This Monday evening the beginning of a process that has been long-awaited by many across the country since the Patient Protection and Affordable Care Act was enacted on March 23, 2010. House Republicans released the American Health Care Act as a vehicle to propagate a conservative vision of healthcare that eliminates subsidies while providing tax credits. At the crux of republican intent, Speaker Ryan and his republican colleagues aim to empower states in crafting their own healthcare policies founded upon a national privatized healthcare system.

However, anybody who followed the rhetoric around the bill found that the reception was hostile, regardless of political allegiance, and a plethora of obstacles lie ahead for Ryan and McConnell before repeal-and-replace sees light of day. In fact, the most ardent opposition hails from republican nodes in Congress. The House Freedom Caucus labeled the bill as “Obamacare-lite” or “Obamacare 2.0” while Senator Rand Paul (R-KY) led the assault in the Senate.

"We never have liked it, ObamaCare is a disaster ... But the only thing that’s really united us over time is repeal. And if ObamaCare lite is the replacement, conservatives aren’t going to accept it,” claimed Senator Paul in an O’Reilly Factor segment.

Infighting and deriding nicknames encumber the promised goal to quickly repeal-and-replace. Speaker Ryan and Senate Majority Leader McConnell cannot afford defections in large groups as democrats will relentlessly stand their ground in both chambers of Congress. Fears of republican contention could be cured with an active President Trump as it pertains to selling the bill. A majority of the members of the House Freedom Caucus represent districts that President Trump won definitively in November. Nevertheless, it is quite unclear where President Trump stands in regards to the bill which is a clear threat to the progress of the bill itself. The severity of this threat can be easily overestimated, but in order to advance to tax reform, republicans need to take care of healthcare overhaul first, due to the nature of the reconciliation process.

According to Senator Paul, the president is open to negotiations on the bill more so than congressional leadership. One thing is for certain: President Trump yearns to repeal Obamacare to fulfill a critical campaign promise which might be the only motivation republicans need from the White House.

When refining the focus to the content of the bill, it is integral to establish the fact that the bill lacks a score from the Congressional Budget Office. In this case, the CBO score will detail how much the plan will cost and how many people the bill will cover. The CBO score abides by a purely accounting perspective. Regardless, Congressional Republicans intend to continue the legislative process without the CBO score which contrasts with the previous administration’s approach which delayed the legislative process with the intent of modifying the bill to accommodate the CBO’s recommendations. Of course, this persistence to neglect the score impedes the ability to properly evaluate and scrutinize the bill by all relevant actors in the expansive process, from House committee members to members of the press.

On that note, this absence has not escaped the minds of members of the White House press corps as Press Secretary Sean Spicer strategically maneuvered around questions regarding the absence of the score. Spicer did so by questioning the accuracy of the score in past legislation. The validity of Spicer’s cynicism is questionable in itself, but the Trump administration might be anticipating a negative score with increased spending and diminished healthcare coverage.

But as you analyze the bill, the above-mentioned results are certainties. Increased spending will result from a compilation of tax cuts that House Republicans are flaunting as the laurel of this endeavor. Meanwhile, it is clear that less people will be covered in short term as subsidies are eliminated and the Medicaid expansion, catalyzed by the ACA, is halted in 2020. A Standard and Poor’s analysis projects coverage losses for 6 to 10 million people by 2024. When bifurcated, 2 to 4 million would lose coverage from the exchange while 4 to 6 million lose coverage under Medicaid.

The CBO score doesn’t take into account the coverage that people would attain via new tax credits. Therefore, America’s coverage metrics will likely differ from the CBO score in the long-term.

Specifically, the American Healthcare Act eliminates the individual mandate. Punitive tax penalties associated with the failure to find a healthcare plan dissipate under the new plan. This action emphasize the core tenet of the republican party to diminish the role of government in society. The thinking projects the notion of individual liberty, in this case allowing people to choose whether they want healthcare or not. Since the public option entered the legislative debate surrounded the ACA, republicans asserted that it was not the government’s duty to provide healthcare. This action would lead to inefficiency that could be cure with a private, free-market healthcare model. This political maxim comes into play in the new legislation with the elimination of mandates and an assortment of taxes.

The bill eliminates a 3.8 percent tax on certain types of net investment income. Additionally, the bill eliminates an earnings-based 0.9 percent Medicaid tax, the Additional Medicaid Tax. For example, the tax applied to single filers earning $200,000 and above. Married joint filers became liable for the tax at $250,000 and above. However, this repeal doesn’t go into effect until 2018, along with the repeal of a 2.3 percent tax on the sale price of certain medical devices and a 10 percent tax on indoor tanning services.

