US Political Thought: ACA is a Republican Proposal

The ACA is a Republican proposal

Imagine a bird with only one wing. It can't fly. If should you throw it off a cliff, it would spin round and round until it crashes to earth.

Now that Republicans have shown us their health care plan, we see that it looks very much like an article-by-article revision of “Obamacare,” the ACA (the American Patient Protection and Health Care Act), rather than something new. Not only have the Republicans developed no plan to replace the ACA with, they never will. Why? Because the ACA itself is fundamentally a Republican plan.

In 1993, when First Lady Hillary Clinton was tasked with developing a health care plan for all Americans, she proposed a state-based insurance plan that would compel all Americans to have health insurance. Costs won’t go down unless healthy Americans who need few health services pay their share of the costs until they do need it. That’s how insurance works.

Republicans responded with a plan that was a cruder version of the current ACA. But they abandoned that plan when they saw the TV commercials sponsored by health insurance companies increasing public resistance to the Clinton plan (remember the “Harry & Louise” ads?).

Health Equity and Access Reform Today, as the Republican plan was called, was introduced by John Chaffee (R) of Rhode Island. It included an individual mandate, the creation of purchasing pools, standardized benefits, a ban on denying coverage for preexisting conditions and vouchers for the poor to buy insurance. This plan was never enacted, since Ms. Clinton’s plan was defeated by a coalition of Democrats and Republicans.

In Massachusetts, Democrats then refined this Republican plan and passed it in a Democratic-controlled state legislature. The Massachusetts plan provided a template for the ACA. It has the individual mandate, which required all citizens of the state to have health insurance or pay a penalty. It contained an expansion of Medicaid, subsidies for the poor and an exchange that pooled insurance plans from all health insurance companies in one simple website where people could choose their plan.

Gov. Mitt Romney, seeing the bill contained an essentially Republican idea, signed it into law. Today 98 percent of the citizens of Massachusetts are enjoying its benefits or those of the ACA.

The ACA improved upon the Massachusetts plan. The federal version applies to Americans insured through their employer as well as people insuring themselves. Companies employing more than 50 people must provide health insurance or pay a penalty. The ACA contains new regulation of the health insurance industry: participation in insurance exchanges are mandated, preexisting conditions are no longer allowed as a reason for denying insurance, no exemption from anti-trust laws, no life-time or short-term limits, children may remain on their parent's insurance until they are 26 years old, and there’s a 20 percent limit on administrative costs charged by insurance companies over the actual cost of medical care.

It also mandated insurance companies to provide preventive care in the form of a free visit to a medical center for a review of a patient’s health. My wife and I took advantage of this with an hour-long visit with a registered nurse who meticulously reviewed all our medical records.

In the past couple decades, as Republicans slid further and further to the right, Democrats moved toward the center, taking up many positions formerly held by conservatives, including the 1993 Republican health care plan. The “new” Republican plan, in fact, is nothing more than a revision of Obamacare and a decimation of Medicaid comprising references to specific articles in the ACA. That is why it is only 120 pages long. Specifically, it turns the Obamacare exchanges over to the states and lifts the regulation of insurance companies.

I am hopeful that we will leave the world a better place than the one we grew up in. We have provided affordable health care for almost all Americans. But I don’t want us to regress. We need to move forward and provide affordable health care for all of us. We need a single-pay system for all Americans like Medicare and the systems of all the other industrialize nations in the world.

Shamokin News-Item, March 26, 2017

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