Later today the House is scheduled to hold its vote on the Americans Without Health Care Act. There are a lot of things to take into consideration as you watch this vote and what appears to be a defeat for trump and Ryan. The hypocrisy on the right is getting very loud and everyone should pay attention to that.
You have heard that the Republicans are claiming that the ACA is crumbling under its own weight. You have heard about insurance companies pulling out of the program and that premiums are rising. What they are not telling you is that all of that is their fault.
In 2015, Marco Rubio got a little measure put into a budget bill which is what is really killing the ACA in some states. Here is what happened. The ACA promised insurance companies to help make up for losses in coverage in the first decade of the law. It was understood that there would be losses because getting some people to purchase insurance would be tough, and it would take some time for those without insurance at the time who were sick to get healthy and let everything balance out.
In 2015, it was estimated that this part of the bill would cost $2.9 billion. However, Rubio and the Republicans decided to cut that amount of money down to about $440 million. That meant that insurance companies did not get their help to stay in the market. As a result, most started to pull out, especially in Red States that were fighting the law in the first place. And, the ones that stayed in the program were forced to raise premiums.
If that little budget line item was not there, we wouldn’t see the problems in some states that we see. It should also be pointed out that very recently, the courts ruled that the federal government reneged on the law’s deal and now owes these insurance companies $80 billion. It won’t help in the short-term because you know it will be appealed. Plus, insurance mergers have been going crazy and many non-profit companies that provided health insurance through the ACA were forced to go bankrupt due to this change in the law.
If the ACA is really failing, it is the fault of the Marco Rubio and his Republican cronies, not the fault of the ACA itself. They sabotaged the law in order to help kill it.
Then we have the so-called Freedom Caucus in the House. These wackos claim to be all for freedom. Yet, their only agenda is to ruin the social safety nets and cut taxes. Their goal is to get rid of the ACA, Medicaid, Medicare, and Social Security. They are opposed to the Americans Without Health Care Bill, because they call it “Obamacare light”. They argue that it won’t cut the deficit enough because of the tax credits to help people get insurance.
What they really want is to repeal the ACA and they don’t care if anything replaces it at all. In fact, they would prefer that no replacement bill even be introduced. But, they are negotiating to get some changes they “might be able to accept”. Only, those changes will make getting real insurance even harder than it already is.
The thing they have latched onto is the requirement that companies cover essential health benefits. They want to cut that requirement from any health law. Those essential health benefits number 10 and they are:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
These are now all required to be covered in health care coverage. The Freedom Caucus wants them to go away. So, for example if you work for someone who believes that they don’t need to cover pregnancy, they can get health coverage that drops that protection. It currently costs roughly $15,000 just to have a baby. That doesn’t even touch pre-natal and post-natal care. The states that have an opioid epidemic right now won’t be too happy about dropping substance use coverage either.
The Freedom Caucus has only been negotiating with trump. The Republican House leadership wants him to placate this wacko group. In other words, they are reeling him in to take ownership of the bill, especially if it goes down.
The irony of the so-called Freedom Caucus is that they claim to be “fiscal conservatives” who are only interested in the deficit. Yet, they are not disappointed with the huge tax cuts in this bill for the rich. They are not opposed to increasing defense spending or in spending 21 billion dollars to build our Berlin Wall. And, you can bet you bottom dollar that they will be all for huge tax cuts that trump wants down the line for the rich and companies. Naturally, according to them, if you reduce revenue and let the rich keep more money, the deficit will magically go down.
Ryan and his group have been negotiating with moderates who also hate the bill. Their reason is that it will cut off their constituents from health care. But, in order to placate them, the tax credits will need to be increased, especially for older people. That won’t go over well with the Freedom Caucus. As a result, it is difficult to see how this bill can get past the House. Though anything is possible.
Over in the Senate, the bill will face much tougher opposition. Especially if the Freedom Caucus gets trump to include the changes to the essential benefits part. See, they are trying to get the bill passed through reconciliation. That only works in the Senate if it only affects the budget. The changes to the essential benefits part will not affect the budget, and it could cause it to go through normal procedures which includes the 60 vote threshold.
