Repeal and Replace: The American Health Care Act

Republicans have been saying "repeal and replace" for seven years. Today, we're talking about their proposal, the American Health Care Act, to repeal and replace the Affordable Care Act. 

The Pearls (our quick discussions at important  stories of the week) 

Attorney General Jeff Sessions requested the resignation of 46 United States Attorneys this week. Though it is not unprecedented for new administrations to transition personnel in the Department of Justice, the Trump administration's approach seemed unnecessarily graceless. The U.S. Attorney for the Southern District of New York, Preet Bharara, was especially taken aback by the Trump administration's move, refused to resign, and was ultimately fired.

We also discussed two thought-provoking pieces on how we take in information. A recent study concluded that Breitbart dominated right-wing media during the 2016 election, creating an ecosystem of thought that altered the broader media agenda. We discuss our thoughts on Breitbart as a nationalist and populist outlet, rather than a conservative one, and on what we see as asymmetric polarization. In connection with exiting the echo chamber, Sarah recommended PolitEcho and Escape Your Bubble

The second piece is a fascinating experiment in gender roles. An NYU professor recreated parts of the debates between Trump and Clinton using a woman actor to play Trump and a male actor to play Clinton. Aside from the gender swap, the language, gestures, and tones of voice exactly mimicked Trump and Clinton during the debates. The results surprised the NYU audiences, and we were surprised by our reactions.

As always, we took a moment to compliment the other party. Beth complimented Congresswoman Debbie Dingell for her measured comments on health care reform. Sarah complimented Rep. Jim Sensenbrenner for his willingness to hold town halls and address constituent concerns. 

The Suit (our closer look at a single topic): 

Following the November 2016 elections, Beth said that Republicans would have to step up and actually govern now because having an undivided government means there are no excuses. The American Health Care Act is Republicans' first real shot at actually governing, and we're not impressed. 

First, we discuss the strategy of beginning the legislative agenda with health care when immigration or tax reform seem like more logical choices that would set the stage for health care reform. We also discuss the rushed, secretive process to create the bill and the hypocrisy in pushing the bill through the committee process without a CBO score. Republicans are also failing to build bipartisan consensus and instead trying to push the bill through with a simple majority in the Senate through the budget reconciliation process. As a result, House Speaker Paul Ryan says the bill is the first of three phases, and the bill can deal only with matters related to the budget under the Byrd Rule. 

The ACHA replaces the individual mandate under the Affordable Care Act with a 30% penalty for failing to maintain continuous coverage. We think the effectiveness of this provision is dubious at best. 

Additionally, the ACHA creates a tax credit system based on age for purchasing insurance, and it takes dramatic steps to change the Medicaid system.  We think the bill largely helps the upper middle class and the wealthy through expanding the use of health savings accounts and repealing a number of taxes, such as the net investment tax, that the ACA imposed. 

Fundamentally, the ACHA does not tackle the hardest questions about health insurance -- namely, how to lower the cost of health care, how to provide coverage for working adults who cannot afford health insurance, and how to provide affordable care to the sickest Americans. Beth feels strongly that employer-sponsored health care contributes to these problems and that Republicans should work to transition health care away from employer-sponsored plans to make lasting and sustainable progress. She references the work of Avik Roy on health care. Sarah also favors getting employers out of health care because of her views on reproductive rights. We discuss competition, market-driven options, and a single payer system as alternatives. Because the ACHA fundamentally doesn't address the hardest questions to promote lasting change in health care, we give it a C-/D, which mirrors comments from David Brooks and John Kasich

The Heels (what we're thinking about outside of politics) 

Sarah is stoked about Paducah's new float center -- Revive Paducah. Beth can't stop thinking about her visit to Glenn O. Swing Elementary School in Covington, Kentucky, which is using innovation in teaching and supporting students to shatter the myth that poor kids can't learn.