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Why Cuts to Health Care Lack Efficiency

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Andrew Vaz
June 16, 2017

President Donald J. Trump promised coverage to every American under his health care plan — a proposal that was rushed through the House of Representatives without oversight and analysis from the Congressional Budget Office (CBO). Perhaps as the CBO revealed 23 million more American uninsured in a decade, President Trump and the GOP were more interested in gutting the Affordable Care Act (ACA) which provided up 95 percent coverage for Americans. What the CBO also pointed out about the GOP healthcare bill was that deficits would be a lot higher. It seems in the search of political victories for their party, the GOP seems to sacrifice efficiency for political capital. It appears the leadership from the executive office down forgets that when the political campaigns have ended, it is time to govern — efficiently.

Why was the ACA more efficient than the American Health Care Act? For starters, the individual mandate. The mandate stopped the “death spiral” trying to obtain fairly priced insurance by just forcing insurers to charge everyone the same price. The bottom line is we can’t have fairly priced insurance for Americans without a mandate guaranteed to help everyone.

Looking back at the ACA, the Affordable Care Act provides Americans with better health security by putting in place comprehensive health insurance reforms that will:

•       Expand coverage;

•       Hold insurance companies accountable;budget-scale - Laura

•       Lower health care costs;

•       Guarantee more choice; and,

•       Enhance the quality of care for all Americans.

The Republicans in Congress generally focused more on reducing health costs than on expanding coverage, not a good idea. Their proposals will inevitably cover fewer people than the Affordable Care Act, they say, because they will not compel people to buy insurance.

What the President and the GOP have to understand is that health care reform must be centered on the patient and not the doctor. Those who are sick, at risk of getting sick or nearing retirement would pay more, while those who are young and healthy would pay less. In states that obtain waivers from rules mandating essential health coverage at uniform rates, the legislation could put insurance economically out of reach for some sick consumers.

The bill would also reduce projected spending on Medicaid, the program for low income people, by $834 billion over 10 years, and 14 million fewer people would be covered by Medicaid in 2026 — a reduction of about 17 percent from the enrollment expected under current law. It begs to question: what are the Republicans and President Trump see as efficient in reducing Medicaid?

I believe the first thing the GOP needs to accept is ideas such as affordable health care or governmental assistance is not charity. Healthcare is a basic human right and the majority of first world nations have universal health care coverage. Congress should be trying to fix the problems the ACA has instead of repealing the entirety of the bill and not replace it with anything better. It took seven years for the GOP to gut the ACA (provided the Senate also successfully votes to repeal the bill). The GOP have held town halls across the country to meet with their constituents and address the changes to the health care law that a majority do not approve of. Instead of making such rapid changes, representatives should be listening to the public and perhaps bringing their problems to floors of the House and Senate for discussion.

Sadly, Congress under President Trump is not listening to the American people. The objective of repealing the ACA is doing more damage and citizens should be concerned. This bill, the American Health Care Act, is not efficient. Programs like Social Security, Medicaid, Medicare and ‘Obamacare’ are prerequisites to a dynamic and efficient national economy. I mean, isn’t that what we want as a country? If we are not striving for efficiency, effectiveness and efficacy in terms of policy… then what are doing? What direction in terms of public policy are we, the United States, crawling towards?

I’ve long since questioned the beliefs that the wealth in a nation must be concentrated towards the richest persons of society and trickled downwards to the poor, and to my defense, there is empirical evidence that suggests that trickle-down economics is problematic. The powers in Washington D.C. are continuing down this path of creating more inequality under the guise of ‘choice.’ Healthcare is not a choice, it is a right and our leaders should not be pretending that creating ‘options’ is helping people without expanding Medicare. This is another firm hit towards the American public and as long as the GOP continue on this path, one day the American public will no longer support their party and it, and the ideas of Conservatism that leaders such as Reagan and Bush have pledged their support towards, will die.

I believe with this law marks the beginning of a troubling period for the American people who will lose their health care coverage, but also the beginning of the end of the Republican Party across the nation.


Author: Andrew R Vaz, M.Sc., M.P.A. is a doctoral student in the public policy and administration program at Walden University. He is a graduate of the Master of Science in Criminal Justice and Master of Public Administration double master’s program at Florida International University. He can be reached at [email protected].

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The American Society for Public Administration is the largest and most prominent professional association for public administration. It is dedicated to advancing the art, science, teaching and practice of public and non-profit administration.

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