The Future of Health Care

Professor Ira Wilson

On House Passage of the AHCA 5.4.17

Income redistribution: The ACA was a massive income transfer from the rich to the poor, and the AHCA passed by the house today accomplishes the opposite -- it is a very large transfer of dollars from the poor back to the rich. Not surprisingly, this will reduce the ability of lower income persons to purchase insurance (thus the CBO estimate that it will cause 24M to lose their insurance over time).

Politics and optics: Passing the AHCA makes the conservative Obamacare opposition in the House feel like they have delivered on their electoral promise to repeal the ACA, that they have accomplished something important. But this is not a bill designed to fare well in the Senate, so it will be interesting to see whether voters see this as a real legislative achievement or a meaningless gesture that has a particularly harmful effect on older, sicker, poorer patients (often Trump voters!).

Medicaid: Somewhat lost in the discussion about exchanges, essential health benefits, state wavers, and high risk pools, is the fact that the bill the House passed makes fundamental changes in how the Medicaid program works. Those changes are good for the federal budget, and good for those who want to reduce federal entitlement spending. But they are disastrous in the long run for Medicaid patients, for state budgets, and for safety net providers, which, in the end, bear the brunt of the responsibility for the care of low income persons in the US.

Deal making: The budget deal to keep the government funded through the end of the fiscal year (until the end of September) was a surprisingly bipartisan effort, a compromise in which both Democrats and Republicans had some wins. This health care bill was very different. It didn't involve the Democrats at all, but instead was a deal between the center and the right of the Republican party. In the end, every Democrat in the House, and 20 Republicans in the house, voted against it. It will be interesting to keep an eye on how the administration and the Republican leadership engage in deal-making going forward. 


Other Overviews & Action Items Related to House Passage of the AHCA:


The Uncertain Future of the ACA

Public Health faculty weighed-in on key health issues after the election of Donald Trump—looking at the Affordable Care Act and the potential impacts of its repeal on health disparities, Medicaid, Medicare, and people living with HIV.