Give Me a Crash Course In . . . the US health­care de­ba­cle

The Irish Times - Weekend Review - - NEWS REVIEW - SUZANNE LYNCH

What’s all this about? The Repub­li­can Party’s plan to re­peal and re­place Oba­macare, the health­care sys­tem in­tro­duced by Barack Obama in 2010, lay in ru­ins this week af­ter it failed to get enough sup­port for its pro­posal in the US Se­nate. With Repub­li­cans hold­ing 52 seats of the 100-seat se­nate, it could only af­ford to lose the sup­port of two mem­bers (with the US vice pres­i­dent cast­ing a de­cid­ing vote). On Mon­day night as Pres­i­dent Trump was win­ing and din­ing seven Repub­li­can sen­a­tors, two oth­ers an­nounced they would not sup­port it, bring­ing to four the num­ber who op­posed the bill. Se­nate ma­jor­ity leader Mitch McCon­nell – the top-Repub­li­can in the se­nate – was forced to aban­don the vote. Hang on, I thought there was an agree­ment on this a few months ago? Yes, but that was in the other cham­ber, in Congress – the House of Rep­re­sen­ta­tives. They agreed a new “Amer­i­can Health­care Act” in May prompt­ing Trump to hold a cel­e­bra­tory press con­fer­ence in the White House Rose Gar­den. This time the pres­i­dent was not so keen to get in­volved. “I’m not go­ing to own it,” he said on Tues­day as the plan col­lapsed. Why did the plan fail?

De­spite Repub­li­cans con­trol­ling both houses of congress and the White House, the party was deeply di­vided on health­care. On the one hand, con­ser­va­tive sen­a­tors be­lieved the re­forms did not go far enough and would still lead to too much gov­ern­ment spend­ing on health­care. On the other hand, mod­er­ates were wor­ried about the im­pact on poorer con­stituents, in par­tic­u­lar cuts to Med­i­caid, the fed­eral pro­gramme for low-in­come Amer­i­cans which ex­panded in some states un­der Oba­macare. The plan was never go­ing to keep all sides happy. Who’s to blame?

Al­most im­me­di­ately the blame-game be­gan. Mitch McCon­nell is a sea­soned op­er­a­tor and many blame him for rush­ing through a vote on health­care with­out any sub­stan­tive pub­lic de­bate or hear­ings. He also un­der­es­ti­mated the con­cerns of sen­a­tors in spe­cific states, such as Ne­vada, Ohio and West Vir­ginia, which would be par­tic­u­larly af­fected by health­care changes. Oth­ers are blam­ing Pres­i­dent Trump. In­stead of try­ing to con­vince the pub­lic and the party of the ben­e­fits of health­care re­form, the pres­i­dent in­stead chose to con­cen­trate on his “Made in Amer­ica” week and showed lit­tle in­ter­est in the minu­tiae of the com­plex pro­posal. Weren’t there prob­lems with Oba­macare?

Yes, ini­tially. The in­tro­duc­tion of the Af­ford­able Care Act al­most seven years ago was be­set with dif­fi­cul­ties, not least the prob­lems that af­fected health­care ex­change web­sites. But while pre­mi­ums rose for many, mil­lions got health­care for the first time. Polls in re­cent months show that sup­port for Oba­macare has been in­creas­ing. There are still prob­lems – pre­mi­ums are con­tin­u­ing to rise for some peo­ple, while in­sur­ers are threat­en­ing to pull-out al­to­gether from some states. De­fend­ers of Oba­macare say part of the prob­lem is the un­cer­tainty around the Oba­macare re­place­ment. What hap­pens next?

McCon­nell has said he in­tends to hold a pro­ce­dural vote on a 2015 bill which would re­peal Oba­macare but de­lay its re­place­ment this week, but cur­rently he does not have the sup­port. The next step might be a joint ef­fort by Repub­li­cans and Democrats to come up with a com­pro­mise. At the mo­ment Oba­macare re­mains the law of the land. How­ever, Trump’s com­ments that Repub­li­cans should “let Oba­macare fail” have wor­ried many. Tech­ni­cally, the ad­min­is­tra­tion could cause dif­fi­cul­ties for Oba­macare by per­haps with­hold­ing sub­sidy pay­ments to in­sur­ers or not ad­ver­tis­ing the an­nual sign-up pe­riod for the pro­gramme. For mil­lions of Amer­i­cans, the fu­ture of health­care looks as un­cer­tain as ever.

Mitch McCon­nell: many blame him for rush­ing through a vote on health­care with­out any sub­stan­tive pub­lic de­bate or hear­ings

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