or the past seven years Republicans have lambasted the Affordable Care Act known as Obamacare as if it were the worst law that was ever passed. Starting in 2011 the Republican-controlled U.S. House passed over 50 meaningless laws trying to repeal it or cripple it; right-wing organizations spent hundreds of millions on grotesque TV ads trying to discourage people from seeking coverage under it; House Republicans caused a partial shutdown of the government in October 2013 trying to defund it; and every GOP candidate in 2016 vowed to repeal it.
After Trump won the election, Republicans in Congress were forced to start thinking about how they would fulfill their campaign promises. Both the House and the Senate quickly passed a budget resolution for fiscal years 2017 through 2026 in January. This would be the vehicle to dismantle Obamacare under the Senate’s reconciliation procedures with only a simple majority vote by Republicans. The stage was set; all they needed was some language in a House passed bill. This should have been easy, right?
But in an unbelievably inept process, the American Health Care Act (AHCA) was drafted by the GOP leadership behind closed doors with no input from Democrats and very little input from various factions of their caucus. They knew Democrats wouldn’t support this bill and they should have known that House Freedom Caucus chair Rep. Mark Meadow (R-N.C.) and his 30 or so radical colleagues probably wouldn’t support it either. What were they thinking?
Then the nonpartisan Congressional Budget Office report comparing the AHCA to Obamacare provided the following estimates — and the data was shocking:
· 14 million more Americans would be without health insurance in 2018.
· 24 million fewer Americans would have health insurance by 2026.
· 7 million Americans would lose their employer covered health insurance by 2026.
· Medicaid funding would be cut by $880 billion over the next 10 years.
Due to the way the AHCA calculates its less generous tax credits based on age instead of income and location, the result would be a massive rearrangement of those who can afford health care insurance and those who can’t. Coverage would be cheaper for younger, healthier people and much more expensive for older, typically less healthy people. Primarily due to these statistics, the original AHCA didn’t even get to a vote in the House.
Trump initially said he was giving up on health care reform and moving on to tax reform. But there was a reason he quickly reversed course and pressured House Republicans to press on and pass the AHCA; he needed it for tax reform.
Vice President Mike Pence was tasked with negotiating with Meadows and co-chair of the more moderate House Republican Tuesday Group, Rep. Tom MacArthur (R-N.J.). MacArthur came up with the idea of allowing states to waive the Obamacare provisions that prevent insurers from charging higher premiums for pre-existing conditions and those that require policies to cover essential health benefits, like maternity and drug treatment.
States that achieve waivers can allow individual insurers to decide what constitutes a pre-existing condition and establish state standards for essential health benefits. Although those with pre-existing conditions can’t be denied coverage, they can be charged more. So waiver states would receive $138 billion over a 10-year period to help subsidize high risk pools where these folks can hopefully buy insurance.
The waivers turned off Republican moderates so another amendment was proposed to add $8 billion over five years to the state high-risk pool subsidies. This pitiful amount helped satisfy a few moderates and was enough to turn their no votes to yes.
Speaker Paul Ryan rushed the revised bill through the House without public input and even most Republican legislators didn’t know what was in the bill until the day they voted on it. Some didn’t even know then. Worse yet, the revised bill had not been scored by the Congressional Budget Office so those voting didn’t know its costs or its effects on insurance markets. The process was pure politics, but they got it passed by one extra vote.
Most House Republicans were all smiles, even giddy with their victory. Then a House leadership group was bused to the White House to meet with Trump in the Rose Garden. After literally signing the death warrant for some Americans who will lose their health care under the AHCA, these Republicans celebrated. Trump was ecstatic too; he finally got a major piece of legislation passed, if only by one chamber. That was his major objective.
Now the AHCA moves on to the Senate where it will be significantly revised or replaced by a Senate bill. It could be months before Trump gets legislation to sign — or maybe not. This bill is the launching pad for reforming the tax system to benefit the wealthy, turning Medicare into a premium support program and dismantling the social safety net in the United States. Republicans are eager to balance the federal budget and they will do it on the backs of the elderly and less fortunate if they can.
Obama wanted to solve a health problem with the Affordable Care Act; Republicans want to begin the process of enacting their radical agenda with the AHCA. If the American people let them get away with this first step they will only have themselves to blame for what comes after.