Every Republican health plan means lousier coverage for fewer people

After supporting a budget outline that would take health care from tens of thousands of Mainers and millions of Americans, Maine Rep. Bruce Poliquin and Sen. Susan Collins have a chance to keep the Affordable Care Act in place or to leave people with less coverage or none at all.

Without the ACA, those losing coverage include a 28-year old I know whose brain surgery to remove a cancerous tumor was covered, as are costly scans every few months to see if the tumor has returned. Another has Crohn’s, a chronic disease requiring medicine and monitoring.

You probably know someone, too. After all, the Center on Budget and Policy Priorities estimates that 95,000 people in Maine would lose coverage if the ACA is repealed. The number of uninsured would double and there would be more people without insurance than before the ACA was adopted.

Ending the ACA would hit rural residents and self-employed people hard. Rural hospitals would suffer. Maine has many of each.

After the ACA was launched, Maine lobstermen signed up in droves. As policy analyst Christy Daggett wrote two years ago, after the Maine Lobstermen’s Association used a grant to reach out to its members, “the state’s coastal fishing towns boast the highest rates of nonelderly residents covered through the marketplace. From Boothbay to Bernard, residents of working waterfront towns along the coast have embraced opportunities to gain coverage in the marketplace, usually with help to pay premiums from generous federal subsidies to people with low and middle incomes.”

Now, it’s true that many (although not all) Republicans say they want to replace the ACA with something better. However, their favored policy pieces, such as health savings accounts and high risk pools, have been floated for a long time and would lead to lousier coverage with fewer people getting coverage.

In a bare bones proposal by House Speaker Paul Ryan, higher-income people benefit the most. Take tax-advantaged health savings accounts, which, as implied by the name, require people to save money for health expenses. These funds are not taxed and can be used to pay health care costs. Lower- and moderate-income people can’t afford to put that money aside. Wealthier people can and would get a bigger tax benefit because of it.

President Donald Trump with House Speaker Paul Ryan on inauguration day. J. Scott Applewhite photo via TNS

President Donald Trump with House Speaker Paul Ryan on inauguration day. J. Scott Applewhite photo via TNS

The House plan would also hurt older individuals and thus Maine, since our state has the oldest population in the nation. Instead of people getting subsidies based on income, monetary support would be based on age. While subsidies would be higher for older people, so would the cost of coverage. According to New York Times reporter Margot Sanger-Katz, “It’s hard to know precisely how many people would lose coverage under this proposal because it’s missing some numbers. But similar tax credit plans from House Speaker Paul Ryan and Tom Price, the new secretary of health and human services, would result in millions losing coverage, according to independent estimates.”

Another plan outline, co-authored by Collins and Sen. Bill Cassidy of Louisiana, would allow states to choose whether to continue with the ACA. Maine and other states could end up with nothing. After all, we’ve experienced Gov. Paul LePage’s refusal to expand Medicaid and his view that the Internal Revenue System’s implementation of ACA tax credits made the agency “the new Gestapo.” The proposal uses implausibly positive language to depict this path, which would take coverage from millions, describing it as “return[ing] power to the States to design and regulate insurance markets that work for their specific populations, without any federal assistance.”

Another option in the Cassidy-Collins proposal would let states expand Medicaid and use federal funding on a per-person basis. The state could automatically enroll the uninsured into a catastrophic plan to cover huge medical expenses and could fund health savings accounts. As Vox journalist Sarah Kliff explained, “There would still be some gap, however, between when the [health savings account] dollars ran out and the catastrophic coverage kicked in. How big this gap would be — or even how big the subsidy would be — is not clear at all, and a big question mark around this plan.”

These many complexities aside, it’s clear that, while the ACA is not perfect, Maine people, particularly rural Mainers, would come out worse under all Republican replacement proposals.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.