Editorial: The AHCA Passes the House
On May 4th, the House of Representatives passed a bill to repeal and replace the Patient Protection and Affordable Care Act (Obamacare). The new bill, called the American Health Care Act (AHCA), passed the House with a narrow margin of 217 to 213 votes. Twenty republican representatives joined democrats in voting against the bill. The bill now passes to the Senate—where the bill will likely be substantially rewritten. This small victory for congressional republicans comes roughly two months after the original version of the AHCA was pulled from the House due to lack of support. The newly amended version of the bill was passed without an evaluation from the Congressional Budget Office within two weeks of its announcement. Our editors have compiled their brief initial thoughts on the bill's passage below.
Brandon Clarkson, Editor in Chief
After the administration’s embarrassing withdraw of the AHCA in March, the White House was desperate for a win. At any cost. The GOP had promised to repeal the Patient Protection and Affordable Care Act since it’s passing in 2010. Now that the GOP has gained majority control over congress, and of course the presidency, it was time for the party to deliver. The resulting bill is hated by just about everyone, including the AARP, and the American Medical Association. Very few republicans in the House were ecstatic about the bill, but none of them wanted to be the lawmaker responsible for stopping Obamacare repeal. The bill now passes to the Senate, where it will likely die due to Republican senators with moderate constituents.
When republicans refused to compromise on a bipartisan healthcare reform bill during Obama’s first term, conservative writer David Frum referred to that choice as the republican “Waterloo.” Republicans had lost their chance, Frum argued, to influence the future of healthcare. Obamacare was here to stay, forever. Although a repeal bill has passed the House, I’m fairly confident it won’t make it to Trump’s desk. However, if it does, this will certainly be the GOP’s next Waterloo—and a far worse one.
A complete implosion of healthcare caused by the AHCA would galvanize the left’s opposition even further, while significantly weakening the reelection prospects of republicans who represent districts that voted for Hillary Clinton last year.
The GOP lost their last chance for a say in the future of American healthcare back in 2009-2010. This week, we saw them dig themselves even deeper. Regardless of whether the AHCA eventually becomes law, the pendulum will indeed swing. The future of American healthcare will be a single-payer system. And in November of next year, republicans in vulnerable districts will be faced with attack ads from a multitude of groups. Waterloo, indeed.
Zachary Sizemore, Managing Editor
When I first wrote about the initial draft of the American Healthcare Act, my main argument was that the Congress must write legislation with the reality of the country in mind. We are in a reality where roughly 30 million people have gained health insurance through the Affordable Care Act, the rise of premiums have been slowed from the crisis of 2009, the healthcare markets are continuing to stabilize, and the current healthcare law is more popular than it has ever been. The initial draft of the AHCA didn’t address these realities, in fact it was written in spite of them. Now, the bill that has passed the House of Representatives has gone even further in avoiding these truths, it has positioned itself in an even worse position to address the health of the American people.
With that it mind, it is incredibly hard for me to wrap my head around the open cruelty of this legislation, and I do not use that word lightly. This legislation is cruel on levels which I have not thought possible for a governing majority to think up. First and foremost, it was simply not written with the good of the American people in mind, it was written to keep a hallowed campaign promise, and an arbitrary metric for when that campaign promise needed to be fulfilled. This legislation will gut the ACA markets, it will cost just as many people their health insurance as the original draft would. Added on to that, this legislation will now give states the options to further gut the protections which the Obama admisntration gave to the American people. Now, according to your geography you may not be able to buy insurance which covers an entire multitude of pre-existing conditions, you may not be able to buy health insurance which covers hospital visits, or prescription medicines. Allowing this to happen is unabashed cruelty, which is made even worse by the fact that the majority of people in desperate need of this healthcare are those in rural, red districts who voted for the GOP congressional majority, and President Donald Trump, hoping that they would be able to help them.
