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No Excuses not to talk about healthcare

Where Are We Now?

PUBLISHED 2017-06-05
The Story

ICYMI, the GOP is in charge of all branches of government. This means that, after seven years of pushing to repeal and replace Obamacare, they can finally do it.

Get me up to speed

On the campaign trail, then-candidate Donald Trump promised “insurance for everybody” and to replace Obamacare with a plan that’s “far less expensive and far better.” He also promised to negotiate with pharma companies to lower drug prices. And he promised to do it during his first 100 days in office. Cut to early March, and House Speaker Paul Ryan (R-WI) said ‘drumroll please.’ He unveiled the GOP’s replacement plan. President Trump quickly gave it the thumbs up and joined the effort to sell it to members of Congress.

Was that the plan?

– First, it aimed to change how the US government helps people pay for health care. Income-based subsidies – which offered more help to lower-income Americans – were out. Age-based tax credits were in. Meaning, younger, healthier people got less help than older people who need more care

– Second, the plan scrapped Obamacare's 'individual mandate', which required everyone to get insurance or pay a fine. The idea being if everyone paid into the insurance system, there would be more funding available for sicker, older Americans

– Third, the plan capped funding for Medicaid. That's the government program that provides health care coverage to low-income and disabled people, and that was expanded under Obamacare

– Fourth, the GOP’s plan kept a requirement that insurance companies cover people with pre-existing conditions (like asthma or diabetes)

What'd people think?

Dems said ‘we're cool with keeping Obamacare, thanks.’ But, plot twist: a lot of GOP lawmakers also weren’t on board. Some felt the bill didn't go far enough to repeal Obamacare. Others worried it would leave too many of their voters without health care. Then the Congressional Budget Office jumped in and made things worse for House GOP leaders.

What's That?

An independent group of numbers nerds that, among other things, calculate how much a bill would cost the federal government. Gripping stuff. Lawmakers typically wait for the CBO's numbers before moving forward with legislation. The group’s report card for the GOP plan was not good. Even though the CBO said it would save the federal government $340 billion over a decade, it also said the number of people without coverage would go up by 24 million in that same time period. 14 million of them would lose health care within a year.

What happened Then?

Congress took a break. Lawmakers went home to their districts. And a lot of them got an earful from voters worried about losing their health care. More and more GOP’ers put themselves in the ‘nope’ column. That included the House Freedom Caucus: a group of a few dozen of the most conservative House Republicans. They wanted to drop the requirements that insurers cover "essential" health benefits (like maternity and mental health care). Trump and Ryan tried to compromise, but the caucus said 'not good enough.' After it was clear it wouldn't pass, Ryan was forced to pull the bill.

Then What?

GOP leaders spent weeks giving the bill CPR by negotiating with the far-right members. The new version let states decide if insurance companies need to cover "essential benefits" that were required under Obamacare. It also let insurance companies charge more to cover people with pre-existing conditions. This is illegal under Obamacare...and Trump promised that people with pre-existing conditions would be protected. In early May, the House juuusssttt barely voted to the bill through.

And now?

Now, the ball's in the Senate's court. They recently revealed their own replacement plan. Here are the main takeaways: it still gets rid of the ‘individual mandate’ and still caps funding for Medicaid. Tax credits that help people pay for coverage would also be tied to income instead of just age. But fewer people would be eligible to get them. The bill also says ‘boi bye’ to taxes on high-income Americans that help pay for Obamacare. It keeps the ‘stay on your parents plan until you’re 26’ rule. And the rule that says insurance companies can’t charge people more if they have pre-existing conditions. The Senate's hoping to vote on the bill before July 4th.


Healthcare is the top employer and the sixth largest industry in the US. Making any kind of change a hugely complicated thing to do – with lots of unintended consequences. That’s why, no matter what Congress does, there are always lots of people who won’t be happy.

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