If the newly unveiled Republican healthcare reform bill, already endorsed by Donald Trump, were enacted, it would cost thousands of American lives each year. That’s because it would drastically reduce the number of Americans who have medical insurance. Experts calculate that the Affordable Care Act’s expansion of healthcare coverage to millions of previously uninsured people saves tens of thousands of lives each year.
There are three main ways that the new Republican plan would slash the number of people with health insurance. First, it would redirect the ACA subsidies for buying insurance away from older Americans. That way, many who actually need insurance would be forced out of the insurance market.
So, the Republican promise to cover people with pre-existing conditions would be a lie to many Americans in their fifties and early sixties. Premiums would be too high for them to afford.
An irony here is that this lie would hit hardest an age group Trump won last year. The Republican bill would let insurers play more games with coverage and avoid paying for certain treatments that are now covered.
The second way that the Republican bill would slash the number of the insured would be to end the ACA’s Medicaid expansion. At last count, more than 14 million Americans have gained coverage through the Medicaid expansion. The Republican bill would leave the vast amount of these people uninsured by 2020.
Finally, the Republican bill wouldn’t just repeal the Medicaid expansion, it would repeal Medicaid’s status as an entitlement program embodied in the Medicare Act of 1965. With that change, Medicaid funding would be re-designed so that it would be much easier to cut. When these cuts hit, many states would implement them with rationing of medical care, making arbitrary rules to avoid covering many life-saving medical treatments.
States could also be pushed to try disqualifying those who do remain on Medicaid. Also, states could go after the home equity of more families with frail elders in nursing homes.
It’s no wonder that Republican leaders want to vote on their proposal before the Congressional Budget Office studies it. Any analysis would show that, if the Republican Congress and Trump administration push though this proposal, millions would lose insurance. The bill would make this Congress the biggest death panel in U.S. history.
Ramon Castellblanch is a professor of health education at San Francisco State University and a visiting scholar at the Institute on Labor and Employment at the University of California-Berkeley.