The New York Times has a useful set of maps today that graphically demonstrate the economic impact that the Republican healthcare plan will have on individuals in various regions of the nation. Supporters are touting the plan as a better and more efficient way to provide coverage. It “use(s) refundable tax credits to help people buy their health insurance,” which also was a feature of the Affordable Care Act. The ACA — i.e., Obamacare, included a variety of other sticks and carrots to expand risk pools and coverage, someof which is being dismantled by the Republicans, who also have changed the way the tax credits will work. Because of this, the plan is going to cost low-income Americans more while saving upper-middle class people money.
As the Times reports:
The biggest losers under the change would be older Americans with low incomes who live in high-cost areas. Those are the people who benefited most from Obamacare.
For some people, the new tax credit system will be more generous. The winners are likely to be younger, earn higher incomes and live in areas where the cost of health insurance is low.
Obamacare’s subsidies were structured to limit how much low- and middle-income Americans could be asked to pay for health insurance. Under the G.O.P. proposal, many of the people whose tax credits would fall sharply would be likely to end up uninsured. For people with few resources, a gap of several thousands of dollars between their tax credit and the cost of coverage would be impossible to make up.
The plan, the Times said, is likely to “result in fewer Americans having health insurance,” while also “represent(ing) a very large outlay of federal money to help Americans buy health insurance.”
That’s why the plan is a dangerous gamble. I am no fan of the ACA, though I do think it represented the first real step toward universal coverage we have seen in 50 years. It was badly flawed, leaving in place private insurance without offering real alternatives, but it has been a lifesaver for many who otherwise would have been unable to buy insurance.
The current debate over the ACA remains an odd one. It is based on a Republican plan crafted during the 1990s by the Heritage Foundation in response to the Clinton HMO-style proposal, with a version put in place in Massachusetts by then-Gov. Mitt Romney, a Republican. Political opposition has always been just political, tied to the identity of the president who pushed it forward.
Any changes to the ACA should focus on expansion of Medicare — make younger people eligible, maybe starting at 55 rather than push Medicare eligibility in the other direction, allow buy in for those even younger, all with the goal of shifting to a single-payer plan at some point in the future.
Author: hankkalet
Hank Kalet is a poet and freelance journalist. He is the economic needs reporter for NJ Spotlight, teaches journalism at Rutgers University and writing at Middlesex County College and Brookdale Community College. He writes a semi-monthly column for the Progressive Populist. He is a lifelong fan of the New York Mets and New York Knicks, drinks too much coffee and attends as many Bruce Springsteen concerts as his meager finances will allow. He lives in South Brunswick with his wife Annie.
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Hank Kalet 
This whole health care song and dance that we go through in the US drives me insane and leaves me with an intense hatred for the GOP, libertarians and the right wing. This is about human lives, about human suffering. People are dying and suffering unnecessarily because we still do not have true universal health care in 2017!!! All the other advanced, wealthy industrialized democracies have universal health care, everyone's covered and no one goes bankrupt from medical costs or drug expenses. We have the most expensive and most cruel so-called health care system of the advanced democracies. The GOP does not give a damn and is determined to destroy what we do have. Given the history of this country, it's a miracle we have Medicare and Medicaid. It took a monster bully like LBJ to get those precious programs passed. Obama was no LBJ and was too conciliatory with the insurance companies. Obama should have gone with single payer or Medicare for all but he didn't have the will or even the intention. He went for this wishy-washy corporate sell out which the GOP hated anyhow. He reached across the aisle and had his arm ripped off.