“The Affordable Care Act”: Isn’t Change Supposed To Make Things Better For Everyone? Not Necessarily, Just Follow the Money

In a civil society, change is often viewed as an opportunity to make things better. It is a chance for self-improvement, is open and transparent and is inclusive. This however does not appear to be the intent of the Trump administration or the republican controlled Congress. This brings us to the Patient Protection and Affordable Care Act (ACA). Since President Obama signed this bill into law on March 23, 2010, there have been a minimum of 60 attempts by republicans to repeal it. Had the law not been signed by President Obama, or had been signed by a republican president, rest assured, it would have been accepted by those on both sides of the aisle without the multiple partisan challenges that we have had to endure over the last several years.

Now let’s fast forward to today. We have a President Trump and essentially the same repeal and replace republican majority Congress. They are counting on the alternative fact that the people are not really onto what their actual intents are, their real reasons for wanting to dismantle the ACA. The underlying intent is a continuation of long held conservative economic policy, cutting taxes for the rich. Oh yes, they proclaim that they are concerned about the health and welfare of you and your family, but do not be fooled and sucked into this vacuous and cowardly view. Their goals and intents are much more devious.

These same republicans want you to believe in their alternative facts about the ACA, that it has been an utter failure, that it has not provided health insurance coverage for more than 20 million Americans, that it has not lowered the uninsured rate from 16% pre-ACA to an all-time low of 9.1%. They are hesitant to overtly acknowledge that much of the revenue for funding of the ACA comes from some very rich people. Them! They are acutely aware of this fact, but do not want you to think they are opposed to the ACA or that their opposition is based on their own self- interest and their self-preservation and ability to continue to line their own pockets. For them, greed is what makes the world go around. They could care less about you.

The concept of repeal and not replace for them has two implications. The first of these is deliberately throwing millions of people out in the cold with no health coverage. The second and most important to them is big tax cuts, again for the wealthiest people in the country. According to the Center on Budget and Policy Priorities, 400 of the richest people in America whose average income is greater than $300 million per year would each receive on average, in the parlance of the greedy, a $7 million “kickback” from the ending of two taxes in the current law; the 3.8% unearned income Medicare tax and the 0.9% Hospital Insurance tax. The basis for these taxes is individuals with incomes greater than $200,000 and couples making more than $250,000 per year.

This means that the 160 million people who live in households with incomes below these levels will receive no tax benefits from the repeal of these taxes. This is the reward that republicans are giving all of those everyday working class voters who either willfully or unwittingly voted for them. Not only are they going to take away your health insurance, they’re going to give the savings to their millionaire and billionaire kindred’s. Don’t expect to see this tax in any replacement plan that they come up with, if they come up with a plan at all. So, thank you for your vote!

It is clear that after 6 long years of attempting to kill the ACA, republicans have only themselves, their corporate lobbyists and their moneyed supporters in mind. President Trump, along with Paul Ryan, Mitch McConnell and Health and Human Services nominee Tom Price want you to believe that they will repeal and replace the ACA with “something terrific”. That translates into high deductible plans, health savings accounts, block grants for Medicaid and “Premium Support” vouchers for Medicare recipients. These plans will only shift those costs to everyday regular people while millionaires and billionaires laugh all the way to the bank.

So if you believe the republican plan of repeal with no replacement of the ACA is in your best interest, think again. Repeal to republicans is about greed and superiority. There is nothing noble about being superior to another person. The true nobility is in being superior to one’s previous self, especially if you have been living in an alternative universe and now relying on alternative facts.

The Budget And The Bungler

State budgets are complex and fluid. That being said, let’s look at some facts. State expenditures include spending on government salaries, infrastructure, education, public pensions, public assistance, corrections, Medicaid and transportation. Revenues come mainly from tax collections, licensing fees, federal aid and return on investments. In fiscal year 2014, 49.7% of total tax revenue came from sales taxes and gross receipts, with income taxes accounting for 41.5% of total tax collections. Maine had the 3rd largest tax collections per capita in comparison to its neighboring states. Federal aid to Maine in 2013 was approximately $2.8 billion or 35% of the state’s general revenue. State spending in FY 2015 was 7.6%, the 3rd largest among New England states. In FY 2015, Education accounted for 20.5% of expenditures while 34.4% went to Medicaid. Between 2010 and 2014, the share of the state budget spent on Medicaid increased from 28.6% to 34.4%.

Gov LePage’s 2016-2017 biennium budget for FY 2016-2017 included $300 million in tax reductions which would primarily lower top individual and corporate income tax rates and adjusted sales taxes. He also proposed increasing taxes on large nonprofits such as hospitals, colleges & private schools. Fortunately his veto was overridden by the legislature. The Governor’s entrenched ideology not to accept Medicaid Expansion has severely undermined the state’s ability to effectively balance the state budget without undermining its citizens.

Medicaid Expansion would provide needed coverage for 64,000 uninsured Mainers, provide jobs across all work sectors and increase the states revenue base. The federal government pays 63% of the current Medicaid program. It would have paid all of the Medicaid costs during 2014-2016 with the federal share decreasing to 95% in 2017, 90% in 2020, and remaining at that level thereafter. Finally, those corporations who come to the state, receive perks and incentives from the state and then abruptly re-locate, leaving workers and taxpayers high and dry, must be required to pay a severe cost for these grotesque levels of greed. The wealthy and powerful should not have a stranglehold on tax cuts/breaks. Businesses owe their lives to the everyday workers and taxpayers.

In the end, Medicaid Expansion is not just about assisting those who are in the most need of health care. It is also about increasing economic activity, supporting a significant number of new jobs, reducing state spending on State-Funded Health Care for the uninsured, reducing uncompensated and charity care for small and rural hospitals, reducing the costs that are passed on to consumers and businesses and increasing state revenue by increasing job opportunities. More jobs obviously means that more people are employed, leading to higher family incomes. Had expansion been implemented in 2014 and 2016, there would have been an additional $288 million in federal Medicaid funds provided to the state. If we want to increase state revenue and effectively balance the budget in the future, we must reverse the course on which we are now traveling.

And another thing. Only 20.5% spending on Education? Don’t get me started!


Richard A. Evans, MD, Candidate, Maine House of Representatives (120th District)