Drilling Down Deeper Into GOP Plans To Repeal And Replace

The Impact Could Devastate The U.S. Economy
By Ross Koppel and Jasmine Martinez

Ending healthcare for those who need it will not make them or their problems disappear. On the contrary, the GOP plan will shatter American families and the economy. Nothing magical happens if we stop caring for the elderly, the ones who need vaccinations, the small infections that can be treated for $2 worth of antibiotics, the uncontrolled diabetics, and those with contagious diseases who clean our schools’ offices and homes. They don’t just get healthy.

            As George Orwell said in Down and Out in Paris and London, “the more one pays for food, the more sweat and spittle one is obliged to eat with it.” Cutting care only exacerbates illnesses, infection, disability, the effects of age and the costs to society. The burdens continue or increase but the cost is shifted to American families, businesses, and states. Here are some stark and underreported examples:


  • Most every nursing homes (SNF— Skilled Nursing Facilities) depend heavily on Medicaid, the program that will face the largest cuts by all of the GOP plans. What will happen to the millions of our elderly, disabled, and infirm? The lawns and parks of Washington DC and the 50 state capitals could hold only about 5% of them, where, of course, they would die without care.
  • 1.75 million Veterans receive care via Medicaid. In fact, less than half receive care via the VA health system because some don’t qualify for various reasons or live too far from a VA facility to for primary care.
  • Hospitals and medical schools depend on many of the programs that would be cut by the GOP plan. The Association of American Medical Colleges (AAMC) “predicts that the United States will face a shortage of between 40,800-104,900 physicians by 2030.”  Cutting training and research dollars will not increase the number of doctors or the good they can accomplish.


This GOP bill forged a rare unity among medical societies, addiction physicians, hospital associations, nursing homes, and almost anyone else involved with healthcare. In contrast, big Pharma and the medical device companies win regulatory freedoms and tax cuts. They seem less hostile to the bill.

Not providing birth control will mean millions of more abortions and unwanted babies. Those children born will not disappear, but rather will need care to become productive members of society. This is an additional burden on the American public and taxpayers.

            The largest growth area in the U.S. labor force was and is healthcare. There are about 13 million healthcare workers nationwide, of which about 3 million are nurses, 800,000 are physicians, while the rest are pharmacists, technicians, respiratory therapists, nurses’ aides, etc. In contrast, there are only about 15,900 miners in the entire USA who are involved with extraction, mining machine operations or earth drillings. Even West Virginia has about 81,000 healthcare workers whereas it has only a few thousand active miners.

            Finally, returning to the costs borne by businesses and society: People denied healthcare are more likely to need caregivers. In 2015, the average age for caregivers was about 49 years old, 85% of which provided care for a relative. 60% of caregivers were employed within the last year while they provided care to someone, while 56% of them worked an average of 34.7 hours per work. 43.5 million adults “provided unpaid care to an adult or a child.”

            The caregiver role is seldom short-term: “three in five care recipients have a long-term physical condition (59%), more than a third have a short-term physical condition (35%), and a quarter have a memory problem (26%).” The unforeseeable end to their role as a caregiver creates a twofold effect on them as their labor remains unaccounted for in the GDP. Unpaid family caregiving costs the nation approximately $470 billion in 2013. For Walmart alone (not exactly the company with the highest paid workforce) the economic value estimate totals more $477 billion.

            Offering poorly designed or no health insurance to Americans will not make their problems disappear. Instead, we are left with more costly health problems. Sicker Americans, in addition to paying incomprehensibly large medical bills, will be forced to exit the workforce early–increasing financial burdens on business and families.

            Perhaps most important, the GOP plan copies Obamacare in not really confronting healthcare prices. Instead, it only denies insurance, allowing largely unchecked the dizzying array of prices.

            The Congressional Budget Office looked at the loss of insurance and the transfer of wealth to the super rich–both staggering. Yes, there were some deficit reductions from denying healthcare to millions. As we try to show here, however, even those “savings” will backfire horribly for the American government, our citizens and our economy. Neither we nor the CBO address the inhumanity implicit in the proposal health plans. For that there are other metrics.


Ross Koppel is a professor at the University of Pennsylvania. Jasmine Martinez is a senior at Vassar College. A version of this article originally appeared at The Health Care Blog.