Why is it so difficult to pass a suitable health care bill? For the last seven years, congressional Republicans and Republican Party members have been anxiously awaiting an opportunity to repeal the Affordable Care Act, and they have made promises to do so on an incessant basis. Throughout his campaign, President Trump also made many promises to the public that he would pass a working health care bill, comments such as “We’re going to have insurance for everybody,” in an interview with the Washington Post.
Even some Democrats have made pledges to compromise with their congressional counterparts to effectively craft a better healthcare system for all Americans. “We would be able to swallow, I think, some things (that Republicans wanted), if that’s the price to pay to get the rest of it,” was the statement made by the House Minority Leader, Nancy Pelosi (D-CA), at a news-maker breakfast hosted by the Christian Science Monitor.
Why is it then, that even after a Republican Congress and President are placed in power, even after both Democrats and Republicans ardently promise the passage of an apt healthcare bill, this perfect bill seems so far out of reach? The reason is that the general debate over health care has cascaded into a confusion of varying goals and approaches to fixing a single problem.
The root of this confusion lies in both sides. Congressional Democrats, at an obvious disadvantage in securing their priorities due to their minority, have the responsibility of negotiating with Republicans to keep some of their ideas for health care alive in the new bill. They should realize that the shift towards a pure single-payer system is dead, represented by voters’ decision to elect a Republican majority. The responsibility of Republicans is simply to craft and pass a bill that incorporates as many conservative ideas and changes as possible. The paramount goal for the entirety of Congress is to write and pass an improved health care bill.
Yet, both sides have largely abandoned these responsibilities, and have made it doubtful that this goal will be reached anytime soon.
The Democrats have been consistent on one thing, and that is caucusing as a united party in Congress. In the successful passage of the House Republicans’ American Health Care Act (AHCA), all 193 sitting Democrats voted “No.” In addition, all forty-six sitting Democrats in the Senate were expected to vote “No” on Mitch McConnell’s (R-KY) configuration of the House bill, the Better Care Reconciliation Act (BCRA). The reason behind the Democrat’s disapproval has been the same; the bills were projected by the Congressional Budget Office (CBO) to leave upwards of 32 million people uninsured, 24 million after adjustment for employer-based insurance pool growth.
The irony is, however, that these new health care bills are nearly identical to the ACA at their structural cores. For example, the ACA subsidies to individual insurance buyers making below $48,000 of income are kept alive in a watered-down form in the Republican bills, as a new formula to set subsidies in the BCRA bases subsidies on age, rather than income.
Similarities considered, why are Democrats so fiercely combating the passage of a bill quite similar to theirs? This is because the goal of their party, at the moment, is to oppose anything and everything that is authored by a Republican congress, mainly because it feeds the narrative that the GOP is unable to direct the creation of a quality health care system for working-class Americans, and will hopefully help the Democrat’s chances in the 2018 congressional take-back effort.
While Democrats contradicted their pledges to compromise, the Republicans have also found ways to impede progress on their own bill. The issue here lies in an intraparty split between the aristocratic party heads and the grassroots members. In the House, a Paul Ryan led effort to write an easily passable bill clashed with the Freedom Caucus, a grassroots group of House conservatives, in a bout that led to the reconsideration of some details, leading to great uncertainty among many Republican voters. “It doesn’t repeal Obamacare. It remains a disaster,” said Freedom Caucus member, Justin Amash (R-MI), in a tweet.
In the Senate, Mitch McConnell’s BCRA and his effort to vote in a straight repeal were halted by four Republican senators refusing to vote in favor of their Party and several others becoming wary about the new bill or a full repeal of the ACA. As previously stated, the Ryan and McConnell led bills are structurally similar to the ACA, prompting the Freedom Caucus and the skeptical senators to be leery of their possible negative effects on constituents. They fear a negative legacy of Republican-brand healthcare that could be left by this congress.
The priority of Republican Party leaders in both chambers is to complete the simple task of passing a bill to avoid being ridiculed for inefficiency and to make it appear as if their promises to GOP voters have been fulfilled. Meanwhile, Republican Congress members who desire to hold true to the goal of creating a system that is centered around conservative philosophies have prevented the leaders from passing any such bill. This means, in the end, that no bill is passed.
If you are still wondering how six months into the Trump presidency we have not managed to see a health care bill passed in congress, the frenzied whirl created by Democrats, GOP leaders and GOP grassroots conservatives, who all have separate goals and approaches, may give you some understanding.
Nothing will ever be accomplished, and a working health care system will never be created, as long as these three separate groups are vigorously battling for their own way. Meanwhile, the group that is suffering, as a result, is the vast population of Americans not receiving employer-based insurance. With ACA mandates, such as the Medical Loss Ratio that has had serious consequences on quality of care in ACA plans, running rampant in the healthcare industry now, we can only hope that the market doesn’t totally fail, leaving those under ACA plans vulnerable.
The question still remains; will we ever solve the decades-old problem of health insurance on a national scale? This could become an ordeal that lasts several more decades, and do the voters trust that this GOP-dominated Congress will achieve that goal? Only Election Day, 2018, will tell.