The Republicans haven’t waved a white flag—yet. They may never formally surrender. But the GOP’s seven-year, take-no-prisoners campaign to repeal and replace the Affordable Care Act, aka Obamacare, has foundered. For good?
Political prediction is a knucklehead’s sport. It’s never safe to predict what’s going to happen, especially when unpredictable tragedies rear up like Sen. John McCain’s brain cancer diagnosis.
No matter. We now know painful truths about the politicians who have sway over our health care—and will continue to do so in vast ways, Trumpcare or no.
They seem impervious to the legislative harms they would inflict, comfortable with throwing anywhere from 22 million to 32 million Americans off health insurance and allowing premiums to double.
They’re almost fanatical in their zeal to gut Medicaid, one of the biggest ways that tens of millions of Americans get health coverage. Republicans loathe this program for the poor, disabled, chronically and mentally ill, and the old and young. Medicaid now benefits their voters, big time, and it no longer helps just the poor but also the middle and even upper middle class.
GOP lawmakers in the House and Senate have shown they’re ready to slash roughly $800 billion out of a popular program they deride as an entitlement, rather than a public benefit.
Further, Republicans have shown they would be pleased to take Medicaid funds from the poor and middle class to give hundreds of billions of dollars in tax breaks and other benefits to the wealthy, Big Pharma, medical device makers, insurance executives, and tanning salon operators.
Republican senators may, of course, hoist on their own petards on health care: They’ve sought to unravel the ACA under arcane Senate processes, a so-called budget reconciliation governed by “Byrd rules” named for a onetime Majority Leader. This gives the Senate Parliamentarian power to rule whether bills may slip past with 50 votes for approval and a tie-breaker by Pence or whether they require 60 votes, meaning the GOP would need Democrat defections for its repeal-and-replace schemes.
The Parliamentarian, fueling more doubt about the Senate’s version of Trumpcare, has said the high-bar votes would be required for GOP hopes to defund Planned Parenthood, impose new abortion restrictions, and upend an array of other Obamacare features.
Let’s see if Republicans amend their hasty bill further to try to steer around this ruling, or whether they also roll over Senate traditions to overrule their Parliamentarian.
Regardless, the partisans have shown they are ready to cast away protections that prevent insurers from denying Americans coverage or jacking up their rates by deeming they have pre-existing conditions. GOP lawmakers are prepared to lift annual and lifetime benefit caps. They would permit a redefinition of health policies’ essential benefits, meaning insurers could decide piece-meal if they will pay for items like emergency treatment, prescription drugs, maternity care, and women’s reproductive health services. These steps, some contested by the Parliamentarian for budget reconciliation consideration, would not only slash at insurance obtained on Obamacare exchanges but also would strike at the heart of employer-provided coverage.
Although it might leave as much as half the nation without providers, GOP lawmakers also would consider an unworkable dual market of ACA compliant and non-compliant insurance, with insurers also permitted to offer skimpy or barebones policies. Combined with their sky-high deductibles, these policies would leave untold numbers of consumers effectively absent of coverage. GOP lawmakers are willing to pit young and healthy Americans against their elders, leaving older customers—with more illnesses and health conditions—forking over big sums they don’t have for health insurance.
Leaders in the House and Senate have played rough backroom politics, using taxpayer funds like Monopoly money to reward and punish partisans with tens of billions of dollars in incentives to support Trumpcare.
Republican lawmakers have come within a scary few votes in a scant few months of a major revamp of an economic sector that comprises 17.5 percent of the nation’s GDP and on which Americans spend $3 trillion annually. They did so not only with negligible consultation with but also eventually the opposition of doctors, hospitals, insurers, patient advocacy groups, economists, academics or most anyone with deep expertise. They acted within their own caucus, never inviting Democrats and giving the loudest voice to extreme elements among their partisans. Women senators were snubbed by GOP leaders.
Representatives and senators voted, they admitted, without fully reading the various versions of Trumpcare or doing so cursorily. They ignored or misrepresented health care legislation and policy, as well as independent analyses by their own Congressional Budget Office. The circus has angered seven former CBO directors sufficiently to lead them to make public a rare rebuke to critics of the agency, its work, and integrity in the lawmaking process.
Trump, who has shown such scant grasp of insurance that he conflated in a major media interview life and health coverage and suggested health insurance could be gotten for as little as $12 annually, has threatened to use all means available to kill Obamacare, if Congress can’t pass Trumpcare.
Trump officials have threatened to destabilize insurance markets and throw tens of millions of consumers off health insurance, for example, by declining to pay cost-sharing subsidies that the ACA put in place to help poorer Americans afford coverage. They have asked the Internal Revenue Service to soft-pedal the ACA individual mandate and its tax penalties for Americans who can’t show they have health coverage. Price has taken after aspects of the ACA that seek to improve the costs, quality, and efficiency in health care, for example, postponing experiments to force providers to agree on service costs and to get a single bundled payment. He also has used his HHS post to criticize Obamacare and to advocate for its demise.
I could go on. In my practice, I see the harms that patients suffer while seeking medical services and their giant economic struggles in trying to deal with and pay for medical care. Health care should not be a privilege but a right in the world’s wealthiest nation, which also now pays more than its peers in the western industrialized world but gets poorer outcomes.
Americans have made giant strides in recent decades by working together and eliminating inequities. We cannot allow health disparities rooted in wealth, gender, race, orientation, geography, social class or … We’re all in it together. We’re all just one major illness or mishap away from medical calamity. When we share risks, we all benefit. We must stay atop what’s going on in Washington because our best values and ideals are under threat, as is our collective health.