The fatal flaw in Obamacare which anyone with common sense could see a mile away (and I myself posted heavily on this is the past before it became mainstream) is that it completely disincentivized young, healthy people from buying in
...which is why the individual mandate and the clause allowing children up to age 26 to be covered under their parents' plan were created to overcome that very obstacle. The push-back on the penalties for not having coverage under the ACA that delayed the implementation of penalties is why there were not enough healthy younger people IN the system to offset the older or more sickly ones that did sign up to take advantage of the waiver for pre-existing conditions.
That caused insurance companies to start pulling out of the marketplace because they simply couldn't sustain it. The Republicans are decrying the current lack of choice; I can understand that to a point, but if the numbers of people the CBO estimated would have signed up under the ACA back when they crunched the numbers in '08 or '09, we wouldn't have had the pullouts by the big insurers and had more choice. Instead, the ACA was denigrated for being an unfair tax and every Republican ran on tickets that promised to repeal and replace it with something better. Their constituents were so ill-informed that a staggering percentage (30% or greater) didn't know Obamacare and the ACA were the same thing. They wanted to repeal Obamacare (because "Obama" is in the word) but liked their coverage under the ACA. What? In hindsight, maybe Obama should not have co-opted the intended pejorative to take ownership of something that was intended to help a great number of Americans. We know Trump has NO plans to take ownership of the AHCA, even if some are trying to label it Trumpcare already.
Supposed policy wonk Paul Ryan in his PowerPoint presentation about AHCA had a stunningly ignorant slide showing how the younger, healthier people were supposed to offset the cost for the older or more sick. Well, duh, that's how insurance of ANY type works. The bigger the pool, the premiums paid by the young and healthy more than offset the claims insurance companies pay out for the infirm. That's how insurance companies make a profit. It works for car insurance, renters insurance, homeowners insurance, etc. The paid claims number far less than the number of people paying monthly for coverage. For example, how many millions of drivers DON'T have an accident in any given month? How many homeowners don't get burglarized or have their houses burn down? They're all paying nonetheless. It couldn't be much simpler to understand.
Now, one small saving grace I hear from the AHCA being proposed is allowing employees of unrelated small businesses band together to create a group for the purpose of lowering overall healthcare expenses. If you could get local Chambers of Commerce on board with something like this, small business owners would not feel nearly the pressure to provide affordable insurance for employees if they could pool various businesses from the community together into a single healthcare pool. I would imagine you would have insurers fighting over landing such an account, which could eventually lower cost for everybody involved. But again, you NEED healthy, younger people in the pool or it will never work.
Without a mandate, many of those same younger and healthy people will choose to skip health insurance altogether. Why pay for insurance when you can use that money to party or take trips? You're young, you're going to live forever, right? The only penalty under the AHCA will be a 30% surcharge on premiums if you have lapsed coverage. The young and healthy could choose to skip paying for years on end. Take about disincentivized! That in itself will collapse the whole current argument about having more choice. The biggest losers are going to be the poor and the elderly/sick. The current plan to give refundable tax credits to the poor and wealthy alike only benefits the wealthy.
People aren't showing up to town halls across the country because they think this program is great and they want to thank their representatives in Congress for all their hard work over the last eight years coming up with such an innovative alternative (snark completely intended). And, no, they're not "paid protesters" either. Some Republicans like to claim these protesters are getting paid $1500 a week to show up and disrupt town halls across the country. Sign me up! What a great part-time job.
Red state governors are already scrambling to try to come up with revenue ideas to replace the Medicaid dollars their states took during the expansion under the ACA and see that the effort is futile. Their constituents were all promised a fairy tale to replace the "evil" of Obamacare. The poorest states continue to vote against their own best interests. The Medicaid expansion under the first draft of AHCA was supposed to end in 2020; now they're seriously considering ending it this calendar year.
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