Daily Local News (West Chester, PA)
Costello: ACA problems to worsen
For the better part of five days last month, U.S. Rep. Ryan Costello, R-6, of West Goshen, found himself in a maelstrom of American government, politics, media, and communication.
He was in demand from reporters, hounded by television cameras, lobbied by interest groups, the subject of public protests outside his Chester County office, and buffeted by discussions with his fellow congressmen and women, and an invite to the Oval Office at the White House for a meeting with President Donald J. Trump — all because of an unwillingness to publicly commit one way or another to the Republican plan to “repeal and replace” the nation’s Affordable Care Act (ACA), also known as “Obamacare” with a controversial GOP alternative, the American Health Care Act (ACHA).
“I had 25 to 30 media requests a day,” he told the Daily Local News in an interview last week. “There were 15 to 20 reporters following me all day. That is not my normal experience down there.” At 11 p.m. on Wednesday, March 22, after a meeting with the GOP leadership at Speaker of the House Paul Ryan’s Capitol office, Costello walked out into the hallway to see 30 reporters and television cameras waiting to film his movements outside.
“You just walk into the throes of it all,” he said, still somewhat astonished by the experience.
He made and received dozens of phone calls, sent and read scores of emails. “My staff was ‘all hands on deck,’” he said of those legislative aides who work in his Washington and district offices. He heard from insurance organizations, hospital associations, representatives of the Children’s Hospital of Philadelphia, members of the ARC of Chester County, and even James Scanlon, the superintendent of the West Chester Area School District, who educated him on the amount of funds that come to the schools under the current legislation for disabled students.
“I think it was the single most intense and potentially most significant week of anything I’ve ever been a part of in elective office,” said Costello, who is in his second term in the House and was a township supervisor and county official for more than 15 years. “There are members who have been down there for decades that would say the same thing.
“But, obviously, (in the end) nothing was achieved,” he said.
Faced with doubts from moderates like Costello and fellow Pennsylvania Republicans like U.S. Rep. Pat Meehan, R-7, of Chadds Ford, and U.S. Rep. Charlie Dent, R-15, of Allentown, as well as open revolt by members of the ultra-conservative House Freedom Caucus, Ryan decided to pull the bill that had been seven years in the offing and 17 days in final form, without a vote.
“It was a missed opportunity to make significant reforms to our health care system,” Costello concluded. “The bill that I voted to advance out of committee could have been the framework (for reform), with enhanced tax credits and some other additional health security provisions, to have significantly improved our health care system. The Freedom Caucus did play a role to stop the bill, and it remains to be seen whether they will have a similar impact on future legislation, particularly
since the administration has now indicated that it may actually move in the direction of working with moderate Democrats.
“The real question moving forward is whether we revisit health care reform and advance a bill to the Senate,” he said. “The problems with the Affordable Care Act aren’t going to disappear, they’re going to significantly worsen.”
Costello spoke with the Daily Local News by telephone on Friday, after having responded to a series of written questions about his thoughts on health care and the recent legislative process that proved to be a defeat for those in his party who had campaigned against the ACA for years. He expressed disappointment in the overall outcome of the process, as noted above, but seemed enthused by the way the legislative dance unfolded.
“I ended up being very calm, and it made me very deliberative,” he said of the whirlwind of the five days between Monday, March 20, and Friday, March 24, when the bill was pulled. “I ended up thinking a lot. I had just one vote in that process, and there were things that I wanted to see repealed, but things that I wanted to see maintained.”
He said that he had long held reservations about portions of the ACA, mostly meaning the so-called individual mandate, the employer mandate, and many of the taxes associated with it, so signing on to an effort to reform the health care law was not something he naturally opposed. But, he added, “I’ve always felt that preserving the protection for pre-existing conditions, allowing children to stay on their parents’ plan until they’re 26, and making sure that low-income Americans have access to affordable health care coverage were pieces of the Affordable Care Act that I support and believe should be sustained even if it were in a new law.
Getting rid of “Obamacare” was not an overarching quest for him, he said. “The term ‘Obamacare’ does not matter to me. Some people get caught up in those political terms, so I try not to use them. But to me it accomplishes nothing to repeal that program without replacing it with something better.”
Monday, March 20, began with Costello feeling uneasy about the bill that had been brought out of committee, even though as a member of the House Energy and Commerce Committee he had voted to move it to the floor.
