On Tuesday, AARP announced its opposition to the American Health Care Act (AHCA). In a written statement, the group argued that the bill “increases insurance premiums for older Americans [without] doing anything to lower drug costs.” The statement also asserted, “Medicaid cuts could impact people of all ages and put at risk the health and safety of 17.4 million children and adults with disabilities and seniors by eliminating much-needed services that allow individuals to live independently in their homes and communities.”

The impact on older Americans would be substantial. CNN reports that this would mean adults ages 60 to 64 “would see their annual premiums soar 22%, or nearly $3,200, to nearly $18,000. … Those in their 50s would be hit with a 13% increase, or just over $1,500, and pay an annual premium of $12,800. Also, the GOP bill doesn’t provide them as generous tax credits as Obamacare. A 60-year-old making $40,000 would get only $4,000 from the Republican plan, instead of an average subsidy of $6,750 from the Affordable Care Act.”

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In this case, AARP has two additional sources of support. First, the bill is horribly regressive, putting it at odds with all the populist talk on the right. It gives a substantial tax cut to the rich while cutting back on Medicaid. “Households at the top of the U.S. income ladder would see taxes on their wages and investments drop under the House Republicans’ new health-care proposal,” the Wall Street Journal reports. “As expected, the bill repeals a 3.8% tax on investment income and a 0.9% tax on wages. Both levies affect only the highest-earning households, those individuals making at least $200,000 and married couples making more than $250,000.” Favoring the rich over the poor and favoring young Americans (who vote less regularly) over older Americans is politically dangerous.

So advocates of the poor and seniors will be fighting tooth and nail — alongside Sens. Mike Lee (R-Utah), Rand Paul (R-Ky.) and Ted Cruz (R-Tex.), who want to eliminate a major role for government in guaranteeing coverage and allow insurers to offer all sort of plans free from the minimum requirements under the Affordable Care Act. These three and other staunch conservatives sincerely believe that government subsidies and regulations drive up the cost of insurance and prevent functioning of a free market. They oppose the concept that the federal government should guarantee coverage. Politics certainly plays a part as well. Paul and Cruz, who both ran for president in 2016, wouldn’t necessarily mind if President Trump’s entire agenda fell apart. Returning as the standard-bearers of the right, they no doubt would be happy to relitigate big-government Trumpism vs. pristine conservatism. In the abstract, they may not have made a compelling case in 2016, but with “Obamacare Lite” as Exhibit A in the case against Trump, they could well force him to pack it in after one term in 2020 (assuming Trump makes it that long).

Taking a step back, lawmakers who find the GOP alternative as bad as — if not worse than — the ACA might start thinking (gasp!) about ways to address problems with the ACA. Repealing the 80/20 rule, which requires 80 percent of all revenue to be spent on claims, could lure more insurers back into the exchanges, increasing competition and helping to lower premiums. Freeing up insurers to offer plans that do not have to comply with the ACA minimum standards could provide cheaper options to younger, healthier Americans.

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Avik Roy and other conservatives have suggested that we take another look at the actuarial requirements (the percentage the insurer expects to pay out), which are now 60 percent for the Bronze Plan, 70 percent for Silver, 80 percent for Gold and 90 percent for Platinum. Creating a lower band of plans (say, at 40 percent and 55 percent) and capping the top tier at 85 percent could increase choice and perhaps lure more people into the exchanges.

Meanwhile, liberals have suggested a variety of state-led reforms, ranging from transparency in pricing to improving long-term and in-home care. Absorbing the cost of high-risk individuals through reinsurance plans may help to stabilize premium costs for everyone else. (The Georgetown University Health Policy Institute noted that a permanent reinsurance program in the Medicare Part D program has helped keep premiums “stable and affordable.” For example, “Reinsurance is also working to keep premiums down in Alaska, a state with traditionally high premiums. Individual market premium rates in that state for 2017 were originally slated to increase by 42 percent. After the reinsurance program was enacted, they only increased by 7.3 percent. Further, actuarial experts estimate that 2018 rates will be 20 percent lower with the reinsurance program compared to rates without the program.”)