cause serious chaos in both the health care system and the overall U.S. economy. It might even bring about another recession.
Fortenberry and Smith would then replace the ACA with a system that relied heavily upon the dysfunctional individual insurance market. The elimination of the tax break for employer sponsored insurance would result in millions of employers cancelling their policies and pushing their employees into the individual insurance market.
The cancellation of millions of employer based insurance policies must be seen in the context of the ending of pre-existing condition clauses and the shutting down of the ACA insurance marketplaces under the Fortenberry/Smith plan. This change would be disastrous for millions of Americans. Due to a lack of competition in many states like Nebraska, the prices for insurance policies in the individual market are much higher than those for employer based health care. Moreover, anywhere from 50 million to 129 million Americans with pre-existing conditions would have serious problems buying an insurance policy at any price.
The millions of Americans who would be involuntarily shoved into the individual insurance market place would be given a tax credit to assist them with the purchase of insurance. However, this tax break would probably only be of benefit to the healthy and the wealthy. Before the passage of the ACA, approximately 90% of the uninsured were below the poverty line and unlikely to pay any federal income taxes. What that would mean is that the Fortenberry/Smith tax break would be worthless to the vast majority of the uninsured.
Not only does Ben Sasse’s plan contains many of the features of the Fortenberry/Smith plan, it also includes so-called medical malpractice or tort “reform.” When he ran for the Senate last year, Sasse called for capping non-economic damages in malpractice lawsuits and implementing so-called “loser pays” rules to cut down on what he termed: “junk lawsuits and defensive medicine.”
The problem with Sasse’s tort revision proposal is that it tramples on our 7th Amendment right to a jury trial and slams the courthouse door shut for millions of Americans. The Founding Fathers were of the belief that the 7th Amendment was sacred and fundamental. As Thomas Jefferson said: “”I consider [trial by jury] as the only anchor ever yet imagined by man, by which a government can be held to the principles of its constitution.” Alexander Hamilton echoed Jefferson: “The civil jury is a valuable safeguard to liberty.”
Sasse could utterly destroy the 7th Amendment and it wouldn’t save anybody any money or increase access to health care. The non-partisan Congressional Budget Office has estimated that all costs associated with medical malpractice total around 2% of all health care expenditures. Many of the states that have adopted the Sasse plan on medical malpractice don’t have lower insurance or medical expenses than the states that didn’t undermine our rights under the 7th Amendment. All medical malpractice “reform” has done is fatten the already healthy bottom line of the insurance industry.
The harsh reality of the Nebraska GOP’s plans is that if they were to be enacted into law, millions of insured Americans would lose their coverage and those that managed to maintain their coverage would pay more for plans with skimpier benefits.
These plans offered by these Nebraska Republicans are similar to other ACA replacement plans that have been discussed by the GOP since 2009. This would explain why the GOP hasn’t coalesced around a consensus plan and held the long promised up or down vote. The GOP doesn’t want the American people to become familiar with what they actually stand for on health care.
What this means is that fate of health care reform depends heavily upon the election results in 2016. The GOP has promised for years to completely repeal the ACA and take away insurance coverage from millions of Americans. Just recently, the Senate passed – using the budget reconciliation rules – the total repeal of the ACA. (Both Fischer and Sasse voted for repeal.) This vote was a dress rehearsal for what would actually happen if the GOP were to regain power.
We Democrats must message the successes of the ACA and the deep flaws in the GOP replacement plans. It’s not fair to the voters to allow the GOP to compare the ACA to some hypothetical ideal that doesn’t exist. Instead, the voters must be asked to actually compare the ACA to what the GOP has to offer. I’m confident that if we can successfully make that contrast, we will have a good election cycle in 2016.