Allow me to come right to the point. Voting on a repeal and replacement healthcare law without it being measured by the CBO for its financial impact is malfeasance. My old party has waited seven years for this, they can at least know what it costs, who is helped and harmed by it and its impact on the debt. Trying to ram something this complicated through is about as poor stewardship as can be found.
This especially true with at least two hospital groups and two doctor groups coming out against it, not to mention the largest lobbying group for retired persons, the AARP. This is especially true with the numbers of people impacted, in particular, the lower paid and older people. As a retired benefit actuary, consultant and manager, I am also troubled by the naysaying of the imperfect ACA in the first place.
The ACA is not in death spiral so says the American Academy of Actuaries. It could be improved, but it is not a disaster as spouted by Messrs. Trump, Ryan and McConnell. It frustrates me that a law that is working pretty good expanding coverage, is being beaten on to support a change that appears to be ill-conceived. It also frustrates me we are not using data driven analysis to decide what to do.
Medicaid expansion is a “no brainer” said Ohio Governor John Kasich, the most reasonable Presidential candidate in my view. This is also the view of The Commonwealth Fund, Economic Policy Institute, RAND Corporation, Kaiser Family Foundation and a study by George Washington University. We have data to contrast the results in the 19 states that did not expand to those of 31 states that did. What I have read is the states that did are seeing fewer personal bankruptcies than before and improved hospital accounts receivable rates.
But, a huge factor should be the following. The ACA administration is already built. As a former benefits manager and consultant, I have witnessed far too many mistakes in administration by reputable insurers and state and federal governments. While the ACA exchange roll out fits this bill, it has now stabilized and is working. My strong advice is to improve the ACA and not throw the baby out with the bath water. To be frank, there is so much in fighting in the Republican Party, that may be the only course of action achievable.