Category: Safety Net

“It is difficult to overstate the sheer unpopularity of the American Health Care Act, the Republican Party’s plan to “repeal and replace” the Affordable Care Act. And it’s not hard to understand why the bill is so unpopular. What’s mystifying is why Republicans insist on passing it, acting as if there won’t be political consequences for a plan that promises pain for tens of millions of Americans.

At Obamacare’s least popular moment, in the fall of 2014, 56 percent of Americans held a negative view of the law, versus 37 percent who approved. Compare that with the Republican version of the AHCA that passed the House of Representatives in early May. In a recent survey from CBS News, 59 percent of Americans disapprove of the GOP proposal, versus 32 percent who approve. A Roper Center analysis shows the proposal with just 29 percent support, making it the most unpopular piece of legislation Congress has considered in decades. And its unpopularity isn’t just a function of blue states like California, New York, and Illinois—there is no state in the union where a majority of voters support the bill.

If the AHCA ends up improving outcomes for Americans—if it delivers affordable health insurance or protects families from medical bankruptcy—it might recover some popularity in the implementation, as was true with the Affordable Care Act, which now has majority support. But we know from the Congressional Budget Office’s evaluation of the House bill that it would increase the number of uninsured by an estimated 23 million people; there are no signs the Senate version will be any less damaging. What’s more, the AHCA may upend the employer health market as well; its deregulatory measures could result in lifetime limits and substantially higher out-of-pocket costs for people who receive insurance through work. The universe of people potentially left worse off by the Republican bill is close to a cross-section of the American public: salaried employees, ordinary workers who rely on the Obamacare exchanges, and the millions of low-income people, children, elderly, and disabled Americans who rely on Medicaid.

Under most circumstances, this would be the ballgame. As a general matter, lawmakers don’t pass hugely unpopular legislation that might harm constituents in such a direct way. It’s easy to say that, for House and Senate Republicans, their “constituents” are those wealthy Americans who receive huge tax cuts under the bill. Still, it’s also true that winning donors isn’t the same as winning elections. Politicians don’t need to value the public interest to reject a bill like the AHCA; a survival instinct should be enough.

Which gets to what’s mystifying about the present situation. If the health care bill becomes law, there’s every indication the Republican Party will suffer for passing it. It is already responsible for a substantial and so-far enduring decline in the president’s approval rating, and it is fueling grass-roots opposition to the already-unpopular Trump administration. If Republicans face an increasingly difficult environment for the 2018 general election, it is at least in part because of the AHCA. And yet, Republicans are intent on passing the bill. Senate Majority Leader Mitch McConnell has cannily adopted an unprecedentedlysecretive process meant to insulate the proposal from criticism and expedite its passage. There have been no hearings and no debate. The plan, as it exists, is for a one-week period of public input before Congress votes.

It’s likely that Republicans know the bill is unpopular and are doing everything they can to keep the public from seeing its contents before passing it. As we saw with the Affordable Care Act, the longer the process, the greater the odds for a major backlash. But this presupposes a pressing need to pass the American Health Care Act, which isn’t the case, outside of a “need” to slash Medicaid, thus paving the way for large-scale, permanent tax cuts. The Republican health care bill doesn’t solve any urgent problem in the health care market, nor does it represent any coherent vision for the health care system; it is a hodgepodge of cuts and compromises, designed to pass a GOP Congress more than anything. It is policy without any actual policy. At most, it exists to fulfill a promise to “repeal Obamacare” and cut taxes.

Perhaps that’s enough to explain the zeal to pass the bill. Republicans made a promise, and there are forces within the party—from hyperideological lawmakers and conservative activists to right-wing media and Republican base voters—pushing them toward this conclusion. When coupled with the broad Republican hostility to downward redistribution and the similarly broad commitment to tax cuts, it makes sense that the GOP would continue to pursue this bill despite the likely consequences.

But ultimately it’s not clear the party believes it would face those consequences. The 2018 House map still favors Republicans, and the party is defending far fewer Senate seats than Democrats. Aggressively gerrymandered districts provide another layer of defense, as does voter suppression, and the avalanche of spending from outside groups. Americans might be hurt and outraged by the effects of the AHCA, but those barriers blunt the electoral impact.

