The nonpartisan Congressional Budget Office on Monday released its analysis of the House GOP’s plan to repeal and replace the Affordable Care Act. The result is about as damning as it gets. According to the CBO, 24 million people will lose health insurance over the next decade under the Republican bill, including 14 million in the next year alone.

I served on President Obama’s healthcare reform team and worked on the Hill to get the legislation passed. It was apparent to me then that many of the Republicans’ criticisms of the ACA were wrong, and yet they now apply to the House GOP bill that Speaker Paul Ryan introduced last week.

Since the ACA was passed by the Senate in 2009, the GOP has been attacking it for delivering unaffordable healthcare. Costs were too high, they said. But according to analysis by my colleague Topher Spiro and other healthcare experts, the GOP bill would raise annual healthcare costs for the average enrollee by $1,542, and those costs would continue to increase each year. Older individuals would be hit even harder, with those between the ages of 55 and 64 paying $5,269 more per year on average.

Further analysis by the Los Angeles Times paints an especially dark picture for supporters of President Trump. Of the 70 counties that would suffer the biggest losses under the plan, 68 supported Trump. In fact, 14 of the 15 states most affected by this bill voted for Trump, with states such as North Carolina, Alaska, Oklahoma and Nebraska bearing the heaviest burden.


The GOP campaigned on high ACA costs but then created a bill that raises, not decreases, those costs for families.

The GOP campaigned on high ACA costs but then created a bill that raises, not decreases, those costs for families. As millions of Trump supporters lose the healthcare coverage they need, wealthy Americans such as Trump can expect a windfall. People making more than $1 million a year would see their taxes cut by $144 billion over the next decade, and wealthy health insurance CEOs would see their incomes skyrocket.

Eight years ago, the GOP decried the creation of a partisan Democratic bill. But today, only Republicans support the Ryan plan. Doctors, nurses, hospitals and most insurers oppose this bill. No Democrats were even consulted on the legislation.

Eight years ago, Republicans accused Democrats of ramming through the ACA, even though we spent more than a year holding hundreds of meetings, roundtable discussions and public hearings with experts, lawmakers and stakeholders throughout the healthcare industry. Obama gave a nearly hourlong speech to Congress, laying out his vision and inviting further discussion from both sides of the aisle. Senate Democrats accepted more than 160 Republican amendments to the healthcare bill. And House Democrats held multiple public hearings before and after introducing their legislation in June 2009, allowing relevant committees time to discuss the bill and make amendments long before holding the final House vote four months later.


Now House Republicans want to bypass that crucial process in order to rush their bill through in the next week or so — no hearings with experts, no bipartisan summits, no testimony from the Health and Human Services secretary.

Trump and Republican leaders have tried to assure their anxious rank-and-file members that they will be able to move on to other issues if they simply deal with healthcare quickly. But as someone who was intimately involved in the crafting, passage and defense of the ACA, I know Republicans are fooling themselves.

For starters, Ryan is asking his members to vote for a bill that is not likely to get enough support to pass the Senate. And even if it does, repealing and replacing the ACA isn’t the end of the process — it’s the beginning of a long and ugly drama that will engulf their party for years to come.


As the infighting spills into public view, the media will feast on every twist and turn. Republicans will no longer be able to shift the blame. No Barack Obama in the White House, no lack of control in the Senate or House.

And when disaster inevitably strikes and people start losing coverage, do congressional Republicans think Trump will defend them? Or will there be a 3 a.m. tweetstorm with their names on it?

As we approach the seventh anniversary of the ACA’s passage, the GOP’s replacement plan is shaping up to be a policy and political disaster. It breaks Trump’s promises to keep everyone covered and to not cut Medicaid; it pits House and Senate Republicans against each other; and it sends premiums up for voters in both parties, especially Trump’s supporters.

The comedian Michelle Wolf recently joked on Twitter, “In the time it took [Republicans] to come up with a replacement plan for Obamacare, [they] could have become a doctor.” It certainly would’ve been a better investment for them, their voters and the entire country.


Neera Tanden is the president and CEO of the Center for American Progress. She served as a healthcare policy advisor at the Department of Health and Human Services during the Obama administration.

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