Bill’s pas­sage puts Oba­macare on death bed

The Hamilton Spectator - - CANADA & WORLD - ALEXAN­DER PANETTA WASH­ING­TON —

More than 50 years af­ter Canada moved to­ward universal health cover­age, and 70 years af­ter it hap­pened in Eng­land and France, the U.S. Congress took a baby step in the other di­rec­tion Thurs­day, ad­vanc­ing a bill that would elim­i­nate health care for mil­lions.

It won’t likely make it through the Sen­ate in its cur­rent form.

But the pas­sage of that bill through the House of Rep­re­sen­ta­tives was greeted as a mo­men­tous event by both par­ties: By Repub­li­cans as proof their ma­jor­ity could get some­thing done, by Pres­i­dent Don­ald Trump as a leg­isla­tive win, and by Democrats as an elec­toral gift.

Democrats in fact erupted in mock cel­e­bra­tion the in­stant the bill squeezed through the cham­ber with a 217-213 vote — teas­ing their Repub­li­can ri­vals, wav­ing, singing, “Na na na na, hey hey, good­bye.”

That’s be­cause they’re count­ing on Repub­li­cans be­ing turfed in next year’s midterm elec­tions over what they say the bill does: help the wealthy, the big­gest win­ners in hun­dreds of bil­lions in tax cuts; hurt the poor, mil­lions of whom would lose cover­age; in­crease pre­mi­ums for peo­ple with pre-ex­ist­ing con­di­tions such as cancer; and anger the na­tion’s main se­niors’ lobby group.

“You have walked the plank,” pre­dicted Nancy Pelosi, the Demo­cratic leader in the cham­ber.

“You have ev­ery pro­vi­sion of this bill tat­tooed on your fore­head. You will glow in the dark on this one.”

The bill’s ef­fects are hard to gauge.

It was rushed to a vote be­fore the con­gres­sional bud­get watch­dog had a chance to as­sess it. An ear­lier eval­u­a­tion of the bill in a pre­vi­ous form con­cluded it would have re­moved in­sur­ance from 24 mil­lion peo­ple.

An­other rea­son it’s hard to pre­dict the im­pact is be­cause key cover­age de­ci­sions would be­long to the states. One such de­ci­sion in­volves whether to re­strict ac­cess to the U.S. Med­i­caid pro­gram, which pro­vides cover­age for the very poor­est Amer­i­cans.

Repub­li­cans savoured the mo­ment.

Trump in­vited the vic­to­ri­ous party over to the White House for a cel­e­bra­tory news con­fer­ence. Des­per­ate for a leg­isla­tive win, he wanted some­thing passed by the cham­ber, so he could move onto more po­lit­i­cally pop­u­lar is­sues such as tax cuts and in­fra­struc­ture. Ear­lier ef­forts crashed. Pre­vi­ous ver­sions of the bill kept stum­bling into op­po­si­tion from the party’s right wing, or its left wing — ul­ti­mately sat­is­fy­ing nei­ther, clog­ging up valu­able con­gres­sional time, and un­der­min­ing Trump’s per­sonal brand as a deal-maker.

The Repub­li­can House leader cast it as a sim­ple mat­ter: keep­ing prom­ises. Repub­li­cans pledged re­peat­edly to undo Barack Obama’s un­pop­u­lar bill. In fact, they rode the tsunami of pop­u­lar anger to con­gres­sional gains in 2010, 2014 and 2016.

“A lot of us have been wait­ing seven years to cast this vote. Many of us are here be­cause we pledged to cast this very vote,” said Paul Ryan, the House Speaker.

“Are we go­ing to be men and women of our word? Are we go­ing to keep the prom­ises we made?”

The other Repub­li­can ra­tio­nale for this bill was that the cur­rent Oba­macare sys­tem is fall­ing apart and un­sus­tain­able. Repub­li­cans pointed to the sky­rock­et­ing num­ber of coun­ties with­out in­sur­ance com­pe­ti­tion, with just one provider or none.

The rate of Amer­i­cans with­out health in­sur­ance has de­clined, from 18 per cent to 10 per cent, un­der Obama’s 2010 health re­form. Democrats say it would be even better, had the project not been sab­o­taged by Repub­li­cans — who, for in­stance, re­moved fed­eral pro­tec­tion for strug­gling in­sur­ance plans.

The bill has now com­pleted onethird of its jour­ney with Thurs­day’s vote.

It still must pass the Sen­ate, and can do so with a sim­ple ma­jor­ity vote un­der the rules for fi­nan­cial mea­sures. But it’s ex­pected sev­eral Repub­li­cans will de­mand changes. Then the bill would go to a rec­on­cil­i­a­tion con­fer­ence, where both cham­bers ne­go­ti­ate a fi­nal ver­sion.

Sen­ate Repub­li­cans aren’t thrilled with the cur­rent bill.

Ohio’s Rob Port­man said he agrees with the gen­eral ob­jec­tive of re­plac­ing Oba­macare with a more sus­tain­able al­ter­na­tive. But he said he doesn’t sup­port the cur­rent ver­sion, as he fears the wa­ter­ing-down of Medi­care will worsen the opi­oid cri­sis.

“These changes must be made in a way that does not leave peo­ple be­hind,” he said in a state­ment.

ALEX WONG, GETTY IMAGES

U.S. Sen. Bernie San­ders sig­nals for quiet dur­ing a Stop Trump­care rally Thurs­day in front of the Capi­tol in Wash­ing­ton, DC.

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