The Republican Party’s healthcare game is a long con. For six years, conservatives demonized the Affordable Care Act (ACA) without offering a viable alternative. Then, when they gained control of Congress and the White House, they came up with the disastrous American Health Care Act (AHCA), which would strip 23 million Americans of their health insurance.
The cynic in me believes this deeply unpopular proposal is part of a plan to play chicken with our healthcare system, allowing Republicans to finally destroy their ACA nemesis. Unfortunately, this reckless strategy is unfolding at the expense of tens of millions of Americans, including the small businesses at the heart of the U.S. economy.
We agree that improvements need to be made to the ACA, but lawmakers in D.C. are actively trying to undermine the law as much as possible. After President Donald Trump took office, multiple insurance companies pulled out of ACA marketplaces and blamed their decisions on uncertainty created by the GOP’s ongoing effort to repeal and replace Obamacare, as well as President Trump’s non-committal attitude toward the future of reimbursing insurers for subsidies for low-income customers.
The result is that we’re already seeing instability in the marketplaces. In the past month alone, Iowa’s ACA marketplace lost three carriers, Aetna said it would stop offering all individual plans in 2018, Blue Cross Blue Shield of Kansas City pulled out of the Missouri ACA marketplace and Anthem announced plans to exit Ohio’s marketplace, leaving 18 Ohio counties with no insurer on the ACA marketplaces.
A shaky individual healthcare market has the potential to wipe out millions of businesses owned by solo entrepreneurs because many of these small business owners depend on that market for their healthcare needs.
Indeed, one of the most significant byproducts of the ACA is that it helped end “job lock,” allowing many workers who felt anchored to a job because of a benefits package to go into business for themselves since they could no longer be denied health insurance. In fact, the Robert Wood Johnson Foundation predicted that the number of self-employed Americans would be 1.5 million greater in 2014 thanks to the ACA.
That importance of the ACA to the self-employed is difficult to understate. In 2011, a whopping 28 percent of the country’s 22 million self-employed were uninsured. As a result, this underserved group quickly took advantage of the ACA: 1 in 5 people who purchased health insurance through an ACA marketplace in 2014 was a small business owner, self-employed, or both, according to a report released by the U.S. Treasury Department.
It is concerning to watch the individual health insurance market wobble because of the harm it will do to small businesses, but it is also deeply concerning because it means the Republican healthcare strategy is working. Lawmakers have chosen a particularly deceptive path with GOP senators behaving like vampires, negotiating the particulars of their healthcare bill in the dark.
These are some of the same senators who say they care about small businesses, but they haven’t sought input from that community. If anyone writing the healthcare bill bothered to ask, we would be sure to note that Small Business Majority’s scientific opinion polling found just 25 percent of small business owners said they like the AHCA better than the ACA and that roughly six in 10 small businesses support the ACA.
We know many Republicans are so ideologically opposed to the ACA that they will do anything to kill it, including destabilizing the healthcare marketplaces. After all, the more serious the problems with the ACA, the more Americans will want help. Even if that help has an abysmal approval rating — as the AHCA has — some lawmakers are betting people will accept it out of desperation. That, right there, is where the GOP’s long con ends.
The price of this con is the American Dream. If lawmakers want to save that dream for millions of our nation’s entrepreneurs, they must abandon reckless efforts to repeal the ACA and work to shore up the individual marketplaces immediately.