Bob Semro: Repealing reform a step backward
January 23, 2011
On Wednesday, the U.S. House of Representatives voted to repeal last year's health care reform law. The vote was 245 to 189.
We think this is a mistake. We consider last year's Affordable Care Act to be one of the most significant and important legislative achievements in generations. It fulfills a longtime goal of ensuring that tens of millions of uninsured Americans finally will have access to more affordable coverage. The new law represents a first step toward limiting the growth of health care costs, and beyond that, it offers one of the most significant deficit-reduction packages ever passed by Congress.
Many provisions of the law already are helping millions of Americans. They include eliminating exclusions for pre-existing conditions for children, insuring dependents younger than age 26 and providing drug rebates and discounts for seniors.
We recognize that the law is not perfect, but as was the case with Medicare and Medicaid, improvements can and will be made. This, we think, is where Congress should focus its energy — not on a political and time-consuming legislative exercise that is certain to fail.
A vote to repeal is a step backward. To illustrate that point and to show how important this bill is for all Americans, we offer our top 10 benefits still to come from last year's reforms.
According to the nonpartisan Congressional Budget Office, repeal will increase the national deficit by $230 billion during the next 11 years and by $1.2 trillion during the next 20 years (1).
Thirty-two million non-elderly Americans will have health care coverage by 2019, the year of full implementation (2). Almost 24.3 percent of Colorado's nonelderly population, or about 1,001,388 citizens, will benefit from some level of health care coverage (3).
The cost of uncompensated care for the uninsured — people seeking routine treatment at emergency rooms, for example — will decrease by 61 percent (4). With repeal, these costs will continue to be shifted to insured individuals and businesses.
The provision that ensures that children with pre-existing conditions are eligible for coverage will be extended to everyone else in the future.
Insurance companies will be required to spend at least 80 percent of premiums on health care.
Medicare's solvency will be extended for an additional 12 years, and measures to reduce waste in Medicare and Medicaid will now be implemented.
Seniors in the Medicare Part D doughnut hole, who pay full drug costs between $2,830 and $6,440 annually, will get help in paying those costs.
New public databases and penalties to curb elder abuse will be implemented.
A $110 billion middle-class tax credit will help families pay for insurance (5).
A small-business tax credit will help as many as 4 million small businesses in the United States — and 69,000 in Colorado (6). The credit could increase employee coverage by more than 25 percent (7).
Now that the repeal has been approved, the next step in the process will have four House committees work on alternatives to the existing law. What seems to have been forgotten is that opponents of the Affordable Care Act formally introduced alternative legislation a year and a half ago. While the Patients' Choice Act of 2009 has many similarities to the current law, there also are striking differences.
First, the alternative legislation only would cover an additional 3 million uninsured Americans by 2019, as opposed to the 32 million uninsured citizens that would be covered under the current law. That increase in coverage would barely keep up with normal population growth. The alternative legislation would reduce the deficit by $68 billion, less than half of what could be achieved under the Affordable Care Act. Medicaid only would be available to low-income people with disabilities, and all other low-income Americans currently eligible for Medicaid would be "integrated" into the private insurance system. Finally, premium tax credits for the purchase of coverage would be provided to only American families with incomes at less than 200 percent of federal poverty level, instead of 400 percent under current law.
If history is any indication, the next round of alternative legislation could likely leave millions Americans uninsured, have limited impact on the national deficit, and leave millions of Americans unable to afford adequate coverage.
Bob Semro is a policy analyst with the Bell Policy Center, a nonprofit, nonpartisan think tank based in Denver.
(1) and (2) Douglas W. Elmendorf, director, Congressional Budget Office. Letter to Speaker Boehner, Jan. 6, 2011.
(3) Karen Davenport and Sonia Sekhar, "Unraveling Reform Would Leave Millions with Less Affordable Care," Center For American Progress, March 29, 2010.
(4) Robert Wood Johnson Foundation, "America Under the Affordable Care Act," December 2010.
(5) Rep. Jim McDermott, D-Wash., The Spokesman-Review, Jan. 1, 2011.
(7) Rep. Jim McDermott, D-Wash., The Spokesman-Review, Jan. 1, 2011.