As our impulsive new president begins to take a wrecking ball to the Affordable Care Act and set a process in motion to make Medicaid a block grant to the states instead of a federal program, Republicans keep promising a replacement. Why haven’t we seen it lo these many years that they’ve hated the ACA and voted over and over again to repeal?
The answer is fairly simple. They have no replacement that will cover nearly as many people, and maintain coverage for people with pre-existing conditions, and provide care without lifetime caps. In a free market system, you can’t provide coverage for really sick people whose care costs a lot — and we have large numbers of them — without obliging everyone, young and healthy and older and sicker, to buy health insurance. Republicans refuse to do that on ideological grounds. They also refuse to consider a single payer option. So, what they’re going to offer is “access to coverage”, which means the same thing as saying anyone has access to booking a room at Trump’s new Washington hotel — as long as the person can afford it. “Having access” and “Having coverage” are dramatically different — don’t be fooled by the rhetoric that is going to come from our new Secretary of HHS.
As the ACA enrolled tens of millions of people, we found that many of them were far sicker and needed more care than expected. The ACA dug in by emphasizing preventative care and case management for people with multiple complicating health issues. The Republican solution is to throw those people off the rolls.
Sick Americans and their health conditions aren’t going anywhere, leaving red and blue state governors to figure out what to do with what will surely be a lot less money and systematic support.