How would Trumpcare affect citizens like my good friend Anonyma, homeowner, early 60s, getting by on $1,200 per month social security and occasional tech contract work, paying for treatments for metastatic breast cancer with insurance she purchases through the ACA? Is there anybody who would actually benefit from Trumpcare? And what was on their minds, those thirteen Republican Senators, toiling away in secret to draft a bill intended to transform the American health care system?
In an interview on NPR's Fresh Air, Sarah Kliff from Vox.com provides preternaturally calm and informative answers to all these questions [transcript, audio]. Under the ACA, 64-year-olds earning 26K per year pay about $1,700 in annual premiums, which buys them health insurance covering 70% of the average enrollee's cost for essential benefits. Under Trumpcare, their premiums would rise to $6,500, for insurance convering only 58% of the cost of whatever package of benefits their state covers with its federal block grant; for example, a state could exclude mental health coverage, mandatory under the ACA. Kliff estimates these sexagenarians would also pay 4K per year out-of-pocket for deductibles/co-payments, bringing their health expenses to 40% of their pre-tax income. For my friend Anonyma, that could mean deciding between selling her house and paying for cancer treatment.
64-years-olds earning $56K per year fare little better; they would need to pay 42% of their pre-tax income on health care, because their premiums would rise from 7K to 20K yearly. In contrast, 40-year-olds earning 26K would see their premiums rise from 1.7K to 3K — under Trumpcare premiums increase with the age, and expected costs, of the enrollee. It is true, as the Republicans claim, that average overall premiums in the individual market (private purchase) would decrease by about 30%, as policies cover fewer benefits, and sick people drop out of the market. But even that would be at least partially offset by the increase in out-of-pocket expenses.
The Republican are unapologetic about the 22 million who would lose their insurance within a decade due to Trumpcare, according to an analysis done by the Congressional Budget Office after the veil of secrecy on the bill was lifted. But the Republicans were thinking about high deductibles, the biggest complaint ACA enrollees have about their insurance. Republican spokespersons stress these hated deductibles when they attack the ACA on TV — but Trumpcare is designed to increase deductibles even further, under the cherished conservative theory that it would encourage consumers to be smart shoppers.
There is a method in this madness. When the ACA was drafted in 2008/2009, Democrats told Kliff their goals were to increase coverage (worked) and reduce costs (failed). Now, Republicans tell her their lofty goal is — to get the 51 votes need to pass a bill in the Senate. Here is an issue that will mean the difference between life and death, solvency and financial ruin, to millions of their constituents. And the Republicans are not fussing about trifles like the contents of their bill contradicting the arguments they make to support it. Diary, seldom in life does one encounter such dedication to an ideal as the Republicans expend on the principle of maintaining the appearance of authority. As well as the principle that more is better, when it comes from taking from the poor and sick, and giving to the 1%. Deep in the heart of planet Republican, score that one as a win-win. The 22 million who will lose coverage under Trumpcare are simply exercising an option cruelly denied to them under the ACA; while the super rich shoulder the burden of finding more investment opportunities for a flood of additional cash.
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