Not the country, the cheese. Like Swiss cheese, the American Health Care Act (AHCA) is full of holes. The first hole is that all the right wing shouting for repeal of the current healthcare law (ACA) is sprouting from a proposal the Republicans touted prior to 2009–ACA funding is a Republican idea. The missing piece causing problems today is the lack of a public option. The Republicans like to say that this bill was “jammed down” their throats, but it wasn’t. Democrats made a gigantic compromise by eliminating the public option and going with state exchanges that totally rely on private insurance companies to keep costs down. It turns out that compromise was the straw that broke the camel’s back. Insurance companies don’t do anything unless it brings in pounds of profit. They are losing money on the exchanges, but making up for it with record profits on the rest of their policies. Healthcare insurance providers have been riding high over the last eight years, but because the one area that helps out those Americans in need of coverage isn’t profitable, they bail out on their responsibilities. Without the public option there is no way to keep the system operating without increasing costs to consumers.


Hole number two is complaining that a third of the country has only one choice in healthcare options. The number is way more than that. Buying healthcare is not like buying a car. You don’t have to be concerned with color or what body style fits your family. All you need is for insurance to pay your bills. It isn’t an issue that your policy contains maternity coverage and you’re male. It isn’t an issue that your policy contains end of life counseling and you are only 32 years old. It costs the insurance company nothing to offer you these coverages when you don’t use them. All policies need to cover major medical for hospital stays, coverage for regular doctor visits, preventative care coverage (free because it reduces the other costs), and prescription drug coverage. We don’t need to see a menu to pick and choose exactly what we think we will use.


But, here’s the real scoop, 90% of American citizens get health care through their employer, labor union, professional association, or one of the government provided Medicare, Medicaid, Tricare, or SCHIP for kids. Guess how many healthcare choices those people have–one, maybe two in a rare case when an employer offers an HMO and a PPO, the PPO generally for a larger buy-in from the employee. One choice–so what?


Hole number three is that Republicans are saying Democrats have no plan to fix Obamacare. The fix is there, but Republican stall tactics since the 2010 midterm elections removed any possibility of working with the original law and keeping it vibrant. It became clear pretty quickly that the lack of a public option was a huge problem. But, after 2010, the Democrats lost any ability to pass additional legislation.


What would that fix be? It could be as simple as adding an option for people under the age of 65 to buy into Medicare. There is no reason others in our society

shouldn’t be able to buy into the system early. As it stands, it is expensive, but not as expensive as buying an individual plan with Medicare-like coverage offered from a private company. The buy-in would be about $8,000 a year or about $666 a month. There are a lot of people who cannot afford that output every month, but we are offering subsidies today, so we could continue to do so bringing down the cost to individuals in need. Paired with that, keep Medicaid for those who cannot pay at all, keep our vets on Tricare, and poor kids on SCHIP. If the public option were Medicare, people buying in would have established, proven, beloved insurance in which they could lay their trust. This option would also benefit the entire Medicare system because younger, healthier people would be buying in and more money would be available to keep the program sound. Choices could include buy-ins for just Part A, the major medical portion of Medicare, if an individual wanted to assume additional risk.


Cut from whole cloth is the Republican claim that the new bill is patient centered. If it were patient centered, the subsidies would be geared to help the needy get insurance. The ACA helps fund families making up to 400% of poverty level income. Under the new plan, the subsidies would be less and allocated by age. Older people would get tax credits because they cost more to insure. In this scenario older people, with middle class income get a subsidy, and a young family just starting out would not. Even so, poor, older people are on the hook for premiums that were once about $1,700 a year jumping to $15,000 over ten years. This demolishes any subsidy. It allows insurance companies to charge different people different amounts for premiums. This is insurance company centered. It helps them defray their own costs, focusing on the needs of the insurance companies rather than the health needs and pocketbooks of patients.


If younger citizens could buy into Medicare with it’s not-for-profit framework, we could control costs. Americans would surely choose that option until private companies could match the lower prices and quality of coverage. All these Swiss cheeseesque holes make this bill weak and expensive.