The Affordable Care Act - better known as Obamacare - was originally, in part, the brainchild of the conservative Heritage Foundation. That flawed, though game-changing legislation was passed without the support of a single Congressional Republican . . . despite the fact that included among its original cosponsors were Senators Orrin Hatch and Chuck Grassley. That bill, by the way, came in at just about 2,700 pages, and took more than two decades to come to fruition. Now 2,700 pages sounds like an awful lot - until you start looking at some of the other legislation Congress routinely deals with. That said, the Affordable Care Act was larger than most bills to begin with, but considering the scope of healthcare reform, that was quite understandable.
From almost the moment of its birth, Obamacare became both an epithet and a vile symbol of all that was diabolic and treasonous among Democrats. To Republicans, Obamacare became the Wolfsbane they hoped and prayed would destroy the werewolves of the left. History records that during the Obama years, the Republican-controlled House - and eventually Senate - voted no fewer than 5 dozen times to eliminate it, all the while scaring the pants off a segment of the American public with talk of "death panels," "socialized medicine," and "government making decisions about your health." During the 2016 election, the alliterative "Repeal and Replace" became a rallying cry - despite the fact that no one, including Donald Trump - had the slightest idea what the replacement would look like. Just that it would be better. And just last week, the so-called "American Health Care Act" - coming in at a sleek 67 pages - was unveiled. Within 24 hours, Freedom Caucus members started calling it "Obamacare Lite," "RINO Care," and "D.O.A," while a handful of Republican heavyweights said they would not vote for it. Turns out, what took Democrats 20 years and 2,700 pages, took Republicans a couple of weeks and less than 6 dozen pages . . . of which nearly 10% took up the question of what to do about a Medicaid recipient who receives a lump sum or large payment from winning the lottery. (Answer: they are to be kicked off of Medicaid.) Imagine that: 10% of the American Health Care Act took up an issue that affects at most about 100 people a year!
Although the AHCA does keep many aspects of the ACA (children being able to remain on their parents' policy until age 26; no penalty for preexisting conditions; no lifetime caps), it relies heavily on tax credits and ultimately would take upwards of $400 billion away from state Medicaid programs in the first 10 years. No wonder both the American Hospital Association and the American Medical Association have come out against the plan. Sure, with lots of people no longer having insurance, hospitals and doctors will see fewer and fewer patients, which means a drop in income. Then again, hospitals and physicians take an oath to "first, do no harm'; fewer insured Americans means fewer healthy Americans and far more Americans using emergency rooms as their only source of healthcare. Additionally, hospitals employ lots and lots of people; the smaller the town, the higher the percentage of those gainfully employed. In other words, with fewer and fewer dollars going into Medicaid on a state-by-state basis, the fewer employed. And do remember, the American Hospital Association and AMA have ginormous lobbying operations on Capitol Hill that are going to do everything in their power to see that AHCA never sees the light of day.
The use of tax credits and health savings accounts is something near and dear to the hearts of most Republicans. It assumes, of course, that individuals and/or families making, say $16,000, $25,000 or $40,000 actually have dollars they can put into these accounts or will benefit from being able to write a certain amount off on their federal tax bill. It is often in these kinds of debates that we find out just how far out of touch legislators can be:
Take House Oversight Chair Jason Chaffetz as an example. A couple of days ago, Chaffetz (R-Utah) said the Republicans' new healthcare proposal will offer Americans at all income levels the opportunity to afford health insurance. Said Chaffetz: “Well, we're getting rid of the individual mandate. We're getting rid of those things that people said that they don't want. And you know what? 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 they want to go spend hundreds of dollars on that, maybe they should invest in their own health care. They've got to make those decisions themselves." Mr. Chairman: while iPhones do cost a couple of hundred dollars, that's just a drop in the bucket when it comes to paying for health insurance. And giving people a $2,000-$3,000 tax credit won't come close to doing what the ACA did for poorer, younger and older Americans who now are insured.
Then there was Speaker Ryan's complaint that "The fatal conceit of Obamacare" is that young and healthy people are subsidizing care for sick people. Well, yeah . . . that's the way insurance works. Think about automobile insurance - which is mandatory: the vast majority of those insured never need use their policies, because they don't get into accidents. Their unspent premiums are used to pay the bills of those folks who do get into accidents. Mr. Speaker: you really should take a 101 course in insurance.
How's about Rep. John Shimkus (R-IL) who, during a committee discussion with Democratic Representative Mike Doyle, laid out some of his problems with the Affordable Care Act, including the requirement that health-insurance plans cover certain basic health benefits like hospital and doctor visits. “What mandate in the Obamacare bill does he take issue with?” Doyle asked Shimkus. To which Shimkus replied, “What about men having to purchase prenatal care?” As the room started to buzz, Shimkus added, “I’m just … is that not correct? And should they?” Tell me Rep. Shimkus: do you think women should help fund men's prostate exams or ability to purchase Viagra?
And of course, virtually no one engaged in the healthcare debate - whether on Capitol Hill, the White House or K Street - are without first-class health insurance . . .
Even without a cost estimate from the Congressional Budget Office (which President Trump and Congressional Republicans have preemptively rejected as being biased), it seems clear that the AHCA will lead to millions of Americans losing their insurance coverage - especially older people living in rural America . . . a huge chunk of whom are devout "Trumpeters." Makes one wonder how all these folks are going to react when they wake up to discover that once again, they're uninsured and must, once again, resort of emergency room care. I don't think they're going to jump up and wave "Trump: Make America Great Again!" signs.
Many of us remember going into toy stores as kids and seeing an ominous sign which read "You break it you buy it." Well, the same goes for healthcare, President Trump. Those of us on the opposite side of the political aisle are going to make sure that people get used to hashtagging this proposal #TrumpCare. In that way, when (God forbid) you dismantle Obamacare, you will have to take complete ownership of its disastrous, heartless replacement. And that won't be good for you, for Republican governors (many of whom have already come out against it) and for Republican members of Congress . . . all of whom have gotten a taste of what it's like to face angry, angry constituents out there in the American heartland.
You may well want to heed the words of Texas Senator Tom Cotton (R-Arkansas) President Trump. For just the other day, in announcing his decision to withhold support for t he AHCA, Senator Cotton said, Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote. If they vote for this bill, they're going to put the House majority at risk next year."
You break it you buy it; you buy it you own it!
51days down, 1,409 to go . . .
Copyright©2017 Kurt F. Stone