The Binary Choice: ObamaCare or BHRA?


The Senate failed to pass its version of the Republican healthcare reform. All Democrats refused to vote for the bill. Most Republicans favored the bill but a few complained it was too conservative while a few others complained it was too moderate. But all of these Senators failed to understand the bottom line.

The bottom line is pretty simple when you get past all the rhetoric. Do you want ObamaCare or something better?

ObamaCare Status Quo

It’s now seven years since the Affordable Care Act, better known as ObamaCare, was passed in March, 2010. It passed without a single Republican vote and now it looks like any replacement will have to pass without a single Democratic vote. Such is the current polarized state of our Congress.

Let’s review briefly what ObamaCare promised us:

  • Universal insurance coverage – Before ObamaCare about 84% of the country had health insurance. Today about 90% are insured, a gain of 6% with about 20 million more insured; about 15 million through Medicaid expansion and about 5 million through private insurance subsidies. More are now covered by insurance but most of these have second-class healthcare (Medicaid) or can’t afford the deductibles to use their new private insurance.
  • Lower premiums ($2500 less according to President Obama) – Reality is premiums have climbed an average of $3500 making the change about $6000 more per year than promised. That doesn’t even include the rapid rise in deductibles that now average $6000 per individual and $12,000 per family. Prices will continue to rise rapidly as more and more insurers are leaving the market. Many counties will have no insurers in 2018.
  • Freedom to choose your doctor (another famous Obama promise) – Few people have been able to keep their doctor as they have been forced onto Medicaid or onto exchange plans their doctor doesn’t accept.
  • Freedom to choose your health insurance plan (another famous Obama promise)For those Americans choosing their insurance on the ObamaCare exchanges, there may be only one choice – or even none! This situation is sure to be worse in 2018 if ObamaCare remains the law.(see graphic below)




  • Lower the “cost curve” of medical inflationIt’s rising rapidly again after a steady decline in the years just prior to ObamaCare.
  • Lower government spending on healthcareThe expansion of Medicaid has ballooned government spending. According to the CBO, Medicaid spending increased more than 250% from 1990 to 2012. Recent CBO projections expect Medicaid costs to increase 67% over the next decade. If so, Medicaid’s share of GDP may reach nearly 5 times as high in 2027 as it was 50 years ago. This growth greatly outstrips economic growth and inflation.


ObamaCare has failed to keep its promises!

The Better Healthcare and Reconciliation Act (BHRA)

The Republican plan in the Senate is called the Better Healthcare and Reconciliation Act of 2017 or BHRA. Here is what it promises:

  • Restore freedom of choice ­– With the repeal of the ObamaCare Individual Mandate, you will have the choice to purchase insurance – or not. There will be no tax (as with ObamaCare) if you choose not to be insured. The CBO predicts 15 -18 million Americans will like this change and drop their insurance. For those who want less coverage than they have now at a lower price you will have that option, too. With no mandated coverage and freedom to choose the coverage you need, no one will be forced to violate their religious freedom, either.
  • Lower premiums – That depends on whether or not you were being subsidized under ObamaCare (those with incomes below 400% of FPL, the sick and the elderly.) Premiums will go down for the young, the healthy, and those who don’t want the expensive coverage mandated under ObamaCare. For those who have expensive pre-existing conditions premiums may rise but high-risk pools will subsidize their premiums keeping them affordable. No one can be denied coverage due to pre-existing conditions. Low-income Americans will continue to get government support through tax credits that are means-tested.
  • Control of Medicaid spendingContrary to liberal and media distortions, there are no “cuts” in Medicaid spending. There is a reduction in the rate of growth of spending which will be tied to medical inflation until 2025 and then to overall inflation thereafter. This significant reform promises to stabilize Medicaid to ensure it continues to be available for those who truly need it for years to come. States will be given greater flexibility to innovate in order to control costs and incentivize able-bodied adults to get off Medicaid.


The Binary Choice

Congress is left with a simple choice; retain the failing ObamaCare or try something different. In seven years ObamaCare has shown it is a system that cannot support itself without huge government subsidies to bailout the insurance companies. Even with subsidies the costs are skyrocketing and the premiums, too – because it is a poorly designed system. With insurers running for cover and many counties left with no choices, it is insane to retain this system.

Democrats are ignoring the deficiencies of ObamaCare because their goal is a single-payer system to “rescue” the country after Republicans fail to pass their version of a replacement. Any Democrat that believes America will be better off with a single-payer system hasn’t been paying attention to their neighbors in Canada, or Great Britain and Sweden, where these systems are failing now. Any Republican that thinks they’ll get a better plan if they negotiate with the Democrats is living in an alternate universe.

Compromise is the essence of legislating. It’s time for those members of Congress, on both sides of the aisle, looking for a better deal to learn to compromise. In an earlier post (Healthcare Reform Principles That Cross Party LinesI reported that the BHRA contains all eight principles that a bi-partisan group of experts agreed must be in the healthcare bill. The BHRA bill is the compromise that everyone should agree to. It’s time to quit the posturing and vote to improve America’s healthcare.


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