EDITORIAL: ACA repeal: third time no charm
Like an ax-wielding zombie from a teen horror movie, Republican efforts to repeal the Affordable Care Act are back from the dead.
And like those slasher movies, the sequels are always worse.
“Slash” is the operative word, as the latest in a string of secretive, slapdash, sprint-to-a-vote proposals would likely cut tens of millions from the rolls of the insured, as analysts estimate states would lose some $215 billion in federal subsidies. Older, sicker and poorer Americans would be hit the hardest.
Like its two ill-fated predecessors, there is little to recommend the latest legislation other than bragging rights for finally putting a stake through the heart of what Republicans derisively label "Obamacare." Never mind that former President Barack Obama’s signature health care plan — despite persistent Republican obstruction and some self-inflicted out-of-the-gate stumbling — has seen more than 20 million Americans added to the nation’s insured.
The plan being foisted by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, along with Dean Heller of Nevada and Ron Johnson of Wisconsin, would:
- Do away with insurance protections, including those for people with preexisting conditions. States could apply for waivers from the current requirement that insurers do not charge more for patients with certain health conditions. They could even seek waivers from the 10 basic types of coverage the new plan would require (including maternity care and substance-abuse treatment).
- Eliminate the federal health insurance exchange. It would also do away with penalties against employers who fail to provide insurance (and individuals who fail to obtain it).
- Phase out the Medicaid expansion that many states used to broaden coverage to low-income individuals. A new formula would instead see block grants redistributed, with states that didn’t participate in the expansion getting more in funding and states that did (such as Pennsylvania) receiving much less. It would also cap spending on traditional Medicaid.
- Cut anywhere from $200 billion to $250 billion in funding for health care coverage between implementation and 2026, then cut funding altogether.
- Defund Planned Parenthood.
That’s a lot not to like. And among those who don’t like it are nearly every reputable medical organization, including the American Medical Association; the AARP; a bipartisan group of 10 governors who called publicly for the bill’s rejection; and even the nation's biggest health insurance agencies.
Who does like it? Forty-something Republican senators, thus far, and President Donald Trump, who will sign any legislation that he can tout as “repealing Obamacare.”
Standing in the way of passage, just as in July, are three or four undecided lawmakers, including Alaska’s Sen. Lisa Murkowski, who took a principled stand against a similarly Draconian and rushed-through repeal effort in July.
Those principles are apparently negotiable.
“The problem last time was process and substance,” she said this week. “If it can be shown that Alaska is not going to be disadvantaged, you gain additional flexibility. Then I can go back to Alaskans, and I can say, ‘OK, let’s walk through this together.’”
Thus far, Rand Paul of Tennessee is the only Republican senator who has vowed opposition.
The measure faces a strict deadline. The clock strikes midnight for enacting legislation under so-called reconciliation — which requires only a 50-vote majority, with Vice President Mike Pence as dependable tie-breaker — on Sept. 30.
Let that hypocrisy sink in. The party that ranted for years how “Obamacare was rushed through” — despite months of debate, hundreds of amendments and scores of public hearings — is again fast-tracking a massive bill to a vote with no public hearings and, potentially, not even an assessment from the Congressional Budget Office. All to achieve a political victory that has neither public support nor palpable benefit.
And where does Pennsylvania’s Republican senator, Pat Toomey, stand? He claims he hasn’t made up his mind, but he has been a reliable backer of past repeal efforts. (Echoes of his refusal to say whether he would support then-candidate Trump before voting for him on Election Day; why can’t this guy have the courage of his convictions?)
On the off-chance Toomey really is on the fence, state residents ought to be burning up his phone, fax and email lines with calls to reject this ill-conceived, hurtful bill.
The real shame is that bipartisan efforts to shore up the Affordable Care Act were ongoing until Republican senators bailed on Tuesday, coincidentally enough, just as the latest GOP repeal effort was gaining momentum.
The bipartisan effort remains the best avenue to ensuring that millions of Americans maintain access to quality, affordable health care.
The current GOP effort is a political Hail Mary that, if successful, will soon enough leave those millions on their knees, praying. Because, for many, that’s all that will be left to protect them from financial ruin should they endure a health crisis.