“Nobody Knew that Healthcare Could Be So Complicated.”

shutterstock_55371712-e1432234255578.jpg(Source: Aristacg

On Monday, the U.S. Speaker of the House, Paul Ryan, introduced the Republican proposal to revise the Affordable Care Act. He explained the bill, called the American Health Care Act, in a snappy PowerPoint presentation later in the week. Pop some popcorn, because his presentation is riveting:

He also wrote an opinion piece in USA Today, where he sought to answer the question: “Do we stay with Obamacare and the unsustainable status quo, or do we repeal it and replace it with something better?” I bet you could guess the answer, but here it is:

“The American Health Care Act offers a better way. It keeps our promise, begins to clean up the mess Obamacare has made, and builds a better system for all Americans. Now we must deliver.”

The repeal and replace bill bypasses any potential filibusters in the Senate, under the guise of reconciliation. The bill will only need a simple majority to pass. Paul Ryan, the AHCA’s number one champion, said this bill is the “only chance we’re going to get” to repeal and replace the Affordable Care Act, or Obamacare. With the promise of smaller government, as illustrated by the size difference between the bills, the AHCA is the first of three phases of GOP health care reform.

The bill faced its first hurdle Wednesday night and into Thursday morning, when it passed both the House Ways and Means Committee and Energy and Commerce committee. Although committee votes were along party-lines, this does not mean that all Republican members of Congress support the AHCA.

Their support will become evident soon, as the bill is being pushed along at a rapid pace. Currently, it’s entering the House Budget Committee and awaiting a score from the nonpartisan Congressional Budget Office. (Although, there is some skepticism from the White House concerning the merit of a CBO score.) It’s possible that the bill could be on the House floor for a vote by the end of the month. After that, the bill will face the Senate. We all remember our civics lessons on how a bill becomes a law, right?

Stay tuned for updates. Or, look to the past. For many, the AHCA brings back the headache caused by the passing of the ACA. It’s the same story, different party.

As we know from the passage of the ACA, health care reform in the United States is a tricky subject. Now, the Republican party is in a tough place. Reforming the bill might impact a core portion of the Republic and Trump political base – working class white voters. Uninsured rates have dropped, and the Medicaid expansion has given more health care coverage to those who may have never had it previously. What happens when the mandate is lifted and the Medicaid expansion is rolled back, as is the plan with the AHCA?

Well, if there one thing you can count on in the United States, it is lawsuits. Undoubtedly, some federal court, possibly the Supreme Court will weigh-in on health care reform. Remember the ACA and the hundreds of lawsuits brought about because of it? Remember National Federation of Independent Business v. Sebelius? Okay, maybe not.  Admittedly, that name doesn’t really roll off of the tongue. (Neither does its full name: National Federation of Independent Business, et al. v. Kathleen Sebelius, Secretary of Health and Human Services, et al.; Department of Health and Human Services, et al. v. Florida, et al.; Florida, et al. v. Department of Health and Human Services, et al.)

But it was the case which SCOTUS upheld that the individual mandate to buy health insurance was constitutional, for it is an exercise of the taxing power of Congress. However, the vote in that case was extremely controversial, not only in the public sphere, but amongst the justices themselves. The decision was 5-4, with Chief Justice Roberts, and Justices Ginsburg, Breyer, Sotomayor, and Kagan in the majority. These justices, save Roberts, are the most Brennan-esque on the court currently. Their interpretation of this clause is a classic example of the living constitution, as described by Justice Brennan “Interpretation must account of the transformative purpose of the text. Our Constitution was not intended to preserve a preexisting society, but to make a new one, to put in place new principles that the prior political community had not sufficiently recognized” (Brennan, 28). An individual mandate on health care certainly qualifies as one of these new principles, radical and unheard of ever before in the history of the United States.

