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UNWOODY, Ga. — House Republicans pitched their health care vote as a victory for freedom: States could do away with expensive Obamacare mandates and liberate insurers to sell much cheaper plans, which would cover far fewer medical needs.

No longer would men have to pay for maternity benefits. No longer would healthy 20-year-olds have to buy prescription drug coverage.

That all sounded very good to 72-year-old Mike Lowey, who was walking laps at a mall here in the hours after Republicans muscled the GOP plan through the House on Thursday afternoon.

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“I don’t like the government being involved in everyone’s lives,” Lowey said. “They want to control everything.” A retiree who voted for Trump, he’s a fan of the American Health Care Act. And he can explain why in one stirring phrase: “This is supposed to be the land of the free.”

But that definition of freedom is proving divisive.

STAT reporters talked to more than a dozen voters in the suburbs of Atlanta and Cleveland after the AHCA vote on Thursday. Many said they found the Republican vision of freedom of choice on health care seductive. It makes intuitive sense.

Yet when they thought about what it might mean for their own lives, they worried.

“I wouldn’t write it off immediately,” said Madison Massey, 20, a student at Kent State University in Ohio. “It sounds reasonable.”

But Massey, a Democrat, said she would be anxious about buying a plan with skimpy benefits. “I don’t know many people who don’t get sick,” she said. “If it’s not the same things being covered, that sounds a little sketchy.”

Aaron George, a 34-year-old cook from Akron, Ohio, agreed: “I see the logic in it,” he said. But he knows the risks of not having good insurance; he still has medical debts he racked up pre-Obamacare. So when he thinks hard about the Republicans’ vision, he concludes: “I don’t think it’s a legitimate argument to make.”

Trump voter Mike Sustar, a retired firefighter from Independence, Ohio, expressed similar qualms. He is all for shaking up the health care system. He wants more competition and fewer mandates. And because he has always been fairly healthy, Sustar might save money with a cheaper plan that offers fewer benefits. Pondering the idea, though, he paused.

“I’ve never really had to utilize health care,” he said. “But it’s that one time you have to go use it …”

The AHCA, which now heads to the Senate, has many components beyond giving states more flexibility. Among them:

  • It cuts $880 billion over 10 years from Medicaid, which covers low-income and disabled people.
  • It lets insurers charge older customers more than they could under Obamacare.
  • It lets insurers charge significantly more to customers with preexisting conditions if they fail to maintain continuous coverage.
  • It requires insurers to charge significantly more to people who come back to buy coverage after a period without it.
  • It repeals the taxes on the wealthy that had been used to subsidize the expansion of coverage.
  • It offers tax credits, on a sliding scale, to help people pay for insurance.

But Republicans have focused most of their sales pitch on the idea of freedom.

The bill lets states redefine the “essential benefits” that must be covered by insurance. The Affordable Care Act required those benefits to be comprehensive, including mental health care, addiction counseling, hospital care, and pediatric care. Under the AHCA, states could allow insurers to craft far narrower plans.

Health economists say that flexibility should drive down premiums, but warn that people could face huge out-of-pocket costs in the long run, if an accident or illness saddles them with bills their insurance does not cover.

To Georgia political consultant Joash Thomas, 23, that’s a risk worth taking.

“I’m all about the freedom to make the decision best for myself,” he said. “One size fits all is a horrible idea, always.”

Thomas, who has worked for several Republican campaigns, is a first-generation immigrant from India. He said he’s studied international affairs and believes the AHCA reflects uniquely American values. “In a free country, you’re free to make good and bad decisions, but you’re still free to make your own choices,” he said. “I’ve seen this. It makes America great.”

While he says he’s no expert on health care policy. Thomas said he has “complete faith” in President Trump and House Speaker Paul Ryan to craft a good plan.

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Laura Wozniak, a freelance writer in Alpharetta, Ga., isn’t so confident.

She sees the GOP talk of freedom as a smokescreen that undermines the entire concept of insurance as a pool that spreads risk and cost — and provides a safety net that healthy 20-somethings might not think they need now, but could be grateful for in the future.

