Economist: Under GOP Healthcare Plan, 24,000 Additional Uninsured Will Die Annually

Interview with Gerald Friedman, professor of economics at the University of Massachusetts, conducted by Scott Harris

President Donald Trump and Republican Party leaders in the House and Senate have followed through on their campaign pledge to repeal and replace Obamacare. But the proposed GOP legislation, dubbed the American Health Care Act, shamelessly fails to live up to Trump’s repeated promises on the campaign trail to provide health insurance to all Americans; ensure that all Americans will have quality health care for less money than Obamacare and to never cut funding for Medicaid. On all three of those important pledges the Republican health care bill flunks.

Analysis of the legislation by the non-partisan Congressional Budget Office projects that 24 million more Americans would be uninsured by 2026 than under Obamacare, including 14 million who would lose their insurance by 2018. While the GOP bill would lower federal deficits by $337 billion over 10 years, largely as a result of cuts to Medicaid that would reduce enrollment, average health insurance premiums would rise by as much as 20 percent in 2018 and 2019 before falling in later years. If the Republican health care plan were to become law, an estimated 52 million people would be uninsured by 2026, compared to 28 million who lack insurance under the current law.

More than 50 national organizations oppose the GOP’s proposed healthcare plan endorsed by President Trump, including AARP, the American Medical Association, the American Hospital Association, the Federation of American Hospitals and the American Cancer Society. Between The Lines’ Scott Harris spoke with Gerald Friedman, professor of economics at the University of Massachusetts at Amherst and who served as an economic adviser to Vermont Sen. Bernie Sanders during his presidential campaign. Here, Friedman assesses the winners and losers of the proposed Republican party health care plan. [Rush transcript.]

GERALD FRIEDMAN:Well, the plan could very well be seen as “wealthcare” instead of “healthcare.” The one definite element in the Republican plan that has persisted throughout all various permutations is that they’re going to repeal all the taxes that fund the Affordable Care Act, or Obamacare. And these are taxes that most people do not know about, because they’re only assessed on people earning over $250,000 a year. So they’re getting rid of all the taxes, which is about $500 billion over the next decade and all of that money is going to the top one percent of American households, most of it going to the top .01 percent. So those people getting a lot of money.

Now, since you’re getting rid of the revenue, you have to find ways to cut spending and they’re doing it by doing away with the subsidies associated with the Affordable Care Act, subsidies that have gone to working people. They go to people earning less than four times the poverty line, which gets up to like, $70,000 for families. And most of the subsidies go to people earning much, much less than that.

Second, they are saving money by starting in 2020, basically phasing out the Medicaid expansion program that was part of the Affordable Care Act that mostly blue states, but a few Republican-dominated states, expanded Medicaid to cover people up to 140 percent, under 38 percent of the poverty line and also did away with all sorts of restrictions on Medicaid. And those two measures – the subsidies for people to buy individual health insurance plans and the Medicaid expansion, account for the dramatic drop in the proportion of Americans without health insurance. At this point, over 90 percent of Americans have health insurance, so the Affordable Health Act has worked to extend health insurance to people through subsidies, for people to buy individual plans and Medicaid expansion, and those are both be eliminated. The subsidies go right away, and the Medicaid expansion after 2020.

Also, while they’re doing this, things get even worse because they will be pulling the rug out from the whole market structure that’s been set up. The Affordable Care Act, by subsidizing people to buy health insurance and requiring that people have health insurance – also that’s a requirement that has never been enforced – has established a market for individual health insurance for people to buy health insurance as individuals. That’s a market that pretty much did not exist before, because health insurance companies would look at people like “Why do you want to buy health insurance as an individual? It must be that you expect you were going to be sick!” The health insurance companies are ready to walk away from the individual marketplaces if there are no subsidies and no mandate.

The Congressional Budget Office – they’re all Republicans over there now. The Republicans took over the House and Senate and they have full control over the Congressional Budget Office, so it’s an old Bush administration economist. I’m sure he’s competent, but their bias has been to downplay how bad this law is.

BETWEEN THE LINES:A quick question for you. Several years ago, Dr. Steffie Woolhandler and David Himmelstein did a study that they published that talked about some 43,000 people would die if Obamacare was repealed because – although there’s a lot of criticism to go around about the Obamacare system, it essentially gave people insurance and access to preventive health care and save lives. Do you have any idea what will happen if 24 million people lose their insurance by 2026 under this Republican plan? How many people would lose their lives?

GERALD FRIEDMAN:Going back to the original study that Woolhandler, Himmelstein and Wilper at Harvard Public Health did – I think it was 2003. I’m not totally sure of the year, but anyway the original study, you’d basically figure a thousand people die for every million people who lose health insurance. So, if you have 24 million people thrown off health insurance, you’d be expecting about 24,000 more or less extra deaths in 2026. You’d expect 14,000 extra deaths next year. Put it in perspective, that’s more than the number of Americans who died in 1967 in the Vietnam War, and we’d be doing that every year. People have to think about that in Congress. How many Americans are you willing to kill?

BETWEEN THE LINES:I wanted to ask you about the possibility that this debacle in healthcare could result in some newfound political energy and popular support for Medicare for All, a single-payer system. Are you optimistic we are going to find ourselves moving toward single-player in this country anytime soon?

GERALD FRIEDMAN:Oh, absolutely, absolutely. For two reasons. The first is the public energy, the resistance energy that is building up against the Trump administration and against the repeal of the Affordable Care Act. And second, destroying the Affordable Care Act is showing that we really need to do something dramatic to improve, to salvage health care in America.

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