However, as we all know, the dynamics of the Supreme Court have changed. With Justice Scalia’s passing, and the nomination of Judge Neil Gorsuch, it is uncertain what will happen to the AHCA when it inevitably comes to the courts. Not to mention the other aging Justices on the court (but not Ginsburg, she’s going to live forever).

Large, overarching, policy reforms are a federal court’s dream (or nightmare). Especially with estimates of loss of coverage ranging from 8 million on the low end, to 20 million people on the high end. It’s all unclear right now. And, just to reiterate the main point of Paul Ryan’s PowerPoint: the AHCA is only the first phase of GOP healthcare reform. There’s more to come.

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3 Responses to “Nobody Knew that Healthcare Could Be So Complicated.”

  1. Ryan Wadding says:

    I recognize the tough position the Republicans are in, but they have only themselves to blame. I might be being unfair, but I have no doubt that if Speaker Ryan and Trump got what they wanted, we would eventually see pre-new deal times. I do not think Republicans are going to “fix” healthcare. I honestly do not believe that has ever been or will ever be their goal. I think they want healthcare completely privatized and an elimination of welfare programs.

    But even if all that is not true. Then I believe if there are serious problems with ACA then we should try to fix it, instead of outright repealing it like the Republicans are trying to do. At least the Obama administration tried to cover everyone. I know trying is not always enough, but I have more respect for effort than I do for idleness. We cannot say that about Republicans; in fact, I am certain it was Republicans that fought their efforts every step of the way.

    Anyway, thank you for writing about this. You did an excellent job. Cheers!

    • bpclass17 says:

      I agree with the general arc of your argument that AHCA is loser legislation.

      It’s frustrating that Speaker Ryan, President Trump, and many Congressional Republicans are engaging in this political cowardice. For seven years, they campaigned on a platform that Obamacare hurt millions of hard-working Americans and a promise to repeal this disastrous experiment in socialized healthcare.

      Millions of conservatives voted for these Republicans, sweeping the GOP into its largest majority in almost a century. Now that Republicans control every branch of the federal government, they have decided to insult their voters by proposing Obamacare-lite. The AHCA is a betrayal of conservative principles and Republican promises.

      With AHCA, the party offered the worst imaginable compromise. Not only does it keep the principles of socialized healthcare around – it’s also a communications disaster. Internal and CBO estimates predict 24 million people will lose insurance coverage in next decade. For what? For Obamacare-lite?

      • azwoodland says:

        Thanks for your comment! I agree, it is frustrating that now that Republican’s are in the position to be the champions of health care reform, the AHCA is the best they could come up with. But, as much as I dislike the AHCA, I understand the rationale behind it for two reasons: speed and logistics.

        To me, the AHCA seems like a paper hastily written the night before it’s due. We’ve all been there. Yes, Republicans have been preaching about health care reform, but with a Democrat in office for the past seven years, they were never in a position to do anything. It seems as if there hadn’t been a united Republican effort to create legislation before this term. (Who knows, maybe they also were surprised by the results of the election?) Now, with President Trump, the AHCA was the best they could do in the short amount of time. Also, numerous Republicans, as well as the President, have created a deadline of April for passing of the AHCA. They simply don’t have the time to create a comprehensive health care bill, at least not right now.

        Logistically, there is no way they would secure the votes to pass a comprehensive health care bill, which effects policy. It seems budget reconciliation is the only option they have, at least right now. Even though only a simple majority is required to pass the AHCA in the Senate, there is no guarantee of its passage. Fifty-one votes may be hard to come by; a republican or two voting across party lines is not unheard of. (*cough* Betsy DeVos Confirmation *cough*) Not to mention, the AHCA has proved to be incredibly unpopular on both sides of the aisle. One side believes it will not provide coverage for enough Americans, while the other believes it still provides health care for too many. The AHCA is a poor attempt at middle ground.

        But hey, I’ve been surprised by this Congress and Administration before. I guess all we can do is sit back and see what happens. (And call our representatives.)

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