Don’t trust the GOP with your health care

Judge politicians by their votes, not their quotes

President Donald Trump chose this newspaper to make his case that Republicans are the party to be trusted and the Democrats are to be feared when it comes to your health care. Polls suggest Americans don’t see it that way. If they’re smart, they will pay attention to votes, not quotes (or op-eds) from politicians and look at what’s likely to happen in health care after next month’s election. What is likely to happen based on who wins the midterms? If you subscribe to the “watch what they do, not what they say” philosophy, it’s fairly easy to see what the world looks like if the Republicans maintain their majorities in Congress. Republicans have voted at least 70 times to repeal the Affordable Care Act and the protections it guarantees for people with pre-existing medical conditions. Every single Republican in the Congress cast a vote for repeal except for 20 Republicans in the House and three in the Senate. Nine in that small group are retiring or not up for re-election this year. So unless you’re voting for one of the remaining 14, you will be casting a vote to make it far more likely that Americans would once again be subject to the tyranny of lifetime limits, Swiss cheese insurance policies and lost preexisting condition protections. A Republican-controlled Congress after the midterms will also be a vote for massive cuts to Medicare and Medicaid. Republicans in the House and Senate have just recently proposed hundreds of billions of cuts to those programs. Given enough votes, this is the budget Republicans would pass as part of the reverse Robin Hood effort to pay back the hundreds of billions in tax cuts they passed last year. Along with a Republican White House and a conservative Supreme Court, a Republican Congress will have free rein — and likely fewer moderating influences after the election. Let’s look at the alternative. If Democrats win at least 23 of roughly 60 competitive House races, they would have a narrow majority in the House. The Senate is much more challenging with a lot of seats to defend and only a few pick-up opportunities. So what happens if Democrats control at least one house of Congress? The short answer is nothing very dramatic, if anything at all. With a narrow margin and a veto threat, only the most incremental changes would be even possible. If you look at the issues Democrats in Congress have championed over the past several years, they center on modest but overdue improvements to the Affordable Care Act and reducing the cost of prescription drugs. Perhaps the most immediate focus would be aiming to prevent the Trump administration from further undermining the ACA. For any Democratic proposal to pass, of course, it would need to happen in a bipartisan fashion, garnering support from Republicans in Congress and the White House. This would almost certainly mean more centrist ideas, and at least some modest thawing of political tensions, to make the most incremental progress possible. As urgent as they are for many, bigger, more systemic questions — such as universal coverage and major steps toward improved affordability of prescription drugs — are not on the docket for the next Congress. And they won’t be until there’s a Democratic president and a Democratic Congress. Many Americans will cast their votes with health care in mind this year. And as much misdirection as we see in TV ads, claims of support for pre-existing condition protections from candidates who a year ago voted to remove them, and efforts by Trump to mislead or misrepresent where the Republican Party stands, the contrast is made simple by looking at the voting records of the candidates and the two parties and by what realistically lies ahead. It comes down to two choices — another epic battle to cut health care for millions, or the potential for small but bipartisan steps toward progress. That is really what’s at stake Nov. 6.

Andy Slavitt, a member of USA TODAY's Board of Contributors, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017.