Healthcare companies will also receive a tax break as the eliminates annual fees on entities that provide health insurance in the United States and for entities in the business of manufacturing or importing branded prescription drugs. The Cadillac Tax will disappear under the act, a 40 percent excise tax on high cost insurance plans that was supposed to go into effect in 2018.

As you can see, the bill certainly delivers on the promise of diminishing the role of government via tax collection. Nonetheless, there is one feature of the bill that prompts a bit of confusing. The bill allows insurers to charge a 30 percent premium for a year to those entering the individual market without continuous coverage. The details of the American Healthcare Act define this as a lapse in coverage of 63 days or more over the previous year. The optics and mechanics of this facet do not bode well for the Republican Party. Allowing insurers to enforce this premium is inconsistent with the notion that people should have the choice to opt out of healthcare coverage if they wish to. In fact, this feature acts as a barrier for low-income individuals who will lose coverage due to the elimination of subsidies available under the ACA. These individuals will have an economic incentive to avoid attaining coverage while maintain more of their income.

Avalare, a healthcare research firm, released an analysis of the bill indicating that this premium penalty would damage the wallets of low-income individuals while providing a break for the wealthy. Clearly, a flat 30 percent premium has a detrimental effect when applied to someone earning $50,000 per year than when a person earning $120,000 per year is subject to the premium.

What is sure to instigate a battle between activist groups and republican representatives concerns Planned Parenthood. The Republican crusade against Planned Parenthood intensified over the republican primaries when an edited video, produced by an anti-abortion group Center for Medical Progress, showcasing Planned Parenthood representatives discussing the abortion procedure engendered a call to defund Planned Parenthood. Republicans deliver by placing a one-year freeze on funding to states for payments to a “prohibited entity” defined by the bill as an entity that provides other than those resulting from rape, incest, or danger to the mother’s life. The bill doesn’t explicitly label Planned Parenthood, but the bill would deal a crippling blow to Planned Parenthood’s budget which relies heavily on federal funding. Of course, federal law prohibits utilizing federal funds for abortion procedures, but Planned Parenthood’s additional services and ability to maintain clinics open. Effectively, women in low-income areas that depend on the diverse service provided by Planned Parenthood clinics will have to turn elsewhere.

Now we arrive at one of the main features of the bill: tax credits designed to help people attain coverage. Under the ACA, low-income individuals receive income-based tax credits. Place of residence also factored into the amount of money provided with tax credits as premiums in Mobile, Alabama are higher than in Reno, Nevada. Republicans scrap this model in favor of one based upon age. The credits range from $2,000 to $4,000 with a $14,000 cap per family. However, individuals earning more than $75,000 and married couples earning more than $150,000 are not eligible for these tax credits. Following two specific examples, a 30 year old earning $23,000 is eligible for a $2,500 credit which would lower annual premiums to $1,344. Meanwhile, a 60 year old making the same amount receives a $4,000 credit which would increase the annual premium to $5,191. A disturbing reality for older insurees lies in the ability for an insurer to charge five times what they charge younger insurers as health complications begin to emerge. Furthermore, upper-middle class individuals benefit more from the new tax credit structure than low income individuals.

According to Kaiser Family Foundation analysis, a 40 year old earning $20,000 in Mobile, Alabama would receive a $3,000 credit contrasted to a $5,725 credit under the ACA. Meanwhile, a 40 year old earning $100,000 in Mobile receives a $500 credit as opposed to ineligibility for tax credits under the ACA. This dilemma could be offset with Medicaid as a safety net for low-income people, but with the expansion ceasing by 2020, it will be crucial to track how this demographic responds to the changes.

True to the words of President Trump when he said republicans would keep the popular parts of the Affordable Care Act, the bill keeps mandatory coverage for people with preexisting conditions and it allows people to stay on their parent’s plan until the age of 26.

At the crux of this legislation process lies a battle between political philosophies concerning the social contract. As previously mentioned, we are seeing that the Republican Party believes the social contract between constituents and states leaves out anything regarding universal healthcare. Across the aisle, it is clear that Democrats believe that the government must play some role in the healthcare industry. Whether you subscribe to the Obamacare school of thought or the single payer persuasion, a critical trust lies at the center ensuring constituents that the government will secure their right to good health. There will not be an explicit declaration of victory for either ideology, but once the final revision of the republican healthcare plan is enacted into law and the effects take root, the American people will decide whether health is a consumer product or a right.