Why Congress Cannot Agree on Health Care Reform
The issue of health care reform in the United States has been the subject of political debate since the early part of the 20th century.
By Robert Steven Ingebo
The issue of health care reform in the United States has been the subject of political debate since the early part of the 20th century. Because of the Democratic Party’s deeply flawed Affordable Healthcare Act (ACA), health care reform remains a current, active political issue among many concerned American citizens and politicians.
Because Republicans now have the majority in the White House, the Senate and the House, the responsibility of providing a new, viable health care system for the millions of inadequately insured and uninsured Americans falls squarely on their shoulders.
Unfortunately, the first Republican effort to repeal and replace Obamacare, which was the simple “skinny repeal” bill, failed on June 28.
The obstructionists were the Democrats, who all opposed the bill, and Senators John McCain, Lisa Murkowski and Susan Collins.
This was a major blow to President Trump and all the Republicans who support him because it undercut his campaign promise to repeal and replace Obamacare.
McCain, who had previously voted for a motion to proceed with the bill, held out all day, including in a news conference where he criticized the partisan process that led to the after-midnight vote.
Multiple Republican colleagues, including Vice President Mike Pence, engaged in animated conversations with the Arizona senator, trying to convince him to vote for the bill.
Trump called Pence just before the final vote, who handed the phone to McCain. The call was brief and ultimately unsuccessful. Even the president of the United States couldn’t persuade McCain to vote for the bill.
The responsibility for the failure to repeal and replace the ACA ultimately lies with Senate Majority Leader Mitch McConnell, who dropped the ball by failing to secure enough votes for the bill to pass, even with a majority of Republicans in the Senate.
A last-ditch effort to repeal Obamacare appeared on Sept. 18, when Arizona Gov. Doug Ducey backed a new Senate plan called “Graham-Cassidy,” authored by Senators Lindsey Graham and Bill Cassidy.
Ducey said, “Graham-Cassidy is the best path forward to repeal and replace Obamacare… Congress has 12 days to say ‘yes’ to Graham-Cassidy. It’s time for them to get the job done.” Ducey’s endorsement put more pressure on McCain to support the legislation.
On Monday afternoon, Collins announced that she would oppose the Graham-Cassidy bill. Collins joins Senators McCain and Rand Paul, who have both said they will oppose the legislation. Sen. Ted Cruz also said he opposed the legislation as written.
That will bring the total to three, or quite possibly four, Republican senators voting against the bill, with zero votes from the Democratic Party, killing the Republican Party’s final hope to repeal the ACA.
This is a punch in the gut to Trump and his supporters, who see this as another attempt by the Republican-majority Senate to obstruct Trump’s agenda to help Americans who either don’t have health care or can no longer afford it.
Apparently, they don’t think these people are worth spending the money on, that there are more important matters for the Republican Party to focus on — for example, all the projects their cronies want to see them get done.
Collins said in her statement that the bill does not go far enough to protect people with pre-existing conditions and that the proposal’s cuts to Medicaid are too steep.
In contrast to Collin’s statement about pre-existing conditions, Trump tweeted on Sept. 20, “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does! A great Bill. Repeal & Replace.”
Let’s examine Collin’s other allegation about Medicaid cuts. The initial version of Graham-Cassidy reveals that it created a system in which, using a new temporary block grant, all states would receive the amount of federal resources necessary to provide coverage to certain individuals who would be ineligible for Medicaid.
However, under this system, the funding pool ends in 2026. The funding formula on which the pool is based accounts for the population that was previously insured through the ACA’s Medicaid expansion. The funding appears not to account for a significant proportion of the expansion, which, in my opinion, is the result of a lot of people who had to drop out of the ACA for various reasons, suggesting that the bill is underfunded.
Based on earlier Congressional Budget Office (CBO) cost estimates the bill would result in hundreds of billions of dollars in reduced federal Medicaid funding for what has come to be known as the “traditional” Medicaid program.
There are two things wrong with this analysis.
Senate Republicans announced major revisions to the Graham-Cassidy health care reform bill in a final bid to win over the three or four holdouts. The revised Graham-Cassidy bill will reportedly boost Medicaid funding for several states, including Alaska and Arizona.
Collins’ announcement came after the CBO released a partial score Monday evening of the GOP’s plan, saying the Graham-Cassidy bill would reduce the budget deficit by at least $133 billion, but millions would lose comprehensive coverage.
The scoring agency estimates that between 2017 and 2026, “The legislation would reduce the on-budget deficit by at least $133 billion and result in millions fewer people with comprehensive health insurance that covers high-cost medical events.”
Congressional members and staffers waste a lot of time waiting for the Congressional Budget Office to release scoring of major legislative proposals. Most Americans don’t even care what the CBO says because the agency is wrong so often.
Take Obamacare for instance. Seven years ago, the Democrats rammed the ACA through the House of Representatives without a single Republican vote and with only three Democratic votes to spare. At the time, the CBO said that in 2017, 23 million people would be enrolled in the ACA. So far, the number is closer to nine million. The CBO missed its projection by some 14 million people. Its projections were off by 48%.
The big question: Is this reform going to change the votes of the three or four senators opposing the bill from no to yes?
It is highly unlikely because, according to Collins, “Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target.”.
She also claims that the bill would “open the door for states to weaken protections for people with pre-existing conditions, such as asthma, cancer, heart disease, arthritis and diabetes.”
Where is her evidence to support those claims?
Collins told reporters that Trump talked to her on the phone Monday and that Pence had called her over the weekend to discuss her stance on health care.
No one can claim that the president hasn’t been involved in trying to save this bill. The Trump voters and many other Americans will look at this display of obstructionism caused by McConnell and the three or four Republican senators as something that will affect their lives for the worse, because they know that when Obamacare fails, millions of Americans will no longer have health insurance.
This puts the re-election campaigns of all the current Republican members of Congress in serious jeopardy because millions of American voters see them as the problem, not Trump.
What could they possibly be thinking?
Robert Steven Ingebo is president of FRI Corporation.
