Republicans in Congress had more than seven years to brainstorm, draft and re-draft, and finalize a ‘replacement’ plan for the Affordable Care Act (ACA). During the years since the ACA’s passage in 2010, congressional republicans consistently swore never to help mend pieces of the legislation. They refused to vote on improvements to any of its provisions. Irritable after its partisan passage, they voted about 60 times to repeal or defund it, knowing full well each time that it was a wasted effort since President Barack Obama was always going to veto these attempts. They chose obstruction over collaboration every time. Republicans and their 2016 presidential candidate promised that if given the White House alongside legislative majorities, they would ‘repeal and replace’ the ACA on Day One. By Day Fifty, the discussion had just begun. With newfound wisdom and frankness last month, seemingly unveiled only after leaving the congress in 2015, the former republican House Speaker finally acknowledged: “In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a health care proposal should look like. Not once.”
The discourse around health care legislation feels more toxic than ever. Republican lawmakers are fighting each other over which parts of the ACA need replacing, and with what. Constituents are voicing support for ACA provisions, only to be accused of being some kind of paid or ‘choreographed protest,’ and are being summarily ignored by republican representatives in the House and the Senate. Democratic lawmakers are still trying to articulate the benefits of coverage expansion and cost management efforts in the ACA. While premium costs have continued to rise, the rise has slowed. Even the republicans seem to know they do not have a plan to cover as many conditions for as many Americans. The current republican House Speaker argued rather plaintively this week that “this is the closest we will ever get to repealing and replacing Obamacare,” which is hardly a full-throated endorsement of his own alternative proposal. The drive to ‘repeal and replace’ has blinded republican lawmakers to what real live Americans actually need. We need to move forward, with the ACA as a starting point, fixing parts of the legislation such as the inequitable Medicaid landscapes that have resulted from some states ‘opting out’ of state expansion.
It is telling that so many professional organizations as well as both liberal and conservative groups, oppose republicans’ current new idea (the ‘American Health Care Act,’ or AHCA) about what to do with health care. The president of the American College of Physicians wrote a letter to Senate leaders urging Congress against ACA repeal until and unless they have a comprehensive and adequate replacement plan. The American Academy of Pediatrics, the American Academy of Family Physicians, the American Nurses Association, the American Hospital Association, Heritage Action, the Club for Growth, and the AARP, among others, all oppose the new republican version of national health care legislation. Crafting a comprehensive and adequate replacement plan for the ACA is hard. Health care is complicated. The ACA has so many different provisions in part because of how complex it is to balance needs of the healthy with needs of the sick, needs of the poor with needs of the wealthy, and other age-old conundrums of a social policy that is not easily managed by market forces alone: health care.
When the current president’s press secretary tried to defend the new proposal as adequate, he pointed dramatically at a very tall stack of papers (the ACA) and declared “This is government,” and then pointed to a much smaller pile of about 60 pages (the AHCA) and proclaimed “and this is not.” We agree.
After going to great lengths to argue that states alone have the best knowledge of their own populations, and therefore states alone ought to set policy for coverage in their own jurisdictions, many republicans also proceed to argue that a fundamental panacea will be to ‘allow consumers to purchase across state lines.’ It remains unclear how this follows logically. If legislators in Oklahoma know the needs and capacities of Oklahomans so much better than the federal government (and any other state, presumably), then why is enabling those Oklahomans to buy Missouri’s insurance, or Oregon’s, the ultimate solution? What role would state Insurance Commissioners then play in consumer protection? If a patient from North Carolina gets mistreated under a policy issued in Alabama, who is their advocate? What if the policy you buy from Vermont won’t pay the price a hospital in Dallas charges for your surgery? There are so many unanswered questions. AHCA proponents say patients will have greater choice; however, the two and a half million patients a year who choose Planned Parenthood will no longer have their care covered.
The AHCA will cause millions of Americans to lose coverage they had obtained under the ACA. Lower income citizens, elders, and women are especially at risk from its provisions. While retaining the requirement that insurers cover people with pre-existing conditions, the AHCA allows insurers to charge higher deductibles to this population. People who ‘allow’ their coverage to lapse will owe stiff penalties. Tax credits replace subsidies. The AARP legislative director has expressed concern that the AHCA is “both jacking up the prices and giving people less of a subsidy, which is a damaging combination.” We cannot know exactly how many will lose coverage until the Congressional Budget Office ‘scores’ the AHCA. Oddly, and suspiciously, its republican backers seem to want their colleagues to vote on the bill before this is clarified. Already crystal clear is that the AHCA strips mental health care, preventative care, and addiction services – essential and urgent needs that were covered services under the ACA.
“All of them who were naked they clothed from the booty; they clothed them, put sandals on their feet, gave them food and drink, anointed them, and all who were weak they set on donkeys. They brought them to Jericho, the city of palms, to their brethren.”
2 Chronicles 28: 13-15
“Americans have choices, and they’ve got to make a choice. And so maybe rather than getting that new iPhone that they just love and want to go spend hundreds of dollars on that, maybe they should invest in their own healthcare.”
Congressman Jason Chaffetz (R-UT),
Chair of House Oversight & Government Reform Committee
The Senate has long had members from opposing parties, in varying proportions. So too has the House of Representatives. What we need today is for the righteousness so proudly touted on all sides, to be earnestly and authentically applied, on behalf of the people living and working and getting sick and staying healthy and caring for family and ourselves, out here in the real world. Our most needy citizens, which any of us could become tomorrow, require actual mercy. And justice. And access to affordable health care.
Stay awake. Speak up. Keep the faith.