President Donald Trump campaigned on repealing and replacing the Affordable Care Act (ACA) and has voiced strong support for the American Health Care Plan, which would weaken the landmark legislation. But although the new bill continues to make its way through the House, it remains intensely controversial among both Democrats and Republicans.
A report by the Congressional Budget Office found the new plan would leave 24 million people without coverage over the next decade. The new plan would turn Medicaid into block grant program and put caps on spending. It would also remove the individual mandate, requiring people to pay a fine if they fail to get health coverage. Instead, people would face a 30% surcharge on top of their premiums for their next year of insurance, if they go without health insurance for 63 days.
Unlike the individual mandate in the ACA, the money from the late-enrollment surcharge would go to insurance companies and not the government.
Barbara Zabawa is a clinical assistant professor in the College of Health Sciences at UW-Milwaukee and founder of the Madison-based Center for Health and Wellness Law. She says says that the conversations about health insurance occurring in congress are ultimately about whether or not people have a right to be healthy. "We pay taxes to support public goods, things like national parks, things like public safety, things like infrastructure that we as individuals may never use," she says.
Zabawa says that support for other public goods, like police or fire departments, is rarely contingent on whether or not people believe they will use their services more or less than anyone else.
"When I hear a lot of the discussions questioning 'Well why should I have to pay for maternity coverage if I never use it,' those same types of questions could be posed in the context of public safety or national parks. 'Why should I have to pay for a national park if I've never visited it or I never intend to visit it,'" says Zabawa. "But yet, we don't ask those questions, but in healthcare we are asking those questions. So as long as those questions continue to be asked, then the debate about whether everyone - regardless of income, regardless of age, gender - is entitled to health care is going to continue."
Zabawa also points to another piece of legislation recently introduced as another future flashpoint. H.R. 1313 - the Preserving Employee Wellness Programs Act - would expand the ability of employers to require employees to disclose details about their family health history. "From the perspective of an employers, that change in the law would make these [wellness] programs much easier to administer - they wouldn't have to worry about a lot of regulatory burden."
"But at the same time," she says, "employee privacy - and their family members' privacy, frankly - would be implicated if this bill becomes law."