In essence, the plan attempts to lower health care costs by making people shoulder a greater share of those costs—or "sensitizing" consumers to the actual cost of health care, as Senate aides put it in a meeting with reporters on Monday.Or, more people will have to penny-pinch when it comes to preventive care—which would no longer be provided without copays under the GOP plan—and will delay care, making costs for treatment higher if they end up getting really sick. Alternatively, they'd only be able to afford junk insurance plans—which would be legal again—and end up bankrupt if serious illness struck. In other words, pretty much just like the pre-Obamacare system, except that even more people could be in danger of losing everything. That's not even considering all those now gaining Medicaid coverage. Under Obamacare's Medicaid expansion, people up to 133 percent of poverty are eligible. The Republican plan would cut that to people at 100 percent of poverty, and provide tax credits to everyone else, up to 300 percent of poverty (under Obamacare, subsidies are available for everyone making up to 400 percent of poverty).
Most people don't recognize how much their employer contributes to their health care plan and don't see the costs the insurance company covers: If people are spending more of their own money, many conservatives argue, they'll be smarter consumers. Overall costs will come down, the argument goes, if consumers have more "skin in the game."
"If they repealed the Medicaid expansion, if they repeal the premium tax credits, people who would be covered by those would probably be terminated," Tim Jost, a health law professor at Washington and Lee University, who supports the ACA, said. "Those people would likely be back uninsured."In other words, back to pre-Obamacare days for everyone who had been uninsured, and making coverage so expensive that more people are put in jeopardy of losing the coverage they have. And if they have to let their insurance lapse because they can't afford it, and have a pre-existing condition, they'll have to pay even more when trying to buy insurance again, because the Republican plan allows insurance companies to gouge on pre-existing conditions again.
In many ways, the Republican plan is worse than the system before Obamacare came along, because it could hurt the 85 percent of people who have had affordable coverage—made even better under Obamacare—from the employers. But as far as Republicans are concerned, that's just "skin in the game."