Repeal and Replace: Why It Failed
Recently, the Republican Party’s healthcare bill, intended to replace Obama’s Affordable Care Act, failed to get the number of votes needed to pass the Senate. This surprised many people. The Republican Party has been touting the slogan “repeal and replace” for 7 years, and with a Republican-dominated House and Senate, it seemed inevitable that President Trump’s effort to do away with “Obamacare” would be a success.
So how is it possible that, with 7 years to prepare and a Republican-controlled government, the Republican Party just couldn’t make their healthcare reform happen? Well, the answer is a rather complicated one, but let us break it down for you.
Understanding Both Bills
First, it’s important to understand that there were two separate bills in play. The first was the American Healthcare Act (AHCA). This bill was passed by the House of Representatives, then sent on to the Senate for a vote. The Senate knew, however, that they didn’t have the votes to pass that bill, so they effectually cancelled the vote on the AHCA and instead produce a new bill: the Better Care Reconciliation Act. This latter bill is the one that was bounced around, revised multiple times, and finally voted down.
This, once again, had many people scratching their heads. The Senate knew the bill was not going to get the approval it needed, so how, after all those revision attempts, did it still not work? Larry Levitt, a health policy expert from the Kaiser Family Foundation, summed it up this way: “In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal health spending, bit increase in the uninsured.” Essentially, the Senate changed the wallpaper but failed to fix the problems with the foundation.
Both bills featured big savings for the rich by removing the “Cadillac tax” on expensive, employer-sponsored healthcare plans. But of course, if the government is missing out on those funds from the upper crust of healthcare plan purchasers, they have to get it from somewhere else—and they get it from big changes to Medicaid that would leave millions of beneficiaries without insurance.
The bills also proposed a completely different tax credit system for purchasing healthcare, which would have made healthcare significantly more expensive while covering a lot less that could go wrong. According to projections, millions would be unable to afford insurance at all, and those who could would find themselves with extremely high deductibles and minimal coverage. Essentially, everyone would suffer. These big issues were present in the original AHCA bill, and the Senate failed to correct these major problems when submitting the second bill.
So now that we understand what was included in the bills, let’s address why such items were included, and how the Republican Party failed to garner the support they needed.
Failing to Walk the Line
The American Healthcare Act (AHCA), also dubbed “Trumpcare” by some, attempted to maneuver a fine line between conservative and liberal desires in the hopes of gaining the Democratic vote. But in attempting to please everyone, the bill pleased nobody at all.
For more conservative Republicans, the bill seemed to keep far too many elements of the original Affordable Care Act (ACA). It kept a ban on lifetime limits, allowed children to stay on their parents’ plans until the age of 26, and protected those with pre-existing conditions from discrimination.
Other elements of the ACA, the Republicans kept but modified. For example, the Medicaid expansion would have continued until 2020, and tax subsidies for healthcare would still be offered—they would just be much leaner and offered based on age instead of income. With so much of “Obamacare” remaining in the new bill, many Republicans balked at the idea of voting it into law. After all, wasn’t the promise to repeal and replace?
As GOP Senator Rand Paul said, when speaking in Washington, the new bill “needs to look more like repeal and less like we’re keeping Obamacare.” For years, the Republican Party promised to do away with Obamacare, and yet, the new bill looked too much like the very healthcare law they had railed against for 7 years. Instead, conservative Senate leaders found themselves look at an “Obamacare Lite,” and devout Conservatives were unhappy.
Attempting to Appeal to the Left
But on the other hand, Democrats and more moderate Republicans were rebuffed by the sheer number of people that would lose coverage under this plan, as well as the projections for healthcare costs over the next several years. The individual mandate instituted by the ACA, which required people to purchase insurance or pay a small fee, helped to force healthy people into the insurance marketplace. Though it was not entirely successful, the aim of this was to drive down insurance costs for everyone.
The Republican bill would remove this mandate and, instead, place a 30% premium on people who choose to jump into the insurance market to cover sudden illness. The moderate and liberal constituents feared that this fee would cause only the very sick to purchase insurance—after all, why would you pay a 30% fee on top of your health insurance costs unless your illness was extremely serious and very costly? This would cause healthcare costs to skyrocket.
Additionally, according to estimates, more than 52 million Americans would be without insurance by the end of the decade. The impact of this? More than 44,000 deaths per year, according to researchers at the American Journal of Public Health. With these numbers in mind, Democrats were not even tempted to vote in favor of the bill.
With elements like tax credits to buy health insurance—a very liberal-minded practice—alongside very conservative actions like large cuts to Medicaid, the ACHA tried to perform an impossible balancing act that ultimately drove away the votes they needed. By failing to appeal to any Democratic constituents, and losing their Republican constituents in an attempt to pander to Democratic desires, President Trump’s team failed to get the necessary votes to pass the bill into law.
What Comes Next?
Trump’s political team has, for the moment, tabled the healthcare issue, and Obamacare remains intact for 2018. President Trump has stated that he will be refocusing his efforts on “big tax cuts and tax reform. That will be next.” However, the issue is far from over.
It’s a well-known fact that Republicans won control of the major government bodies because of the pledge to repeal and replace Obamacare. With that in mind, it would be nearly impossible for Trump’s team to wave the white flag on the healthcare issue and still have any hope of reelection. Trump and his team have made it clear that they intend to make another attempt at repealing Obamacare and replacing it with their own bill.
Only time will tell if their next attempt will garner more success.
Sources:
https://www.theguardian.com/us-news/2017/mar/24/why-healthcare-bill-failed-republicans-trumpcare
http://www.newsweek.com/senate-health-care-bill-will-fail-now-trumpcare-may-still-take-shape-628424
http://www.npr.org/2017/06/22/533947844/senate-republicans-reveal-long-awaited-affordable-care-act-repeal-bill
