Republicans in the U.S. Senate will spend a long Fourth of July break trying to figure if they can repeal and replace the Affordable Care Act, aka Obamacare, with their Better Care Reconciliation Act, aka Trumpcare. Their bill, drafted in large part by just 13 GOP senators, some of the most conservative in the Senate, failed to win sufficient support so Majority Leader Mitch McConnell even could get it up for a vote before the holiday recess.
Lots of negotiations are under way.
In case you missed it, the Congressional Budget Office provided its independent analyses, scoring the cost and effects of the bill. The CBO estimated it would save the nation $321 billion in health-related expenditures in the next decade but would strip 22 million Americans of coverage, slightly fewer than would lose health insurance under the House-approved Trumpcare.
The Senate bill savages Medicaid, with Democratic senators asking CBO to project further out in time than Republicans first did, finding Trumpcare would slash federal outlays for the health program for the poor, chronically ill, disabled, the old, and children by fully more than a third of what the nation spends now.
Public support for either the House or the Senate GOP versions of Trumpcare has plummeted, polling in the teens, at best.
Republicans, desperate to make good on a seven-year vow to get rid of the Obamacare that they detest, have blown up more legislative trial balloons to advance Trumpcare than clowns do at a kid’s birthday party.
President Trump even resurrected the discarded idea that Republicans could just repeal Obamacare and figure its replacement, later. That would, of course, increase deficits, throw some tens of millions of Americans off health coverage immediately, and create chaos of unintended consequence in insurance markets.
Just to remind on a few points, though:
- Despite all the claims about Trumpcare, analysts say it fails to fix some of Obamacare’s weaknesses. Most of all, it does not deal with soaring medical costs, instead increasing already high deductibles and rising premiums that make medical services unaffordable and inaccessible—not just for Americans on Obamacare exchanges but also for those who get coverage through their employers.
- Republicans face increasing opposition to their attacks on Obamacare because their bills deal more with Medicaid than health insurance. Voters are angry at attempts to slash a popular program that not only helps the poor but also the middle class: Because few Americans save enough money or have sufficient retirement benefits, most of us—including in the middle- and, yes, the upper-middle class—rely on Medicaid for help with giant nursing home bills.
- Americans aren’t, by nature, mean, and moderation matters to them. They aren’t buying the GOP notion that America’s rich need a giant tax break. They’re rejecting the idea, for example, that 400 of the wealthiest families in the U.S. should get a tax cut that equals the cost of Medicaid in four whole states—health coverage for roughly 725,000 residents in Alaska, Arkansas, Nevada, and West Virginia.
- It’s become clearer that GOP changes to Obamacare will effectively eliminate protections for patients with what insurers deem to be preexisting conditions from either skyrocketing costs or denial of coverage. GOP changes also will undercut accepted basics of what health insurance can and should cover, items that might include emergency care, maternity and women’s reproductive health services, and prescription drugs. Partisans may claim that novel or “innovative” policies would be cheaper, especially for the young. Experts say Trumpcare will mean health insurance so skimpy that it will be as good as zero coverage.
- Americans who get their health insurance through their employers won’t be exempted from Trumpcare’s sweep. Because there won’t be a mandate for health coverage, many employers won’t offer health insurance any more. Because there may not be essential benefit requirements, companies may slash coverages. Workers may see companies reinstate annual or lifetime caps on how much their insurance will cover and pay for.
- Small businesses already are clamoring about the uncertainty that Trump and the Republicans are creating for them in securing and paying for health insurance for their employees. If Trumpcare takes effect, this issue will worsen, experts say.
In my practice, I see not only the harms that patients suffer while seeking medical services but also the struggles so many Americans go through to get safe, sound medical care at all. Obamacare is imperfect. There are big areas where thoughtful, careful, bipartisan legislating could improve Americans’ health and well-being.
But, so far, the GOP has all but written a textbook on bad lawmaking, done in haste and secrecy, without expert consultation, and contravening evidence. The GOP-controlled House has, as expected, advanced a wrong-headed measure that strips patients of their rights to seek legal remedies when they are harmed by medical service providers. That measure also imposes harsh caps on what juries can order wrong-doers to pay injured patients and their families, sums that harmed patients may need to live on for a lifetime. Lawmakers have ignored research and independent expertise who have decried as unneeded and unwarranted the GOP actions on medical lawsuits.
Failing to listen to experts, and most importantly, to one’s own voters may hurt, at some point, job security for elected officials.