The Republican Party is in a tough position on health-care legislation and is in danger of confirming what the opposition has called it, “the stupid party.” For seven years the party railed against Obamacare, promising to abolish it and replace it with an alternative that would be market based, bring down costs, and deliver better coverage for everyone. Obviously, Republicans should have spent more time working together on developing their own plan and educating the public about its virtues. Instead, both the House and now the Senate have put up bills that leave moderates like Senators Susan Collins and Lisa Murkowski, the ideological Right like Sen.Ted Cruz and Mike Lee, and libertarian free-marketers like Sen. Rand Paul opposed to it.
The bill is widely unpopular with the public as well. Recent polls (USA Today/Suffolk University and Quinnipiac poll) show that only 16 to 17% of Americans approve of the Senate health-care bill; a Fox News Poll concluded that just 27% favor it. As Aaron Blake writes in The Washington Post, the health-care bill as it now stands is “political Kryptonite.” Its popularity is so low, Blake writes, that “it’s difficult to believe the bill is being entertained.” One reason for its unpopularity is that Republicans echoed the tactics the Democrats used in 2009: keeping the text secret and arguing, as Nancy Pelosi so famously put it, that it had to be passed and then “we’ll know what’s in it.” There were no Senate hearings, no testimony by health-care experts, etc. Thus far the Republicans have pulled off the impossible by making Obamacare more popular than it had been.
Now there is a mad dash to see if all sides can be brought on board to pass a revised bill with enough adjustments to satisfy all sides when the Senate returns from the July 4th break. It might take a Solomon to come up with such a compromise. On Friday, Trump threw a monkey wrench into Majority Leader Mitch McConnell’s efforts to muster the votes needed to pull this off by tweeting that if a bill wasn’t passed at the end of the July 4th recess he would support first repealing Obamacare and later passing a separate health-care bill that would replace it.
During the campaign, Donald Trump promised that he would not cut Social Security, Medicare, or Medicaid. Now it seems that he has forgotten those promises. According to the CBO, the Senate plan will cause 22 million Americans to lose their health insurance by 2026 and would lead to 15 million fewer people receiving Medicaid by then. It’s the cuts to Medicaid that have received the most attention. The proposed Senate bill would cut Medicaid by $774 billion over the next ten years; polls show that 71% of Americans oppose such cuts. These cuts will especially impact poor rural areas. Business Insider surveyed some of the local press and their reports reflect the fears and animosity of citizens in these states. The Portland Press Herald, for example, ran the headline “Older, rural Mainers hit hard by Senate’s health care plan,” and Rep. Sen. Susan Collins, as one would expect, is thus far a “no” vote. Citizens are concerned about McConnell’s own state of Kentucky, where one out of every three people is covered by Medicaid. As one person told the New York Times reporter, Obamacare is broken, but if the Republicans “want to take away insurance from 22 million people — a lot of them would come from these mountains. That would be devastating to our area.”
Most Medicaid recipients are children. School superintendents across the country are alarmed that such severe Medicaid cuts will ultimately deprive students with disabilities and poor children from getting the help they need. Currently the funds pay for nurses, physical and speech therapists, and necessary medical equipment like wheelchairs. Poor children would no longer receive immunizations, hearing and vision screening, or treatment for chronic conditions like asthma and diabetes.
The cuts will also disproportionately affect the 74 million low-income Americans who depend on Medicaid for their health care and older people who need long-term services like nursing-home care. It is not just the poor who will feel its impact. While Medicare covers those over 65, it only covers some 14% of the cost of nursing homes. Currently, once a resident has depleted his savings and can no longer afford the average $80,000-a-year fee, Medicaid will take over the payment. The Kaiser Family Foundation study showed that in 2015, 62 percent of the 1.3 million people in skilled nursing-home facilities paid for their stay with Medicaid.
A New York Times report featured the case of 90-year-old Alice Jacobs. Jacobs, a middle-class woman who once owned a factory and raised two children, used up her life savings paying for an assisted-care facility. With no alternative, she applied for Medicaid, which now pays for her nursing home. “You think you’ve got enough money to last all your life,” she said, “and here I am.”
Now the Republicans in the Senate are facing pressure from Republican governors, especially those from swing states and from states that accepted expanded Medicaid funds. Many fear possible electoral losses if the bill passes (38 states will hold contests this year and in 2018) and are concerned about how the proposed cuts to Medicaid will adversely affect the people in their states. They believe the current draft bill would lead to the phasing out of federal funding for Medicaid. The states would then have to decide whether to pick up the cost. Should they vote to do so, it would mean large and unacceptable tax increases. If they decided not to, it would mean significant cuts in crucial areas.
I do not envy senators this week as they encounter constituents at town halls, if they are brave enough to hold them. On Friday, when Rep. Senator Bill Cassidy (LA) appeared before a meeting in Baton Rouge, he was confronted by an agitated crowd. He wanted to discuss other things, but many of them simply chanted: “Health care, health care.” And Cassidy had already stated that he couldn’t support the health-care bill in its current form because of how the Medicaid cuts would affect Louisiana.
It is not clear how all this will end. Will McConnell work out enough of a compromise to satisfy the party’s different flanks, so that a bill can pass? Or will Trump’s suggestion that if a health-care bill isn’t passed when the senators return on July 10th, they should simply vote to abolish Obama’s Affordable Care Act and then pass a separate health-care bill? Another alternative would be to compromise and negotiate with Democrats. That is the way important legislation used to be passed. Several governors, led by John Kasich of Ohio and John Hickenlooper of Colorado, have led the way by working across party lines to make sure that whatever health-care bill is passed, it will be in the best interests of the people in their states, and that Medicaid coverage will not be rolled back.
While this approach is anathema to many Republicans, it could just save the GOP from the voters’ wrath down the road, and preserve the Republicans’ once strong and proud party.