House narrowly votes to repeal Obamacare

President Trump and Paul Ryan

With the aid of a single vote on Thursday, House Republicans voted to repeal Obamacare, a move that has been in their crosshairs since the Affordable Care Act was created in 2010. While pictures of the smiling Speaker of the House Paul Ryan and President Donald Trump have hit the wire services, the vote is being hailed as a victory of party, but also as a referendum on the presidency of Barack Obama, America’s first black president, who became the default for anything, and everything, that could ever be wrong in the country.

The Obama haters, revealed their true feelings when they burst into song while the final vote was tallied, singing, ‘Nana na hey hey kiss him goodbye.” If governance is fueled by hate for the previous administration, whose leader was a racial minority, then the tenor of American political life has reached an alltime low. Underscoring how low that could be was Arizona Republican Martha McSally who shouted,“Let’s get this fucking thing done!”

The bill does face substantive, and expected changes when it goes to the Senate, where it will face closer scrutiny, especially on the financial side. Especially, problematic will be the loss of Medicaid as an open entitlement age based program, and its replacement with either federal dollars for each recipient, or a block grant to the states, a move that critics say will not be enough to provide coverage and increase premiums for low-income people.

A last minute maneuver by New Jersey Rep.Tom McArthur, designed to mollify hardocre House conservatives gives states, upon their discretionary choice, $8 million for  high risk pools to insure coverage for those with preexisting conditions and those with lower incomes. Critics also contend that in the past these pools gave inadequate coverage, and at much higher costs, and that states had to fill the gap. And, with many states still on the rebound from the Great Recession, additional monies may be hard to come from. In debt ridden Illinois, where a partisan stalemate has resulted with no budget, for nearly two years, the prospect is dim.

Significantly, for Trump, as his first near legislative victory appears, the removal of taxes on high income earners, drug companies, and others, leaves room for him to take the 3.8 percent tax from the ACA, (worth nearly trillions of dollars) to use for infrastructure improvement, a laudable goal, but which may come at the expense of 24 million people, without health coverage, unless there are changes, in a decade.

As I noted two weeks ago, “The White House also needs the money from the repeal to help fund the tax overhaul and the tax code revision. In a sharp reversal from earlier statements from Trump, Mick Mulvaney, his budget director, said that had the president saying he was going to do tax reform next, now says that has to wait. He said in an interview with Fox Business that if health care doesn’t happen “fast enough, I’ll start the taxes. But, the tax reform and the tax cuts are better if I can do health care first.”

The group that will benefit least from the proposed changes are older Americans who, with tax credits (worth $2,000 to $4,000) swapped for the Obama subsidies, by Ryan, face higher rates up to five times higher than their younger counterparts. $13,000 increase in annual premiums, reduction of coverage of pre-existing conditions -  which among the ages of 50 to 64 years-of-age, total 25 million, says the AARP Public Policy Institute.

They also note that there would be an expected decrease in Medicare would hamper preventive care and push the program to insolvency in four years. And, Medicaid would be cut by $800 billion over 10 years.

In a “gotcha” moment the bill also suspends any payments to Planned Parenthood, for a year, until they stop performing abortions, but does retain the provision for young people to retain coverage until the age of 26.

Notably, this revision of the March effort, drafted by Ryan, was passed the day before it received an analysis by the bipartisan Congressional Budget Office, a move that observers say was deliberate, since the prior version received a negative review.

Reaction from Democrats has been swift and immediate:“You vote for this bill, you’ll have walked the plank from moderate to radical,” said House Minority Leader Nancy Pelosi, D-Calif., warning Republicans that voters would punish them. “You will glow in the dark on this one.”

This is no empty rhetoric by Pelosi, as many rural and low-income whites who voted for Trump, largely depend on these very programs, and many Dems are noting that a backlash inevitable should the bill be passed into law. As Rep. Louise Slaughter (Dem-New York) noted that it was political suicide, and the like of which she had never seen, “in all my life like I’m seeing today.”

On the heels of victory and an 11 day recess,Republicans, jubilant with hyperbolic rhetoric had a field day; with some even saying they would “gut Obamacare and rescue the American people,” said Rep. Doug Collins, R-Ga, reported the Chicago Sun Times.

He also stated that he came to Washington to get rid of such gut as Medicaid - which he bill expanded and that Obamacare had “hijacked the free market.”  Critics have pointed out that the GOP had seven years to work on the effort to fix the problems of the ACA but refused and instead told untruths to protect the hatred for Obama.

The take-away from this is that the the bill is not a health care bill, but a tax cut, pure and simple, and there was never any intention by the GOP to provide appropriate health care coverage. As The New Republic pointed out, “House Republicans have effected a massive transfer of wealth from the poor and middle class to the very wealthy—consistent with the only economic principle the GOP seems to believe in.”

While political predictions are not as easy to proved as partisanship, and gridlock, it’s easy to see that even if this bill does not pass, 2018 may provide Democrats the opportunity to take back the House, after Americans see that behind the false rhetoric, Ryan and Trump are not invested in the common good of the nation.

Writing for the Washington Post last October, Paul Waldman noted, in a succinct summary of what could have been done by Republicans to fix the holes in the ACA, “If they were being honest, they’d admit that their real goal is to get the government out of the business of offering or even guaranteeing coverage, and that they don’t really care how many people are uninsured.”