Americas: United States
Republican health plan to repeal and replace Obamacare hits snag in Senate
In May 2017, the Republican-controlled United States House of Representatives narrowly approved a bill to repeal the Affordable Care Act -- the signature Democratic health care bill known colloquially as Obamacare that went into effect during the Obama presidency. In June 2017, the Republican-led Senate of the United States put forth its version of the Obamacare repeal and replacement plan. However, criticism to the plan was marring necessary unified Republican support and ultimately forced the Republican leadership in the upper chamber to delay a vote on its passage. It was to be seen if deal-making, persuasion and pressure could end these objections, and ultimately faciliate the bill's passage.
On May 4, 2017, the Republican-controlled United States House of Representatives narrowly approved a bill to repeal the Affordable Care Act -- the signature Democratic health care bill known colloquially as Obamacare that went into effect during the Obama presidency.
Obamacare, which allowed more than 20 million Americans access to health insurance, has long been the top of Republicans' target list to excise. That goal was partially achieved in the lower house, and gave President Donald Trump a political victory by fulfilling a campaign promise.
Central to the Republicans' plan, called the American Health Care Act, were provisions to:
- repeal most Obamacare taxes, which funded the program
- roll back the Medicaid expansion, which provided affordable care to the indigent
- remove most of the program’s funding
- repeal the penalty for not purchasing insurance
- replace tax credits with flat age-based credits
The bill passed 217-213, with not one Democratic vote in its favor.
The legislation would thus be sent to the Senate where it would have to either considered and/or reconciled with that chamber's version. Objections to the health care repeal were expected to be strong, even from among Republicans, due to aspects of the bill that would allow states to discontinue coverage for individuals with pre-existing conditions, as well as other strictures that would result in onerous costs for people, or lost health care altogether.
Nevertheless, Republicans in the House celebrated their success in killing Obamacare, with trucks carrying beer arriving at the Capitol for a party of sorts. On the same day, President Tump, in the Rose Garden of the White House, declared: "I went through two years of campaigning and I'm telling you, no matter where I went, people were suffering so badly with the ravages of Obamacare." He added, "We are going to get this passed through the Senate. I am so confident."
It should be noted that this legislation was voted on in the House of Representatives before it could be assessed by the non-partisan Congressional Budget Office, which estimates costs and effects on insurance rolls.
In June 2017, the Republican-led Senate of the United States put forth its version of the Obamacare repeal and replacement plan. This reconciliation bill was titled "Better Care Reconciliation Act of 2017" or BCRA.
There was significant criticism for the Republican health bill because of its cuts to Medicaid -- a program that helps the most impoverished Americans receive health care coverage. That criticism was particularly amplified given the fact that the health plan also provided impressive tax cuts for the richest econhelon of society. As such, there was an unflattering characterization of the Republican health plan as "reverse Robin Hood-ism," with tax breaks for the ultra-wealthy being paid for via increased pain and suffering for for the lowest income brackets.
When asked about this particular angle in an interview with an ABC news reporter, President Trump brushed aside this suggestion, saying instead: "This will be great for everyone." It was unclear how less Medicaid benefits would actually benefit the poorest Americans dependent on the aide program.
Democrats were voicing their objections to the Republican health plan, with senators taking to the floor to excoriate the proposed bill as heartless, and making note that it was actually a tax break for the rich masquerading as a health plan. Some Democratic senators even took part in a "sit in" at the Capitol to protest the bill.
On June 26, 2017, the Congressional Budget Office (CBO) issued its score for the Republican Senate health bill, BCRA, and it was highly unfavorable. Of note was the fact that the Republican plan would significantly increase -- rather than decrease -- the number of already uninsured Americans. In fact, the CBO score made the following conclusion:
"The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation. By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law."
Stated in plain terms, whereas 28 million people lack health insurance under existing conditions, in less than 10 years, that number would skyrocket to just under 50 million, should the Republican health plan take shape.
The CBO also concluded that out-of-pocket medical expenses for the working poor would exponentially increase under the Republican health plan. To that end, the CBO score made the following conclusion:
"Under this legislation, starting in 2020, the premium for a silver plan would typically be a relatively high percentage of income for low-income people. The deductible for a plan with an actuarial value of 58 percent would be a significantly higher percentage of income—also making such a plan unattractive, but for a different reason. As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan."
