The GOP ACA Replacement Strategy: Repeal and Go F*** Yourself

I stole that description from a podcast I was listening to recently, but that is exactly what came to mind when I heard the news on the GOP “replacement” bill this morning.  So here is a summary (via VOX):

  • Some of Obamacare’s signature features are gone immediately, such as the tax on people who don’t purchase health care. Other protections, including the ban on discriminating people with pre-existing conditions and the provision that allows young adults to stay on their parents’ plan through age 26, would survive.
  • The plan maintains the Medicaid expansion — for now. The Affordable Care Act expanded Medicaid to cover millions of low-income Americans. And, in a big shift from previous drafts of the legislation, which ended Medicaid expansion immediately, this bill would continue to that coverage expansion through January 1, 2020. At that point, enrollment would “freeze,” and legislators expect enrollees would drop out of the program as their incomes change.
  • The replacement plan benefits people who are healthy and high-income, and disadvantages those who are sicker and lower-income. The replacement plan would make several changes to what health insurers can charge enrollees who purchase insurance on the individual market, as well as changing what benefits their plans must cover. In aggregate, these changes could be advantageous to younger and healthier enrollees who want skimpier (and cheaper) benefit packages. But they could be costly for older and sicker Obamacare enrollees, who rely on the law’s current requirements.
  • The bill looks a lot more like Obamacare than previous drafts. A curious thing has happened to the Republican replacement plan as it has evolved through multiple drafts: it has begun to look more and more like Obamacare itself. The bill keeps some key features of Obamacare, like giving more help to lower-income Americans and the Medicaid expansion, in a scaled-back form. This speaks to how entrenched the health care law has become since its enactment seven years ago, and how difficult it will be for the GOP to repeal it entirely.


Medicaid expansion would come to an end in 2020.  The thought being that all of these people who need insurance subsidies will have incomes that can support paying the full freight in 3 years.

Penalties for not having insurance would be eliminated, but insurance companies will be able to charge you a 30% premium if you have a break in your insurance coverage. So basically the penalty gets to be collected by the insurance company and they get to charge way more than the Government did.

The protections to older people from steep insurance premium increases is ended.  So that young people do pay less, but this bill lets insurance companies charge older people 5 times what younger people pay.

Tax credits are no longer income based — they are age based.  So that older people get larger tax subsidies than younger people, but these tax credits don’t offset the new ability of insurers to charge older people substantially more.

The CBO has not scored this yet, so no one knows its true costs or how many people would no longer be insured.

This bill defunds Planned Parenthood AND starts dismantling private insurance coverage for abortions.  Insurance plans that cover abortions will not be eligible for tax credits.  Got that?

So at first blush, we have a new bill that helps you if you are younger and wealthier.  And male.  If you are older or poorer, you are on your own.  Which is the usual GOP playbook, right?

I’ve heard this called Obamacare Light.  Which translates to me that they have fixed none of Obamacare’s issues and they certainly have not taken the opportunity to expand coverage for Americans.  This bill’s only success is that they repeal the taxes on the 1% that fund some of Obamacare, which I have maintained all along, is the real goal of the GOP here.  There’s no additional cost containment, but definitely some cost shifting — there aren’t many incentives for poorer people to maintain insurance which would mean that ERs become the treatment option of choice again.  And ERs will no longer get paid for this.

The GOP seems to have decided here that they could get rid of the tax on their rich friends, stick it to poor people, disadvantage women again and walk away.  They still have issues within their caucus on this — with some who still think that this maintains an entitlement and the others who will see that this screws over their voters.  And I suspect they know that the CBO news is not going to be good — they are planning to start moving this bill fast, probably to not have to deal with either the costs or the loss of coverage.

But it is pretty clear that the GOP doesn’t care about whether or not you have health care and they certainly don’t care if it costs too much.



23 comments on “The GOP ACA Replacement Strategy: Repeal and Go F*** Yourself

  1. Bottom line: The GOP has promised that their plan will cover more people for less money than the ACA.

    I’ve lost count of how many times they’ve promised this. That’s the bar they’ve set, and I plan on repeating their promise. Again, and again, and again.

