National Nurses United (NNU) today sharply criticized the Republicans’ proposed healthcare “repeal and replace” bill as a cruel abandonment of the gains made under the Affordable Care Act (ACA), and a betrayal of the promises made by candidate Donald Trump to ensure that “we’re going to have healthcare for everybody” that is “far less expensive and far better.”

“While there are legitimate criticisms of the ACA, notably the 28 million who remain without health coverage, and the law’s failure to rein in escalating out of pocket costs for millions more, the Republican alternative is far worse,” said NNU Co-President Jean Ross, RN.

“Instead of fixing the very real holes in the ACA – and moving forward to a permanent solution for our broken healthcare system, as could be done by expanding Medicare to cover everyone, at lower cost – the Republican plan moves us back, far back, to the worst vestiges of a profit-focused system based on ability to pay and widespread health disparities,” said Ross.

Further, “the architects of the new bill have exploited the repeal and replace meme with paybacks to some of their wealthiest friends and donors,” said Ross.

The draft bill includes a rollback of most corporate and high income taxes used to pay for the ACA, and said Ross, “as Rep. Keith Ellison has noted, a tax cut for wealthy people’s investment income and tax deduction for healthcare CEOs making more than $500,000 a year.”

The principal effect of the bill, said Ross, “will be the loss of existing health coverage for tens of millions of people, without any restraints on healthcare industry pricing practices that add up to massive health insecurity for the American people.”

That will be the inevitable result primarily through the cut in Medicaid expansion and replacement of the ACA subsidies with refundable tax credits. Among NNU concerns:

• Medicaid expansion, the mechanism of most of the ACA expanded coverage, is temporarily retained, but open-ended federal funding would be ultimately replaced by a cap on federal payments that would encourage financially strapped states to slash eligibility of those covered and sharply cut covered services.
• The tax credits would provide less financial support than the current ACA subsidies, and by most initial analyses provide far less help for low and moderate-income people.
• A 30 percent premium penalty surcharge on people who allow their “continuous coverage” requirement to lapse completely undermines the false promise that the bill retains the ban on insurers denying coverage for people with pre-existing health conditions. Even through the ACA health exchanges, insurers routinely change plan designs yearly in ways to increase out of pocket costs and limit patient choice through narrower networks. The surcharge will increase insurer incentives to engage in these practices.
• Cuts in minimum covered health benefits, services now required by the ACA, would expire in 2020.
• Elimination of funding for Planned Parenthood is a significant attack on women’s overall healthcare. Planned Parenthood clinics provide a wide array of needed health services.
• Reduced funding for public health. Elimination of the ACA’s Prevention and Public Health Fund will disproportionately harm low-income people and patients with chronic illnesses like diabetes and heart disease that will worsen the health of communities and facilitate the spread of infectious diseases. As reported today by Vox, affected programs include the federal vaccines program, and programs to reduce heart disease and hospital-acquired infections.

“With no controls on the notorious price gouging by insurance companies, hospitals, pharmaceutical corporations and other corporate interests in healthcare, more and more people will simply opt out of buying private insurance rather than endure the skyrocketing premiums, deductibles, co-pays and other fees that are endemic to a wholly market based healthcare system,” said Ross.

“The philosophy of a you’re on your own healthcare system is exactly how the U.S. plummeted in a wide array of health care barometers, including infant mortality and life expectancy rates and people skipping needed care due to cost compared to the rest of the developed world, especially before the ACA,” said Ross.

“We cannot accept a return to those harmful days, and will vigorously oppose this legislation while continuing to campaign for real reform – an improved and expanded Medicare for all,” Ross concluded.