Along a similar vein, the CBO a concluded that out-of-pocket medical expenses for individuals close to retirement would dramatically increase under the Republican health plan.
The CBO findings provided cold comfort to conservative market fundamentalists, noting that state waivers advocated by far-right Republians would actually "cause market instability in some areas” and “would have little effect on the number of people insured." In fact, many seriously ill people would likely be priced out of the health insurance marketplace entirely and be completely deprived of health care.
Note: The complete CBO report can be found via this URL: https://www.cbo.gov/publication/52849
As June 2017 was coming to a close, Senate Majority Leader Mitch McConnell signaled that the vote on the Republican health care bill would be delayed until after the July 4 (Independence holiday) recess. In making the announcement, McConnell said, “We will not be on the bill this week, but we will still be working to get at least 50 people in a comfortable place."
Accordingly, it should be emphasized that the delay on the vote was not a sign that the Republican plan was dead. Instead, it was simply an opportunity for the Republican leadership in the Senate to breathe new life into the proposal, and to dispel doubts of the few Republican holdouts. Those doubts, though, were emanating from two different factions.
For the likes of some deeply conservative Republicans, such as Senator Mike Lee of Utah and Senator Ron Johnson of Wisconsin, the bill was not draconian enough. Overall, far-right conservatives wanted to dispense with Obamacare's regulations that prohibit insurance companies from charging people with more serious illnesses more for health coverage. They were also demanding that there be more leeway for states to sidestep regulations aimed at protecting consumers (patients). Alson on their list of demands was the call for more funding for tax-free health savings accounts, aimed at incentivizing people to pay for private insurance.
For the likes of others representing states that went for Obama and Clinton at the presidential level, such as Senator Dean Heller of Nevada and Seantor Susan Collins of Maine, the bill contained harsh measures that they were unwilling to back for political reason. For senators from states with expanded Medicaid programs, the notion of curtailing this provision was tantamount to snatching benefits away from people. Also in that category of scaling back (rather than expanding) benefits was the Republican plan to
weaken protections for people with pre-existing medical conditions.
As such, McConnell's task would be to either balance the polarized interests of these intra-party divisions, or to appease one side sufficiently so that there were enough Republican votes to narrowly pass the bill. That latter ta tactic had worked in the House of Representatives when the House leadership in the lower chamber appeased the most conservative representatives, while compelling moderates to fall into line with a narrow offering of incentives.
To this end, McConnell said that the postp0nement was due to a desire to make adjustments in the bill. As intimated here, it was clear that those changes were aimed at persuading the handful of reluctant Republicans to cease their objections and support the plan. Moreover, McConnell wanted time to get a new CBO score -- one with more favorable results that might help bring "on the fence" Republican on board, while tamping down public criticism.
In the lower chamber, House Speaker Paul Ryan was urging House Republicans to allow the process to unfold in the Senate without interference. By interference, what he meant was that criticism from the House about the provisions of the Senate bill -- including proposed amendments -- were not likely to be helpful in getting it passed. The goal at had was to get the legislation passed in the Senate so that the House could come back with its own input after the fact.
For his part, President Donald Trump said work was continuing on the Obamacare repeal and replacement plan, and that Republicans were "getting very close" to forging a deal that would pass. Trump also declared that Obamacare was "melting down as we speak." The imperative for the Republican president was as follows: "For the country, we have to have health care and it can't be Obamacare."
On the other side of the aisle, Senate Minority Leader Chuck Schumer, was warning Democrats that "the fight was not over."
Meanwhile, opposition camps -- political, health policy oriented, socio-economic and otherwise -- were expected to mount aggressive pressure campaigns to kill the Republican health bill. Of significance was mounting criticism from doctors, nurses, hospitals, and health care provider groups, along with patient advocacy entities, siuch as the American Heart Association.
But the business community had a far different view, with the United States Chamber of Commerce encouraging Senators to support the bill.
It was to be seen if deal-making, persuasion, and pressure could end the prevailing objections to the Republican plan in the Senate, and ultimately faciliate the bill's passage.
-- June 28, 2017
Written by Denise Youngblood Coleman, Ph.D.
President and Editor in Chief