Justin Amash Is In Need Of An Ex-Lax

Nothing puts a smile on my face like killing my supporters!
Nothing puts a smile on my face like killing my supporters!

In an absurdly mendacious Facebook post, far-right ideologue and supposed Michigan Representative Justin Amash said, in effect, `y’all need to chill the fuck out!’:

The AHCA repeals fewer than 10 percent of the provisions in the Affordable Care Act. It is an amendment to the ACA that deliberately maintains Obamacare’s framework. It reformulates but keeps tax credits to subsidize premiums. Instead of an individual mandate to purchase insurance, it mandates a premium surcharge of 30 percent for one year following a lapse of coverage. And the bill continues to preserve coverage for dependents up to age 26 and people with pre-existing conditions.

I want to emphasize that last point. The bill does not change the ACA’s federal requirements on guaranteed issue (prohibition on policy denial), essential health benefits (minimum coverage), or community rating (prohibition on pricing based on health status). In short, Obamacare’s pre-existing conditions provisions are retained.

This is, (how should I put this?), ….

a bald-faced lie.

For all its faults, the Affordable Care Act cut the uninsured rate in half in this country, bent the cost curve down, saved at least 50,000 lives, and shaved at least half a trillion dollars off the 75-year debt projections.

What the new bill does change is significant. It ditches means-based and geographically-based subsidies altogether in favor of an age-based subsidy, so that Bill Gates would get a higher tax credit to purchase a plan on the exchange than I would. At least $600 Billion of the revenue that makes the ACA work is cut in the AHCA. The Medicaid expansions, about half of the ACA reduction in the uninsured, are phased out after 2020, affecting millions who will have little to no access to health insurance if this bill becomes law. That will cost tens of thousands of lives every year.

The changes in subsidies, the uncertainty of the non-statutory cost-sharing subsidies, and the phase-out of the Medicaid expansion will trigger a death spiral on the exchanges and for rural hospitals that will deny millions of Americans life-extending health care and cause immense quantities of needless suffering and death. At least 24 million of those insured on the exchanges and through Medicaid because of the ACA will lose coverage. The coverage losses from the exchanges are probably worth at least another ten thousand deaths a year. These losses will hurt Republican voters the most. Coverage loss maps show that the areas of greatest insured reductions are in some of the reddest places in America, like Nebraska, Kentucky, and Kansas.

Even for those who get health insurance through their employers or those of their family members, about 150 million, the bill has a serious problem. The states can petition this administration for exceptions to the mandated coverage provisions. They will get it. Then, there is a provision in the bill to allow large employers in any state to adopt the exemptions of the most backward state, so that employees of large companies can lose hospitalization coverage, or maternity coverage, or prescriptions, or whatever. I guarantee you will see at least some of this.

The idea that this bill makes no significant changes because somebody did a word count and found 90% commonality in the text is a childishly disingenuous dodge. It doesn’t take much textual change to cause suffering for millions.

And for what? To put some money in the pockets of a tiny handful of wealthy donors and to make a political point. Justin Amash is, how to put this delicately, ……

stunningly full of shit.

Author: Rob Field

Campaign worker, policy wonk, history buff.

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