Political, moral fight joined over health care

People with pre-existing conditions fear that they “are going to die because of a vote we might be taking.”

Rep. Tom Rooney (R-Florida) said that earlier this week. He added, “(A) lot of people … call my office … daily who are extremely angry … because they are sincerely scared.”

With good reason. The Republican legislation to repeal Obamacare, which the House of Representatives approved Thursday, 217-213, in Rep. Jim McGovern’s words “take(s) away essential health care protections (and) allow(s) insurance companies to discriminate against people with preexisting conditions.”

It does this by scuttling the Affordable Care Act (ACA) requirement that insurance companies charge every person of the same age living in the same region of the country the same amount for medical insurance without regard to their medical history.

Republicans’ devotion to dismantling Obamacare has been — let’s be generous with our adjectives here — ironic. After all, the ACA is essentially the program initially drafted by the conservative Heritage Foundation and proposed by then-President Richard Nixon.

Here’s the Republicans’ sleight-of-hand: Their bill first slashes money for Medicaid, the program that provides coverage for millions of low-income Americans. Then it allows any state to be granted a waiver from the requirement to cover preexisting conditions and allows insurance companies to charge people with preexisting conditions as much as they want. That, as a practical matter, will make medical insurance unaffordable for millions.

The Republicans purported solution to this impending denial of medical care is to create a high-risk pool, that is, a pool of money to pay for the expensive cases. That theoretical solution comes with a big asterisk. The high-risk pool would be only partially funded by the federal government and then, not for long.

The most disingenuous part of the bill is that Republicans know that high-risk pools don’t work. America has a long history with high-risk pools. Indeed, they existed in 35 states before the Affordable Care Act became law. They have a repeated, consistent record of failure, only serving a tiny fraction of the people who need coverage and only paying a fraction of the cost.

The Republican plan has more destructive parts. It specifically allows cash-strapped states to save money by opting out of the requirement that all insurance plans cover essential health benefits. No coverage for prescription drugs — that’s fine. No maternity care — great! Exclude mental health care and addiction services, including all those caught up in the opioid crisis – throw that out the window, too. Deny all money to Planned Parenthood for at least a year, which will prevent Planned Parenthood’s cancer screenings and contraceptive services — that’s also included in this bill.

The legislation now goes to the Senate, where it faces an uncertain future. The uncertainty stems in part from the fact that Speaker Paul Ryan pushed the bill through the House without any hearings and without the customary assessment of cost-and-effect from the nonpartisan Congressional Budget Office

But if the Senate should refuse to pass the House bill or pass legislation that cannot be reconciled with it, Republicans have concocted a Plan B.

Mick Mulvaney, Trump’s budget director, announced this week that the administration might kill the Affordable Care Act even without Congress by, Mulvaney threatened, not spending the money that Congress has authorized to pay for Obamacare. Those funds were included in this week’s bipartisan budget agreement that will keep the government running through September.

Mulvaney said, “There is absolutely no language in this bill that requires us to make any Obamacare payments of any way, shape or form as a result of this deal, OK?”

Actually, no. Not OK.

The political and moral fight now has been joined. Sen. Chris Murray (D-Connecticut) said, “I hope this (bill) is dead on arrival, and I hope a ton of House members lose their seat for voting for something this inhumane.”

Senate Minority Leader Chuck Schumer (D-New York) described the bill as “a breathtakingly irresponsible piece of legislation that would endanger the health of tens of millions of Americans.”

And the truth is that many Republican lawmakers harbor grave doubts about the repeal of the ACA, doubts that, as the New York Times has reported, have been “reinforced by constituents who said that the health law (Obamacare) had saved their lives.”

But Republicans have united in opposition to the plan — with great success. Before the 2016 election, polls showed that a majority of Americans opposed Obamacare. But if the poll referred to the health initiative as the the Affordable Care Act, then it was supported by a significant majority of Americans. The disconnect was palpable, but the anti-Obamacare sloganeering served Republicans and Trump well.

Trump has repeatedly promised that Trumpcare, now formally the American Health Care Act, would cover all preexisting conditions. It doesn’t.


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