    • This is probably another post, but the Dems have a pretty big test here in terms of #resist. They need to get their messaging and coverage sharp and focused here.

      • This is such an easy message for Dems. Like I said, use their own words. The GOP has promised that their plan will cover more people for less money than the ACA. There is zero incentive for Dems to touch this.

        • Other than Manchin, I doubt Dems will touch this. But they need to make plain why this is a fraud precisely to the people who voted for 45 and who rely on Obamacare. This is the stuff I worry about — taking these opportunities to show how the GOP fails them and talk about ideas Dems have to make their lives better.

  2. Prop Joe

    Am I wrong to doubt the impartiality of the CBO to objectively analyze and report the costs/impact? I mean, I find it far more plausible that this Administration and it’s Capitol Hill enablers strongarm the CBO into cooking the books…

    • I don’t know about this yet. They may not have had time to swap out enough people for this. And if they do juke the stats here, I think that this is just another round where 45-Land damages their credibility.

    • Always go with multiple sources. Though not exactly impartial, the Kaiser Family Foundation ( has been pretty spot on with their ongoing assessments of the ACA and its impact.

  3. Prop Joe

    Another thing that caught my attention… Why in the hell would you establish 1/1/2020 as the end date for Medicaid? Which genius made the date they plan to cut off millions more Americans from healthcare right in the middle of a Presidential election?!

    • Yes, isn’t that strange. Even the swapout in insurance will happen (supposedly) this Open Enrollment season, so that people have all 2018 to fume about what has been taken away from them.

    • Republicans are trapped by timing. Their most loyal base is screaming for them to repeal the ACA NOW! This is a weird sort of compromise that will make no one happy. I think this plan is dead, and it will be killed by all sides.

  4. delacrat

    ObamaCare should be understood as a Medicare-for-All prevention plan.

    The GOP does not like it b/c it’s not their Medicare-for-All prevention plan.

    • The funny thing is that, largely, IT IS THEIR PLAN (or was). And it is easy to see why they want these things to happen in election years. They have the hubris to believe that they will be lauded as heroes. Greeted as liberators, if you will.

      • I can’t believe – after all those town halls – that they would still believe this, LG. But you’re probably correct. Trump isn’t alone in his nuttiness.

        • p’shaw! Those are just paid protesters and loser liberals looking for handouts, not real Americans.

          I swear, it must be so easy to be a conservative “thinker”.

          • LOL! They are really out of touch on this one. Can’t wait for the town halls!

          • I don’t know, the sheer amount of mental gymnastics they do on a daily basis has to be exhausting.

          • Not sure that it is mental gymnastics to repeat what your “news” sources tell you to repeat on the daily.

  5. As has been widely reported, this bill faces steep opposition in the Senate. If you think like a Republican for a moment, you’ll see that it will be easy to find four Senators who’ll shoot it down (if the Democrats don’t do it first) so that the rest of them can continue to preen for the rubes. Those four will be vilified (Collins and Murkowski already are anyway) and thrown under the bus, Obamacare (mostly) survives and Republicans can keep milking it for donations from the rubes.

    From the standpoint of a GOP congressperson in a safe, gerrymandered seat, it’s the best-case scenario. Why solve a problem when you can raise money with it?

  6. Oh and look at this — Health Insurers Would Get Fatter Tax Break on CEO Pay Under GOP Health Plan

    CEOs of insurers get a personal tax break in this bill, while this bill undermines healthcare for most Americans.

  7. As predicted the final product will look a lot like Obamacare, but tilted in favor of the rich. Having howled about Obamacare and it’s numerous evils the Republicans find that some of it made a lot of sense, if you wanted more people to be insured which they could care less about. This is not over and I would not be surprised to see a “revolt” or two more in coming weeks. As noted Manchin the marvelous is likely to be the only senator who takes the bait, despite strong urges on Tom Carper’s part.

  8. Conservative Republicans talking now: They want straight, “clean” repeal of ACA.

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