Amidst shouts of “Kill the bill” and “Shame! Shame! Shame!” the U.S. Senate agreed to begin debate on the repeal of the chief legacy of President Obama, the Affordable Care Act, which President Trump has characterized as a “nightmare” that in turn also claimed “victims.”
In a tie vote that was broken by Vice-President Mike Pence, the procedure took held some surprise votes, including Rob Portman, of Ohio, and Rand Paul of Kentucky, who previously had been holdouts, voted yes in the procedural vote to begin the debate. They were joined by Dean Heller of Nevada, who previously had said, no to the Senate version, the Better Care Reconciliation Act, but perhaps in a nod to his vulnerability in 2018, said yes.
Saying no was Susan Collins of Maine, who has decried the effect on many rural and community hospitals, as in her own state, and who had questioned aloud, what was being voted on. As she said, I “don’t known whether we’re going to be voting on the House bill, the first version of the Senate bill, the second version of the Senate bill, a new version of the Senate bill, or a 2015 bill that would have repealed the Affordable Care Act now and that said somehow we’ll figure out a replacement over the next two years”, she remarked.
Minority leader, Chuck Schumer, argued that repeal without replacing would lead to legislative failure.
One of the more vocal critics, Shelley Moore Capito capitulated, and said yes to the vote but noted that she was determined “to make decisions that are in the best interest of West Virginians,” and those who were on Medicaid, and also struggling with drug addiction; a reference to the growing opioid addiction problem, facing her state, that needs a well-funded intervention.
Adding drama to the procedure was the appearance of John McCain,who had recently undergone neurological surgery to vote and who had, while assenting, cautioned that everyone needed to refocus on the procedures.
He urged Senators to "stop listening to the bombasting loud mouths on radio and television, to hell with them!" But, he also said, "I will not vote for this bill as it today, it's a shell of a bill right now we all know that." Most significantly, he noted that there is a need to work across the aisle to pass "something full of compromises."
The real work begins when it is time to give amendatory proposals and fashion them into something that looks like a bill - preceded by a floor vote, not an easy task with the majority of Americans who are happy with the colloquially named Obamacare, which has given most people health care, especially preventive measures, that they had long lacked due to low incomes or a menu of options that preceded the ACA.
With ranks of healthcare organizations, including the AMA and American Nurses Association lined up against it, not to mention state governors and congressional critics, then the beginning will be as important as the end.
As this blog has noted, earlier, It cannot be ignored that the White House has three goals in what is essentially a wealth transfer bill: decrease coverage, remove consumer safeguards (in the insurance business), and gut Medicaid.
Any attempt to repeal the ACA without replacement is doomed to failure, and with a seven year desire for repeal, the GOP has refused to work in a bipartisan manner, despite a recent poll that had 71 percent of people wanting just that.
A newly touted so-called “skinny” bill would raise the average premium by $1,238, and is predicated on the repeal of the coverage mandates, and also the medical device tax; and it would also decrease those younger people from signing up for coverage, and those that are healthy, might entirely forgo coverage, reported the American Center for Progress.
This version would also destabilize markets and some insurers would simply withdraw from the marketplace, decreasing options for thousands of people.
Fueled by a none too subtle racism against a program by America’s only black president, Republicans ironically face legislation that was crafted mostly by a white politician, Mitt Romney, the Republican governor of Massachusetts.
This repudiation, as we have seen, has drawn fired from both moderate Republicans who see its deleterious blow to working-class people, and also the self-employed, as cited by the Congressional Budget Office.
On the other hand are those hard-liners who say that the subsequent revisions contain far too much of the ACA, what some have labelled “nanny-state” sections.
As with any legislation, “A key factor is time: the longer the bill languishes, the less likely it will pass,” said Greg Valliere, chief global strategist at Horizon Investments. “And there won't be much time left after Labor Day as Congress shifts its focus to budget and tax issues.” As the Wall Street Journal noted, this gives supporters of the ACA more time to continue their fight.
Already, firms that have given support to assist people who want to enroll in the ACA, have not had their contracts renewed by the Trump administration. If the individual mandate is removed, as noted with the “skinny” plan, the system would truly collapse, with the result of skyrocketing premiums, even more than it did last year for some people who bought insurance on the Obamacare marketplaces.
A March editorial for the Chicago Tribune noted, there will also be more “insurers that have not already bolted for the exits will soon decide whether they will offer coverage next year. Already nearly a third of American counties have but one carrier. What happens if there is none?”
Continuing, they noted that Trump may feel that if the system implodes, or collapses, then Americans will blame the Democrats who passed the law; “No voters will blame the person in charge. That’s you, Mr. Trump. This is your watch. So be careful what disaster you anticipate.”
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