He said his initial thought on AHCA was that it “was the right framework.” By providing tax credits to those who would no longer be covered under Medicaid expansion, “we would be able to create a more robust individual and small group insurance market for those who are now on Medicaid expansion.” But then came the announcement that the Congressional Budget Office had ‘scored’ the bill, and estimated that within a decade 24 million Americans would have lost their health care because of the way the legislation was written.
“Once the CBO score was issued, I then felt both the number of uninsured was insufficient to incentivize low-income Americans into purchasing health insurance,” Costello said. “It was certainly a fast-paced process, but I don’t control the process, though I do have to work through it. I remained focused on maintaining my integrity of evaluating things to the best of my ability, and voting my conscience and my district. It seemed like every hour a new amendment, news report, or position paper was put in front of me.
“It was five long days,” he said. “And I didn’t know where it would end up going in.”
On Tuesday, March 21, he and 15 other representatives were invited to the White House to meet with the president and discuss the legislation. He was at a point where his misgivings were beginning to take hold, although he had determined not to announce a decision one way or another publicly. “Once you come out in a certain way, you lose leverage to be able to influence the direction of the bill,” he said. His encounter with Trump was brief, but to the point. “I said, ‘I can’t support it,’ the way it was presented then. He shook his head.”
Of Trump, whom Costello has never enthusiastically supported, he commented simply that he “was definitely very involved. I believe most members that I was with that have been here for quite some time indicated that he’s been more personally involved with members of Congress than President Obama ever was. But it’s also very clear that he is still filling out his legislative affairs team and still putting people in place so that he can govern effectively.”
Wednesday, March 22, included a meeting with the House GOP leadership and the announcement that some essential health benefits (EHB) would be dropped from the legislation in order to appease the Freedom Caucus: procedures
like mammograms and maternity care, preventative care and other benefits popular with the public and the medical profession. At some point, Costello told his wife, Christine Costello, that even though the bill was set to be voted on Thursday, he might be staying in D.C., over the weekend. The 40-year-old had been sleeping on a mattress on the floor of his office all week.
He continued to press to find out more of the details of the bill, and to communicate with others on ways it could be improved.
“I believe the (press) coverage encapsulates my position as it was, which is keep your powder dry, analyze, and continually ask questions on the implications as policy changes are made,” he said. “My hesitation was not received favorably in the Capitol because most people want you to be a ‘yes’ or are trying to get you to a ‘yes’ vote, and most constituents, I believe, just wanted to know whether I was going to be for it or against it.
“Everything moved very quickly and there were a ton of cross-pressures other members, protestors, calls, staff, news reports, outside groups, and so on,” Costello said. “But I just kept coming back to what I felt was the objective: ‘Will the reform measures improve our health care system?’ And different proposed amendments were shaping my opinion on that in real time, along with the feedback I was constantly getting.”
Wednesday turned to Thursday, March 23, and the meetings with leadership and interviews in front of TV cameras. Costello sat in his office with staff, watching the coverage to gauge the bill’s chances and progress.
“I did not sleep Thursday night,” he said. “I was thinking all night.” At some point the idea occurred to Costello that he
could vote in favor of the bill despite his misgivings, “and let the Senate clean it up. There was something compelling to that.” Then a subsequent reconciliation bill would have a better outcome, he thought. He decided, however, that he would have to vote against the bill unless it changed in its final form.
“I had told the voters in my district what would be non-negotiable (in health care legislation),” he said. “I could not justify removing things that I had campaigned on. I would end up being for a bill that was inconsistent with what my position was” on matters like affordable access, insurance for pre-existing conditions, and keeping adult children on their parents’ policies.
When he walked to the House on Friday morning, March 24, Costello approached the leadership vote counter and told them, “I’m a ’no,’ and there is no way to move me.” He stayed in the cloakroom for much of the morning, and then watched on television as the events of the day unfolded. “When I saw the news that the Speaker was going to the White House, I had a feeling he was going over there to say that the votes were not there.”
He was right; they were not.
Costello says he is skeptical that health care reform as a bill can move forward in a bipartisan manner with the current divided climate in the Capitol. “There is an ideological divide over the individual mandate, and it is hard to bridge that gap,” he said.
Republicans, he said, would also have to put aside differences if they were to be successful in that regard. “We have to learn to not point fingers at each other. We have to realize that we are all not going to get all that we want.”
“I’ve always felt that preserving the protection for pre-existing conditions, allowing children to stay on their parents’ plan until they’re 26, and making sure that low-income Americans have access to affordable health care coverage were pieces of the Affordable Care Act that I support and believe should be sustained even if it were in a new law.” — Rep. Ryan Costello, R-6, of West Goshen