As the late, sultry diva Peggy Lee used to croon: Is that all there is?
The Republicans in Washington, after seven years of trying and dozens of faux earlier votes, have failed to repeal and replace the Affordable Care Act. Obamacare, the signature legislation of the previous Democratic administration, persists as the law of the land.
Not hearing champagne corks flying after the end for now of the desperate legislative floundering of Republicans in the House, Senate, and White House?
That’s appropriate. Partisans may yet renew their attacks on the ACA. And as even its advocates have conceded, Obamacare needs work. Although it has reshaped the American health care system—and now likely will do so for longer still—the program that tens of millions of patient-consumers rely on for health insurance coverage has flaws and these make it vulnerable to bureaucratic foes who would cripple or kill it with neglect or malice.
Will President Trump, as he has long suggested, work to cause critical protections for Americans’ health to “simply implode?” Will Tom Price, the head of the Health and Human Services Department, wage an official campaign to undermine the ACA? Will Republicans in Congress, having seen their last and best Obamacare replacements plunge in public popularity and go up in flames in votes on the Senate floor, now turn to make needed ACA repairs?
Here’s some of what we might wish to be vigilant about in health care policy terms in the next bit:
- Will the administration and Congress now pony up money for Obamacare’s cost-sharing reduction payments, sums that help poor and lower-income Americans better afford to buy health coverage on ACA insurance exchanges? Trump has threatened to stop paying these, an action that critics say will destabilize markets, cause premium hikes for millions, and throw many more off coverage.
- What will Trump, Price, and Congress do to stabilize markets and encourage insurers, who have options and choices, to offer health coverage across the country? Dozens of counties now are “bare,” meaning insurers see the risks as too great to offer residents there any health plans. Insurance companies were slow to do so. But they eventually made clear that GOP efforts to repeal and replace Obamacare created such market uncertainty that they were unwilling to risk offering coverages in select areas. These included spots heavy with older, poorer, and sicker Americans and light on younger, healthier customers whose payments might help to offset their neighbors’ risks. Insurers, for example, fled a part of thinly populated rural Iowa where, apparently, a young girl with hemophilia required $12 million a year in medical services.
- How will the administration enforce the ACA mandates requiring Americans to carry health insurance or pay penalties and for employers of a certain size to offer workers coverage or face fines? Although supporters say these requirements help spread risks broadly and help make the ACA economically sound, Republicans loathe this aspect of Obamacare with zeal. Trump has asked the IRS to soft-pedal enforcement of the mandates’ tax penalties, and Price and the HHS could act to undercut them more.
- Will the administration grant GOP governors more waivers to experiment with Medicaid in their states, effectively shifting to another governmental level partisans’ huge push to gut the program that provides health coverage to tens of millions of poor, elderly, young, chronically and mentally ill Americans? The GOP’s proposals for Trumpcare exposed their wish to strip Medicaid of hundreds of billions of dollars in sustained support to provide massive tax and other breaks to the wealth, Big Pharma, medical devices makers, and tanning salon operators. That naked money grab failed. But will GOP governors, for example, impose punitive requirements on Medicaid recipients, forcing the sick, old, and young to prove that they can’t work for benefits, or requiring the working poor to return repeatedly to re-up their coverage every few months?
- What will happen with the Children’s Health Insurance Program, aka CHIPs? It costs the nation $15 billion or so but provides desperately needed medical care and coverage to 9 million youngsters in poor, low- and moderate-income families. Congress has until the end of September to renew CHIPs, which long has received noncontroversial, bipartisan support. Lawmakers have been so consumed with Obamacare and Trumpcare that CHIPs has languished, as have some other key Medicare program renewals. By the way, what will Republicans do to make good on their promises to beef up funding to battle the nation’s opioid drug abuse epidemic?
The GOP’s 2017 fiasco with the ACA got so much coverage that there isn’t much to add. It is worth asking whether the Senate has debased democracy in irreparable fashion, creating an autocratic policy path that Americans should fear will be followed any time in the future.
Republicans came within a few votes of passing Trumpcare in lamentable fashion. The so-called skinny option—for which no hearings ever were held, no experts ever were consulted and a handful of senators knew the details of—was written up as a legislative text during a partisans’ lunch. It didn’t get shared with all members of “the world’s greatest deliberative body” until 10 p.m. that same day. Its opponents, not its backers, had to get the independent Congressional Budget Office to try to score the measure in a dead heat for its costs and effects. Majority Leader Mitch McConnell put it up for a vote in the dead of night.
That’s an awful way to make laws affecting a sector of the economy that comprises 17.5 percent of the GDP and on which Americans spend $3 trillion a year.
In my practice, I see the major harms that patients suffer while seeking medical services and the wrenching economic struggles they put themselves through to try to afford medical care. Our leaders put the country through the wringer for half a year now to accomplish what with the ACA? Is our health care better, more affordable, accessible, or safer? Health care policy isn’t fun. It has been heartening to see that as complex and daunting as it can be, American voters understand its importance and they have exercised their democratic rights to stay all over their lawmakers. They need to keep doing so.