How To Effectively Argue Against The GOP's Health Care Bill

by Seth Millstein
Justin Sullivan/Getty Images News/Getty Images

After around a month of debate, Senate Republicans have finally unveiled their health care bill, and they plan to vote on it by the end of June. It's unclear whether or not it has the votes to pass, but regardless, you may find yourself debating about the bill's merits at some point. If you oppose the GOP plan to gut Obamacare, there's an effective way to argue against the Republican health care bill.

The CBO has estimated that that bill would result in around 22 million Americans losing their health care by 2026. Broadly speaking, the health care proposal reduces federal subsidies for low-income Americans, repeals various taxes on high-income Americans, defunds Planned Parenthood for a year, fundamentally restructures Medicaid, and loosens regulations on what coverage insurers are required to include in their plans.

Shortly after this version of the bill was released, five Republican senators announced that they couldn't support it in its current form. Assuming every Democrat votes against it, that would leave the bill a few votes short of passage; however, the legislation will be amended before it comes up for a vote, so it's still quite possible that it could ultimately pass.

While Republican leadership is attempting to rally up the votes, here's how you can argue against the most common claims supporting the bill.

Common Argument #1: Obamacare Is Already Dead

At a rally in April, President Trump said that "Obamacare's dead, it's gone," adding later that the law is "in a death spiral."

To be clear, the Affordable Care Act is still on the books, and millions of Americans continue to get their insurance through the law's various provisions. Therefore, there is no factual sense in which Obamacare is "gone."

But is the law in a "death spiral?" That term refers to a very specific situation. In health insurance debates, a death spiral occurs when the healthiest people in an insurance pool drop out, thus raising premiums for everyone else. These premium increases, in turn, convince even more relatively-healthy people to leave the market, causing a vicious cycle and eventually, the collapse of the that particular insurance pool.

According to PolitiFact, the Kaiser Family Foundation, and the Congressional Budget Office, Obamacare is not in a death spiral. There is no data suggesting that healthy people are leaving the health insurance market; in fact, the U.S. Centers for Medicare and Medicaid Services found that the healthiest demographic, Americans between the ages of 18 and 34, enrolled in Obamacare at the same rate in 2017 as they did the year before.

The CBO determined in March that "the nongroup market" — that is, the group of people who don't receive health insurance from their employers — "would probably be stable in most areas" if Obamacare remained as is. This is largely because, as the CBO puts it, most people who buy their own insurance "are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference."

The Kaiser Family Foundation wrote in December 2016 that while health care isn't in a death spiral, it could easily enter one if it's repealed. Meanwhile, various experts told FiveThirtyEight that the manner in which Obamacare restructured the insurance market has made the very concept of "death spirals" obsolete.

Common Argument #2: The Republican Bill Will Make Health Insurance More Affordable

Speaker of the House Paul Ryan and other Republicans often say that the GOP bill will "lower premiums." Similarly, Trump promised that the legislation "will lower premiums & deductibles." The implication is that the legislation would make health insurance more affordable to consumers.

But it won't for two reasons. When the CBO projects that the Republican bill would "lower premiums," it means this in an extremely narrow (and somewhat misleading) sense: The CBO found that Americans who are still able to afford health insurance after the bill is passed will be paying less for that insurance. The problem is that millions of Americans won't be able to afford insurance if the Republican bill becomes law — around 22 million Americans, according to the CBO. Specifically, many older and sicker will see their premiums skyrocket; as a result, they will no longer be able to afford to pay them, so they'll be priced out of the market and left without health insurance.

Second of all, premiums aren't the end of the story with regard to the affordability of health insurance. The CBO also found that the Republican bill would result in higher deductibles for people who actually have to use their health insurance, thus increasing out-of-pocket costs.

Ryan's claim that the Republican bill will "lower premiums" is correct but misleading, as it incorrectly implies that consumers will be paying less for health insurance. Trump's claim that the plan will "lower deductibles" is factually incorrect.

Common Argument #3: Nobody Will Lose Coverage Under The Republican Bill

While discussing the Republican plan on Sunday, Health and Human Services Secretary Tom Price claimed that "we would not have individuals lose coverage that they want for themselves and their family," and that the GOP bill "would not allow individuals to fall through the cracks."

However, according to the CBO, 22 million Americans would lose their health insurance by 2026 if the Republican bill becomes law.

Common Argument #4: The Republican Bill Does Not Cut Medicaid

Trump advisor Kellyanne Conway said the changes the Republican plan makes to Medicaid funding "are not cuts to Medicaid"; Trump himself pledged many times during the campaign that he wouldn't cut Medicaid.

But, in fact, the GOP bill would, in several different ways, both cut funding to Medicaid and reduce the number of Americans eligible to enroll in Medicaid. Under Obamacare, states are allowed to expand their Medicaid programs and allow more people to enroll, with the federal government paying for most of the additional costs; so far, 31 states and Washington D.C. have opted to do this.

However, the Republican bill would phase out this expansion: Starting in 2021, states would begin receiving less and less money from the federal government to fund their Medicaid expansions. Republican Sen. Pat Toomey's claim that the Republican bill will "make permanent the Medicaid expansion" is factually incorrect — the bill does no such thing.

The Republican proposal would also reduce overall funding to Medicaid. Under current law, the federal government pays each state for the cost of its Medicaid program, regardless of what that cost is or how many people are enrolled. The GOP plan would place limits on how much federal funding for Medicaid each state is allowed to receive now.

As Republican Sen. Susan Collins pointed out, the GOP bill would cut Medicaid quite significantly, resulting in 15 million fewer people being enrolled in Medicaid by 2026, according to the CBO.

Common Argument #5: The Republican Bill Will Continue Obamacare's Protections For People With Preexisting Conditions

Republican Sen. Lamar Alexander claimed that "the draft Senate healthcare bill makes no change in the law protecting people with preexisting conditions."

Obamacare prohibits insurers from denying comprehensive coverage to people based on preexisting conditions. It does this through a combination of policies:

  1. Insurers have to offer insurance to everyone who wants to buy it;
  2. premiums have to be set based on the needs of the average community member, not any individual enrollee;
  3. insurance plans must cover 10 essential health benefits.

In conjunction, these policies mean that insurers have to offer reasonably-priced, comprehensive health plans to people with preexisting conditions.

The GOP bill, however, would allow state governments to exempt insurance companies in their states from the 10 essential health benefits requirement; the manner in which it does this is extremely complicated, but you can read more about it here. Essentially, it means that a person in one of those states with a preexisting condition may only be offered a skimpy, bare-bones insurance plan that doesn't actually cover, for instance, the preexisting condition that they have.

Common Argument #6: The Republican Bill Was Written Transparently

GOP Sen. John Cornyn told the Associated Press that he "can't imagine a more transparent and open process" than the one Republican senators used to craft their health care bill.

However, Obamacare was written in a much more open and transparent manner. Most importantly, the Senate held over 30 public hearings on Obamacare while hammering out the details of the bill. By contrast, Senate Republicans haven't held a single open hearing on their bill since announcing it in May; instead, the legislation was crafted in secret by a group of 13 Republican Senators (all of them men).

"If you're frustrated by the lack of transparency in this process, I share your frustration," Sen. Mike Lee told Bloomberg. "I share it wholeheartedly."

It's also worth noting that Senate Democrats spent around a year writing and debating Obamacare, while Senate Republicans will have completed that entire process in roughly a month by the time they vote.

Those are probably the six most common arguments in favor of the Republican bill. Now, you know how to debunk each and every one of them.