GHOSTS OF HEALTH CARE BATTLES PAST
Obamacare repeal is an ideological crusade past its sell-by date. Give it up, Republicans.
Just when Democrats thought it was safe to either stop paying attention or go full Don Quixote on Medicare For All, Obamacare repeal is back.
When an entire political party has campaigned and won for seven years on getting rid of a law that was about as popular as President Trump (as in not very), it’s hard to move on. And who would have thought the country would change its collective mind, just when Republicans won control of the whole government?
Actually, that was predictable. Those dozens of Republican repeal drives, that “Defund Obamacare Town Hall Tour,” those threats to shut down the government, were consequence-free while President Obama was in office. Republicans didn’t have an alternative, but they didn’t need one. Obama was the fail-safe. And indeed, when a repeal bill finally passed both the House and the Senate last year, Obama vetoed it.
Now Trump is president and Republicans are trying to do things their way. However, the dogs don’t like the dog food. In fact, many of them seem attached to what’s in their bowls right now. And why not? It has expanded insurance coverage to millions, driven down the personal bankruptcy rate, saved lives.
EXPOSED REALITIES
OK, voters aren’t dogs. But the analogy is apt. There’s been so much overblown rhetoric in the last few years that it took actual GOP health proposals to expose the realities, both good and bad, of the Affordable Care Act.
It’s true that premiums jumped for some people, and that needs to be fixed. The insurance markets are unstable, but they wouldn’t be so shaky if Trump weren’t sharply cutting outreach and enrollment help, shortening the enrollment window, and threatening payments that keep costs down for low-income customers.
Yet now, like some Dickensian ghost of health battles of the past
25 years, comes the spectral coda: the repeal bill known as GrahamCassidy. Among other things, by
2026 it cuts one-third of the money now helping cover low-income people; eliminates requirements that people buy coverage and that large employers offer it; gives states control over a shrinking pot of health dollars, and redistributes the money so some states get a lot less.
If and when it’s graded by the non-partisan Congressional Budget Office, there is no reason to think this repeal bill would fare better than the last one, which failed in the Senate by one vote. CBO has projected that previous versions of Republican repeal bills would result in up to 24 million or even 32 million fewer people with insurance by 2026. Those reports have made splashy headlines and mobilized opposition from the public and some lawmakers.
That’s no doubt why doctorSen. Bill Cassidy of Louisiana, the force behind the last-chance repeal bill, has dismissed in advance whatever the CBO might say this time: “I just don’t care about the coverage numbers, because their methodology has proven to be wrong. And ours, frankly, empirically, is correct.”
OUT OF THE ASHES
He needn’t have bothered with the pre-emptive damage control. With only 52 senators, Republicans are desperate to meet a Sept. 30 procedural deadline for passing the bill with just 51 votes. CBO said Monday it will need “at least several weeks” to analyze the bill’s impact on the deficit, coverage and premium costs.
The good news for the GOP: No devastating headlines before the deadline. The bad news? Not much information for Congress, which could give one or two GOP senators a reason to vote no.
Cassidy’s comments were depressing but not surprising, given disregard for evidence in our time. The repeated rise of health care repeal out of the ashes is a sad demonstration that evidence can’t compete with ideology and special-interest money.
We’re stuck with ideology and the priorities it drives. That means the GOP is sticking with campaign rhetoric that was always overheated, and with freemarket, freedom-of-choice ideals that are irrelevant and unworkable in the health care arena.
If only facts and data had as many lives as Obamacare repeal. Evidence — in this case, data that suggest how we might cover more people, improve their health, curb costs and make the whole system more efficient — may yet stage a comeback. But for right now there is Graham-Cassidy and the fight to keep what we have, imperfect as it is.
Jill Lawrence is the commentary editor of USA TODAY and author of The Art of the Political Deal: How Congress Beat the Odds and Broke Through Gridlock.