“It’s shortsighted to assume that because you have good health now, or a specific condition doesn’t apply to you, that it’s never going to happen to you. … I feel like we’re being sold a bill of goods,” said Wozniak, who described herself as “wildly liberal.”

As for the idea that freedom means not paying for benefits only your neighbors will use? Wozniak recoiled.

“What’s the point of society,” she said, “if we don’t help others out?”

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  • A good analogy to health care insurance is automobile insurance. I would like to have my auto insurance payments reflect the risk of an accident that individuals around 65 as opposed to reflecting a good share of the risk that 20 year olds incur. But, that is how insurance largely works – whether it is on your auto or on your body!

  • Buckaroo. So many with chronic illness shouldn’t have healthcare because it’s their fault it’s chronic or that it gets worse? That includes babies who are born with them or people like my Dad who never smoked or drank alcohol but became ill because he worked too darn hard. Me I have hereditary high blood pressure and although I work out and try to eat right it not always controllable and the damage that is done can be significant as time goes on. Please think before you speak. When I read comments like yours I actually want to cry at the thought of people being so cold hearted. Is that Christian values?

  • Life is full of choices. The life one lives is the result of the choices one makes.
    So many seek health care for chronic diseases made worse by failure to make lifestyle changes. i.e. obesity, alcohol, smoking, etc. Diet & exercise is usually a part of most treatments along with medication, and sometime surgery

    • While you are correct that many poor healthcare choices can cause chronic health conditions , cancer , etc. Other times causes can be beyond one’s “choice” such as trauma, genetics, etc.

  • I am the (former) wife of a man who suffered from kidney failure in his late thirties. He never expected that to happen. As it happened, he was without insurance and on dialysis when he got the call that there was a kidney available for him. The hospital performed the surgery, but then all the money was used to pay for his anti-rejection medicine and other medical bills. We missed payments on the house we owned, and we had to declare bankruptcy…all because he couldn’t afford the insurance.

    The real question regarding insurance regulation comes down to first cost versus life cycle cost, and that’s what isn’t being considered in these replacement bills. When people without insurance get sick, they still wind up at the doctor or the hospital. They receive services, but when they can’t pay their bills, it becomes more than a personal freedom issue. The bill doesn’t get paid, and the provider never receives compensation. This results in layoffs and closures of facilities, an inability to renovate/keep up with technology changes, higher costs assessed to those with insurance, and effects that go beyond just that one individual and their freedom to be selfish. The studies that show that the wealthier members of our society live years longer on average than their economically challenged counterparts should be a sharp reminder that we need to be caring for all of society. What if YOU were the one who needed help?

    No one person is better than another; some people were simply born with more advantages than others. Rather than begrudging those who don’t have the same advantages, we should be helping each other to reach a common baseline level. Everyone deserves to access to care that they can afford, and everyone should have the same life expectancy.

    • Extremely well written. I just wish everyone understood that the freedom FROM paying for health care just passes on the pain (bankruptcy, high premiums, death) for others.

    • The issue is really not insurance at all. If we went back in time…before insurance..there would be fewer procedures, fewer tests,fewer drugs and a lot less greed in healthcare. If we had to pay cash for all those unnecessary blood sugars and EKG’s…we would elect not to get them. We might not rush to the ED if we smashed a toe or had a hangnail. The outcomes…high risk people might not get exotic procedures. We already have that, in some places. In other places a surgeon with nothing else to do might do a heart valve replacement on a 90 year old which will have the expected outcome for a 90 year old….death..it just might take a little longer.

    • While it is true no one person is better than another and some people were born in better circumstances than others. However, you forgot to mention some people work harder than others. I stayed in a job I disliked because it gave me health insurance and continues to do so in retirement. We all make choices.

    • So Jeanne, you believe that you worked harder than people whose employers don’t offer good health insurance? That’s standard “born on third and think you hit a triple” reasoning. I have great employer-provided health insurance as well, but I recognize that equal parts hard work and luck are responsible for that.

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