From ACA to CACA

The Republican bill that would replace Affordable Care Act (ACA) wouldn't just repeal it, it would unravel it to the point where there would be even less of a health care system than there was in 2008, before the the ACA.

Among the things the legislation would do is replace income-based subsidies with age-based tax credits at its centerpiece. The GOP says that this would make health insurance more affordable for older people, but the smaller subsides for younger people would discourage the young to buy insurance and thus drive up premiums for whoever's left in the insurance pool - thus, the older people in the system would pay more than the tax credits could help them.

Meanwhile, although the Medicaid expansion program would continue until 2020, no one could enroll after the beginning of that year, and Medicaid itself would be funded with block grants - fixed amounts for each state in the name of the "flexibility" for the states to pay as they see fit.  So, New York would be generous, Mississippi would be stingy, and many states would be caught with less money to spend in the event of a recession.

Oh yeah, the Republican bill would eliminate taxes on upper-income earners, capital gains, insurance plans and medical device manufacturers, and it would delay implementing a tax on high-end insurance policies until 2025.  Tax breaks for people who don't need them would be doled out to the tune of $275 billion.

Watching the Republicans craft a health care reform bill is like watching Michael Scott on "The Office" hold his own diversity seminar after his bosses at Dunder Mifflin held one to hide the fact that he was the only one who needed it.  Paul Ryan wants to fix a problem that someone else took care of and that had been created by his own party, so he looks like the good guy.

He doesn't look like the good guy.  He isn't.  Democrats are up in arms over it, constituents have been flooding congressional town halls to protest changes to the current law (which is why GOP House members stopped having town halls until after this bill is passed at the end of the current session on April 7, just before the Easter recess), and it's even gotten opposition from Republican governors who expanded Medicaid and even Senate Republicans opposed to changes in Medicaid or to the tax credit.  Republican senators said the House bill couldn't make it through the Senate.

If this bill becomes law, it will be for the same reasons other Republican legislative initiatives have become law; because the GOP will have rammed it down or throats despite public opposition and because the Democrats in Congress will be too mealy-mouthed in their own opposition.  None of that, of course, is anything new in Washington.