The Confused State of Republican Healthcare Reform

Republican efforts to overhaul American healthcare have run into significant roadblocks in the past few months. Recent developments, namely the withdrawal of support from many Republican senators and John McCain’s (R-Arizona) cancer diagnosis, seemed to preclude any significant conservative healthcare reform from materializing in the near future. A series of confusing votes last week have only reinforced this atmosphere of uncertainty.

The American Health Care Act (AHCA) represented the culmination of Republican efforts to change healthcare policy in America by repealing and replacing the Affordable Care Act (ACA), commonly known as Obamacare, with a conservative alternative. Effectively, the bill boiled down to stripping away hard-earned Obama-era healthcare provisions, like protections against exorbitant premiums for Americans with pre-existing health conditions.

Soon after the bill’s successful House of Representatives vote early last May, a flurry of issues ground the proposed law’s progression to a halt, starting with the Congressional Budget Office’s (CBO) renewed evaluation of the AHCA. The report, published in late May, estimated 23 million Americans would be left uninsured after 10 years if the AHCA were to become law.

This didn’t seem to sway the consciences of the GOP. Speaker Paul Ryan (R-Wisconsin) patted himself and his party on the back for the bill “[achieving] our mission: lowering premiums and lowering the deficit,” conveniently omitting the fact that the House version of the AHCA only stripped insurance away from 5% fewer people than the previous version.

Once under the Senate’s purview, further changes were made to the proposed law. These were precipitated due to significant opposition from Senate members, and possibly President Trump himself urging that the bill be made less “mean”, more “generous”.

The Senate’s first revision of the bill, called the Better Care Reconciliation Act (BCRA), contained much of the same fundamental policies as the AHCA, like tax cuts and reductions in Medicaid expansion. However, an important distinction between the two is that this version retained protections for Americans with pre-existing health conditions, shielding them from prohibitively expensive health insurance premiums and from being denied coverage by insurance firms.

That said, the CBO’s review of the BCRA revealed that a whopping 22 million Americans would lose insurance due to it, with 15 million expected to lose insurance within one year of the bill becoming law, another meagre reduction in the number of people losing coverage. This statistic further contributed to the bill’s dwindling popularity.

Increasing anxiety about the policy’s damning lack of support led Senate majority leader Mitch McConnell (R-Kentucky) to delay voting, until after the July 4th Congressional recess. More revisions were added to the bill in mid-June to increase support from within the GOP, with one amendment notoriously bringing back the right for insurers to discriminate with regards to patients with pre-existing health conditions.

The vote was further delayed with McConnell insisting on waiting for Senator John McCain to recover from a blood clot removal. The operation, initially thought to be innocuous, revealed a much graver result about the Arizona Republican’s health: John McCain’s office disclosed on July 19th that he had been diagnosed with glioblastoma, an aggressive form of brain cancer.

The final blow to the BCRA was dealt on July 17th, when Senators Mike Lee (R-Utah) and Jerry Moran (R-Kansas) announced their refusal to support it. In addition to the two Republican senators already publicly out against the bill, Senators Rand Paul (R-Kentucky) and Susan Collins (R-Maine), this move effectively killed any chance it had to make it out of the Senate.

This prompted McConnell to plainly state that “the effort to repeal and immediately replace the failure of Obamacare will not be successful,” as he called for a straightforward “repeal of Obamacare with a two-year delay,” hoping that an adequate alternative could be written in two years’ time.

Such a reckless idea, which garnered support from the President in a tweet demanding Republicans “immediately REPEAL, and then REPLACE at a later date,” would leave about 32 million Americans without health insurance, per the CBO.

Faced with the looming possibility of failure, Senate Republicans hurriedly voted to open debate on an ACA repeal on July 25th. Fortunately, this did not result in the death of Obamacare.

A proposal for repeal without replacement was squarely rejected in a Senate vote the day after debate was opened. Thereafter, Senate Republicans attempted to repeal the ACA piecemeal, in a so-called “skinny repeal,” removing unpopular elements of Obamacare like the individual mandate.

This process ended fruitlessly when Senator John McCain, who’d voted to open debate on the ACA, voted no to the hastily cobbled together “skinny repeal” alongside other Republican critics of the idea. He accused the bill of not doing enough to “[increase] competition, [lower] costs,” and called on his Republican colleagues to return to a “correct way of legislating” in its future attempts to pass healthcare reform.

Observing from the sidelines, we might wonder why Republican efforts to pass a healthcare bill are facing so many difficulties, when it’s been a central goal of the party that now controls the White House, House of Representatives, and Senate, for nearly a decade?

Potential answers to this question abound. Some right-wing critics accuse the GOP of missing a “unified theory” in its crafting of the bill, or of utilizing the same “opaque process” and lack of bipartisanship they accused Democratic lawmakers of using to pass the ACA.

However, perhaps the main factor behind the GOP’s difficulties in passing conservative healthcare reform is the Republican party itself. Most Americans are quite happy with the ACA, for all of its flaws, and Republicans seem unable to offer an alternative that would not eliminate coverage for millions.

Congress began its 5-week long August recess last Friday. While GOP efforts to change healthcare in America will probably resume once the House and Senate are back in session, Republicans are already showing a desire to change their focus from healthcare to tax reform, a switch in priorities endorsed by the Chamber of Commerce of the USA. The Republican Party will ostensibly face less resistance on this issue, though prominent interest groups are already getting ready for a protracted battle with US lawmakers.