By Mike Appleton, Weekend Contributor
“We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us. . . . It will be in a much simplified form. Much less expensive and much better.”
-President-elect Donald Trump, Washington Post (January 15, 2017)
Even if one supports the Affordable Care Act, there was nothing satisfying about watching the legislative circus over repeal and replacement unfold in the Senate over the past few weeks. To an outsider the entire process appeared disjointed and at times almost incoherent. It became increasingly impossible to fathom what Senate Republicans were trying to accomplish. So when the final effort, an eight-page bill apparently drafted over lunch, was rejected in a 51-49 vote, the most appropriate emotional response was neither elation nor disappointment, merely exhaustion.
Efforts to lay blame for the debacle have already begun, of course. Reince Preibus has been summarily booted from the White House and the three Republicans who defied Mitch McConnell by voting against the so-called “skinny” repeal bill have been castigated by the right. But it would be wrong to think that there isn’t a way forward. That first requires that we dispel several misconceptions.The first attempt to fully repeal the ACA was the “Repealing The Job-Killing Health Care Law Act,” introduced by then House Majority Leader Eric Cantor and passed by the House on January 19, 2011. According to a recent report by the Congressional Research Service, while there were several additional pure repeal bills over the following years, the vast majority of the proposed bills concerned modifications to the ACA, either by eliminating or postponing the effective date of certain provisions, withholding funding approval or otherwise hindering implementation of portions of the Act. Several proposed revisions to the ACA actually passed both houses of Congress and were signed into law by President Obama. Therefore, the Democratic charge that Republicans have had eight years to draft a replacement for the ACA, while technically accurate, is somewhat misleading. A true replacement bill has never been drafted because replacement of the ACA following repeal was not a Republican goal. The “repeal and replace” slogan only came into prominence when Donald Trump was nominated with his promise to give the nation better and cheaper health insurance coverage as soon as he took office. His surprise election victory left Republicans scrambling to come up with something in a hurry. The fact that they were unable to do so does not mean that a good faith effort to develop a comprehensive bipartisan solution to the acknowledged deficiencies in the ACA is impossible.
A second misconception is that Congress can expect meaningful leadership from the White House on healthcare reform. In the same interview with the Washington Post quoted above, Mr. Trump said that his proposed plan was “very formulated down to the final strokes. We haven’t put it in quite yet, but we’re going to be doing it soon.” Either his plan was not submitted to Congress in the ensuing six months or I missed it. But if I missed it, so did Congress, because neither the measure passed in the House nor any of the Senate’s failed efforts bore any resemblance to what the President has repeatedly described: lower premiums, lower deductibles, more coverage and cheaper prescription drug costs. He celebrated the passage of the House version in May, only to criticize it in June as “mean, mean, mean.” Since the most recent Senate vote, the President has almost simultaneously vowed to let the ACA die on its own and encouraged the Senate not to give up on passage of “Repeal & Replace.” One is left with the impression that were Congress to pass a statute simply stating, “We love healthcare,” Mr. Trump would sign it with a flourish before a battery of cameras and send out multiple tweets proclaiming his great legislative victory for the American people. If any bill it adopted under guidance from the White House, it ought to at least mandate whiplash coverage.
Perhaps the biggest misconception, however, is the assumption by the President and congressional Republicans that their views on healthcare policy represent prevailing public attitudes. The unpopularity of the House and Senate bills has been widely reported. Moreover, recent polling suggests that a slight majority now prefers that the ACA be retained and improved upon. Most importantly, a January report by Pew Research reveals that fully 60% of the public believes that “government should be responsible for ensuring health care coverage for all Americans . . . .” That number includes 52% of Republicans with annual incomes below $30,000.00. What this means is that it is time for political leaders to abandon partisan rhetoric and seriously engage voters in debating questions which are routinely relegated to academics. What kind of animal is healthcare? Is it a public good or a commodity like any other? Where do personal and collective responsibility intersect? What is the role of the free market in the provision of healthcare? What are the proper limits of government involvement? Is universal healthcare a moral imperative or merely a desirable goal? How should the burdens of the cost of healthcare be allocated? These are issues that go to the heart of how we view ourselves, our relations with others and the limits of constitutional government. Until we eschew the slogans and the convenient labels we use to categorize political views and thoroughly review first principles, no consensus is possible. Part Two will address some of these questions.
Sources: “Trump Urges Republican Senators Not To Give Up On Healthcare,” Huffington Post (July 30, 2017); David A. Graham, ” ‘As I Have Always Said’: Trump’s Ever-Changing Position on Health Care,” The Atlantic (July 28, 2017); Kaiser Health Tracking Poll: The Public’s Views on the ACA (July 15, 2017); Astead W. Herndon, “What’s more popular than the Senate health care bill?,” Boston Globe (June 29, 2017); Jessica Estepa, “Poll: Majority of Americans want to keep Obamacare,” USA Today (March 7, 2017); C. Stephen Redhead and Janet Kinzer, “Legislative Actions in the 112th, 113th and 114th Congresses to Repeal, Defund or Delay the Affordable Care Act,” Congressional Research Service (February 7, 2017); Robert Costa and Amy Goldstein, “Trump vows ‘insurance for everybody’ in Obamacare replacement plan,” Washington Post (January 15, 2017); Kristen Bialik, “More Americans say government should ensure health care coverage,” Pew Research Center (January 13, 2017); Byron York, “No, House Republicans haven’t voted 50 times to repeal Obamacare,” Washington Examiner (March 25, 2014); Ed O’Keefe, “The House has voted 54 times in four years to repeal Obamacare. Here’s the full list,” Washington Post (March 21, 2014).
The views expressed in this posting are the author’s alone and not those of the blog, the host or other weekend contributors. As an open forum weekend contributors post independently without pre-approval or review. Content and displays of art are solely their decision and responsibility.