First, on taxes, the bill would undo the tax penalty associated with the individual mandate and repeal Obamacare’s taxes, including the 3.8 percent surtax on investment income and a 0.9 percent surtax on wages for households making more than $250,000. Second, it would phase out the Medicaid expansion and cut funding to the program, depriving up to 14 million people of health-care by 2026, according to the CBO. Third, it would allow insurers to charge more for patients who are older and sicker—including those with pre-existing conditions, like cancer, diabetes, or even injuries from domestic violence—while allowing young, healthy, high-income adults to save money on skimpier insurance.
House Speaker Paul Ryan and other Republicans have defended the bill with vague allusions to choice, freedom, and cheaper premiums, but the bill itself is a violation of practically every promise from President Donald Trump and many of the 217 Republicans who voted for it. Rather than protect Medicaid, as Trump promised, it cuts Medicaid severely. Rather than cover “everybody,” as Trump promised, it will deprive about 24 million people of health-care, which is just shy of the population of Texas. Rather than protect coverage for people with preexisting conditions, as Trump promised, it will force many sick patients to pay thousands of dollars extra to buy insurance. Rather than ensure that the rich do not get a tax cut, as Treasury Secretary Steve Mnuchin pledged in an interview last November, this bill creates a $600 billion tax cut that goes entirely to high-income households. Rather than make insurance more affordable, as Republicans have promised over and over, an early 60-something making less than $27,000 would go from paying a few thousand dollars max on a premium and out-of-pocket expenses to spending half his or her income on insurance.
Obamacare has issues. Premiums are rising faster than anticipated in some states, and big-name insurers are pulling out, or threatening to pull out, of the exchanges. The rising cost of coverage in some areas could discourage healthy young people to leave the insurance market entirely, even at risk of paying a penalty, which could drive up insurance costs even more for less-healthy people. Although the Congressional Budget Office predicts that the recent round of premium hikes might resolve itself, there is a clear political mandate to improve the status quo.
But the Republican replacement bill improves nothing. It doesn’t reduce premiums for the sick, or expand coverage. It just takes a pool of federal funds used to expand coverage to lower- and middle-class families and transfers it back to rich Americans. If Obamacare is unpopular in name, while its provisions are well-liked, its replacement is popular only in name, and its provisions are despised.