No solution in sight on U.S. health-care dilemma
The health care impasse that Republican Senate leader Mitch McConnell faces is basically the result of a trap he set for himself, by steadfastly demonizing the Obamacare provisions over the past seven years, without ever establishing a coherent alternative of his own.
During that period, his party passed some 60 congressional resolutions, safe in the knowledge that President Barack Obama would veto them. Now, however, Donald Trump is in the White House, and the previous strategy appears to have been a bluff.
As former Republican House speaker John Boehner has suggested, Republicans have never been able to agree on a health care alternative of their own.
They repeatedly promised their partisan base they would repeal Obamacare, while Trump made his own promises of wider coverage, availability to more people and less expensive rates — pledges that were irreconcilable on their face.
He further promised to preserve Medicare and Medicaid, which is now contradicted by congressional Republican proposals.
What many failed to understand was that Obama’s Affordable Care Act wasn’t just an expansion to uninsured citizens with preexisting medical conditions, but it also significantly expanded Medicaid coverage to poorer Americans.
This latter group now exceeds 70 million, including two-thirds of those in nursing homes, 40 per cent of maternity deliveries, and 45 per cent of all U.S. children. The proposed reductions would eliminate much of their coverage, or bankrupt states that would no longer receive the previous level of federal subsidies.
Among other things, rural hospitals would be particularly jeopardized, which is why the American Medical Association and the American Hospital Association, among many other groups, oppose it.
What is unprecedented about the Republican approach, is that for the first time it would remove an entitlement from Americans already receiving it.
Perhaps more surprising is that it disproportionately affects less educated and poorer working class citizens in rural areas, demographics that are largely Trump supporters. McConnell’s proposal was also accompanied by huge tax cuts of over $700 billion (over 10 years), that are mostly directed to the wealthiest 2 per cent (people making over $250,000 annually). Warren Buffett claimed he alone would save $680,000 a year from the proposal.
This reverse Robin Hood policy is increasingly challenging for Republican senators from swing states to justify. Especially so for those from states like Ohio, West Virginia, Colorado, Arizona and Nevada, that signed up for additional Medicaid coverage.
Public opinion polls show that overall support for the Republican bill is in the 12 to 17 per cent range, and Congressional Budget Office scoring estimate that 22 to 24 million fewer Americans would have coverage over time.
This is probably why McConnell attempted to bypass the normal rules, and tried to jam it through quickly before it received much attention. Alas, this strategy seems to have failed, and in his quest to gain 50 pliant Republican votes, he has the unenviable task of simultaneously placating hard conservative ideologues who want total repeal of Obamacare, and swing state moderates who are afraid of antagonizing voters who depend upon government support.
Another complication for Republicans, is that the cuts in health care spending were intended to provide additional scope for reductions in tax reform, another policy priority of theirs. Infrastructure policy, the proposed border wall with Mexico, and other policies are also affected. In other words, the challenges they face in negative reaction to their health care agenda have implications for gridlocking their entire domestic program. Despite Trump’s claims of unprecedented accomplishments during his first six months in office, little of legislative policy substance has actually been achieved, unless you count the naming of post offices.
According to those who have spoken with him, Trump has shown little mastery of the details of the issue. “Who knew health care was so complicated?” He clearly wants to claim a victory on the subject, but seems to have less concern for what is actually in the bill.
Of late, he is said to be content with simply repealing Obamacare, and leaving replacement for some other time, if ever, a very unlikely occurrence. In reality, if a suitable replacement is to occur, it will likely require some compromise that includes Democratic support, but the Republicans aren’t ready for that quite yet.