The Republican Party has made their living crying about the ACA. They have undermined the bill wherever they could in order to cause it to fail. They have promised over and over to “repeal and replace” the ACA. They have had seven years to come up with a workable, viable plan that the American People could get behind.
In all of those years, they did absolutely nothing to craft a replacement. They did nothing to make the ACA better. They passed laws that made the ACA harder to enforce and do what it had promised.
Now, they have control of both the House and Senate, and trump is sitting in the White House. And, the Americans Without Health Care Act is the best they could come up with? Oh, Ryan says this is only part one of a three-pronged plan. First is this horrible bill. Then, they will let Price make administrative decisions on doing more. Then, they will pass another law to fully replace the ACA and it will be much better. Yeah, that sounds like one of the three great lies like the check is in the mail. Hell, even Ted Cruz says the third part is a “bucket for suckers”.
The simple fact is that once Americans saw this bill, they lost their minds. They realized that their own health care coverage lies in the balance, and it doesn’t look good for them. They flooded “town hall meetings” and expressed their dissatisfaction about his horrible bill.
I guess the real problem the Republicans have right now, is that they are having a hard time explaining why they need to repeal the ACA since it was their bill to begin with. Almost every line in the ACA came from the Heritage Foundation’s plan to help defeat universal health care in the 1990s.
They claim that the ACA was passed too fast. That the Democrats went with reckless speed to pass it. It took the Democrats nine months to get the law written and passed. They tried to include Republicans, but they didn’t want to talk about their own bill. Democrats also talked to health organizations and insurance companies to get their input. They at least made an effort to pass a good bill.
This bill was kept secret until about a week ago. The Republicans held no hearings on the bill. They called no witnesses to testify about the bill. They never spoke to Democrats to get their input. They never talked to health organizations or to health insurance companies to get their input. And now, they are trying to ram this bill through both Houses of Congress in less than 10 weeks! If nine months of work is reckless speed, what do you call 10 weeks?
The Americans Without Health Care Act is nothing more than a tax cut bill for the rich. It has nothing to do with your health care simply because Republicans don’t give a damn about hour health care. It has brought to light the terrible “management” skills of Ryan and Republican leadership. And, it has brought to light the terrible “deal making skills” of our beloved leader.
If this bill fails to even pass the House, both Ryan and trump will have a huge black eye. It will call into question everything that they want to pass, even their tax reform bill. It will especially call into question their ability to actually govern.
In the two plus months of the trump administration nothing has been done that will help bring down premiums for health care. Nothing had been done to increase jobs. Nothing has been done except help trump’s own companies and pollute our water and air.
This bill was supposed to show us how “great trump really is”. It doesn’t look like very promising on that front. If this bill passes we know that up to 24 million people will lose their health coverage. Medicaid will be cut so badly that old people will be thrown out of nursing homes. Premiums will go up even more. And, deductibles will go up as well. The Kaiser Foundation said yesterday that deductibles will increase an average of about $1400.
The good news of this bill is that the upper 2 percent of income earners will gain about $250 million in tax cuts over the next 10 years. If you are not one of them, you lose.
If this bill does not pass, and it is looking like it won’t. The health care industry will be thrown into a tizzy. It is even doubtful if it will survive. Since Republicans have done everything they could to kill the ACA over the last six years, and with no replacement, uncertainty will rule the health care industry. Uncertainty is never good for any business.
If I were in the Democrat caucus right now, I would be writing a Universal Health Care bill to walk down to the White House after this disaster plays out. I would put it on the desk of trump and say: “You promised health coverage for all. Here is the bill that will make your promise come true. Support it and force your party to pass it with us and you will look good”.
You may be thinking that is crazy. Why would I want trump to look good. I don’t. But, I would rather take care of the American People as I was sworn to do and worry about things later. If you think about it, it could be a win-win for Democrats. At least they would have a real plan to run against the Republican do-nothings.
Especially when you consider that the majority of the public favors keeping the ACA. Just think of the political capital you could earn by doing even better. As it is, all we can do is watch, wait, and hold our breath. That is no way to run a government.