The grounds for political combat seem to have changed as well. If recent special elections are any indication—where GOP candidates refused to comment on signature GOP policies—extreme polarization means Republicans can mobilize supporters without being forced to talk about or account for their actual actions. Identity, for many voters, matters more than their pocketbooks. Republicans simply need to signal their disdain—even hatred—for their opponents, political or otherwise. Why worry about the consequences of your policies when you can preclude defeat by changing the ground rules of elections, spending vast sums, and stoking cultural resentment?

It seems, then, that we have an answer for Republicans insist on moving forward with the American Health Care Act. Because they can. And who is going to stop them?”

Here’s some analysis of the GOP Senate Bill from the Washington Post:

“The Senate proposal largely mirrors the House measure with significant differences, according to a discussion draft circulating Wednesday among aides and lobbyists. While the House legislation would peg federal insurance subsidies to age, the Senate bill would link them to income, as the ACA does.

The Senate measure would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health-care program for low-income Americans. It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.

[Complete live coverage: The Senate health-care bill]

But McConnell faces the prospect of an open revolt from key conservative and moderate GOP senators, whose concerns he has struggled to balance in recent weeks. Republicans familiar with the effort said Senate leaders have more work to do to secure the 50 votes needed to pass the measure, with Vice President Pence set to cast the tiebreaking vote, from the pool of 52 GOP senators. No Democrats are expected to support the bill.

According to two Republicans in close contact with Senate GOP leadership granted anonymity to describe private conversations, McConnell is threatening to bring the bill to a vote next week even if he doesn’t have the votes to pass it. But some believe that message is aimed at trying to pressure Republicans to support the bill, rather than an absolute commitment. A McConnell spokeswoman declined to comment.

[Democrats begin mobilizing to fight health-care bill]

Republican aides stressed that their plan is likely to undergo more changes to secure the votes needed for passage, but there were major concerns Wednesday from senators on opposite ends of the GOP spectrum.

“My main concern is I promised voters that I would repeal — vote to repeal Obamacare. And everything I hear sounds like Obamacare-lite,” said Sen. Rand Paul (R-Ky.).

Sen. Shelley Moore Capito (R-W.Va.), whose state expanded Medicaid and has been pushing for a more gradual unwinding of that initiative than many conservatives prefer, said she is waiting to scrutinize what is released but has not seen anything yet that would make her drop her concerns with the proposal.

“Up to this point, I don’t have any new news — tomorrow we will see it definitively — that would cause me to change that sentiment,” she said.

Like the House bill, the Senate measure is expected to make big changes to Medicaid, the program that insures about 74 million elderly and lower-income Americans and was expanded in most states under the ACA. In effect, the revisions would reduce federal spending on the program.

The Senate measure would transform Medicaid from an open-ended entitlement to one in which federal funding would be distributed to states on a per capita basis. The Senate measure would also seek to phase out the program’s expansion — although at a more gradual rate than the House version.

Yet the Senate bill would go further than the House version in its approach to cutting Medicaid funding in the future. In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill. That move could prompt states to reduce the size of their Medicaid programs.”

Here’s a link to the complete Post article: https://www.washingtonpost.com/powerpost/senate-gop-leaders-set-to-unveil-health-care-bill/2017/06/22/56dbe35c-5734-11e7-a204-ad706461fa4f_story.html?hpid=hp_rhp-top-table-main_healthcare835am%3Ahomepage%2Fstory&utm_term=.31690d0232b7

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As long as folks stubbornly keep voting for their own demise, that is, against their own best interests, Trump and the GOP are going to take them to the cleaners every time. The GOP Congressional leadership has “bought into” the Trump “Time Square” theory:   “There’s absolutely nothing that we could do that would make these folks vote against us. And, we’re going to take full advantage of them by sticking it to them just like they were Democrats or minorities (or both).”

I suppose if it works, why not line your pockets (and those of your buddies) to the full extent possible at the expense of the People until the party ends (which it might never do — and, if it does, the GOP will be laughing all the way to the bank)?

PWS

06-22-17