Additionally, I would like to make mention of the amount of obfuscation used to pass this bill through the legislature. It has become a fundamental truth on the right that the Affordable Care Act was passed through the Congress in the dead of night, and shoved down the throat of the American people. These claims are blatantly false — The ACA was subject to 9 months of amendment, public comment, committee hearings, testimonials, fiscal scoring, and public debate. The irony is that while Republicans have spent seven years lying about the ACA’s congressional process their own bill was guilty of the made up sins they attributed to Democrats. The second draft of the American Healthcare Act was passed through the House with no fiscal scoring from the Congressional Budget Office, it received no public committee hearings, there was no amendment mark up period, there were no public testimonials, there was no consideration of the people which the legislation would effect. In fact many members of the House have admitted to having not even read the legislation before they voted for it’s passage; instead hoping the Senate would pick up their pieces and present a more responsible proposal. This kind of behavior is beyond irresponsible governance, and unacceptable for a majority which has always touted itself as the party of responsibility.
There is a possibly apocryphal quote, attributed to George Washington writing to Thomas Jefferson, where the Fonder compared the Congress to a tea cup, saying: The House of Representatives is the hot liquid in the cup, and the Senate is the saucer in to which that liquid is placed to cool. With this legislation I fear that the House has all at once boiled over, and I hope that the Senate may be able to once again take up it’s calming role. Because, if not and this bill were to be enacted, I would be deeply worried about the lives of any American citizens subject to it.
With the recent passage of the American Health Care Act of 2017 in the House of Representatives, press coverage of the legislation has mostly centered on state waivers to the Essential Health Benefits required of the exchanges and the elimination of premium-stabilization subsidies under the Affordable Care Act. However, the American Health Care Act significantly alters the way the state-run Medicaid program is funded and administered. Presently, the Medicaid program covers 74 million individuals that account for the poorest and most disadvantaged amongst us. The bill as passed by the House of Representatives breaks the solid foundation of federal support for the state-run program. The changes proscribed by the AHCA would tatter the social safety net and increase per-capita costs for elderly and disabled Americans as well as low-income individuals covered by Medicaid expansion.
While no score from the Congressional Budget Office exist for the most recently passed version of the AHCA, the original bill was estimated to reduce the deficit by $337 billion dollars through a reduction of spending by around $1.2 trillion dollars. Of that $1.2 trillion dollar reduction in spending, there are $880 billion dollars in budgetary savings from cuts in Medicaid. Throughout the program’s lifespan, the individual states and the federal government have shared Medicaid’s costs. The American Health Care Act drastically changes this dynamic by capping the federal contribution to Medicaid. Medicaid matching funds, promised by the Federal Government since the program’s inception, have allowed states to care for their residents and counteract the constraints posed by rising prices of health care inflation, the emergence of pricey drugs and treatments, and an aging populous. Under the AHCA, beginning in FY 2020, the House bill would impose a per-capita cap on Medicaid spending, and it would reduce Medicaid spending by 25% of current law. By 2026, 14 million fewer people would be enrolled in state Medicaid programs. Many of the people forced out of Medicaid due to inadequate funding would go without the medical care they so desperately need. This would also hamper the states’ ability to respond to emerging health issues such as mental illness and the opioid crisis. In a letter to Majority Leader Mitch McConnell, Republican Governors John Kasich (R-OH), Rick Snyder (R-MI), Brian Sandoval (R-NV), and Asa Hutchinson (R-AR) noted that the bill “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states.”
To meet public health demands, states would have to reprioritize limited funds that go to other critical services such as education and public safety. While Medicaid funds go to subsidize medical care for financially needy individuals, one in five beneficiaries are of Medicare age, and two in five have mental or physical disabilities. New flexibility through an optional block grant would mainly be used to shift costs to the elderly and disabled. States would be enticed to charge new or higher premiums and copays to Medicaid enrollees. The bill would also end enhanced federal contributions to entice states to expand their Medicaid program, and it would put another 11 million adults outside of the exchanges at risk of losing their health coverage.
This bill not only fulfills the desires of rank-in-file Republicans to repeal and replace Obamacare; it fundamentally changes the social contract between a government and its citizens. The AHCA gives tax cuts to those who need it the least, and it strips health care coverage from those that need it the most. The bill also shifts health care costs from the federal government to the cash-strapped states. It is incumbent upon the aggrieved governors to voice opposition to this legislation and lobby the Senate as it deliberates their iteration of heath care reform.