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Thursday, August 17, 2017

Reprinted with permission from AlterNet.

Congress members’ votes to destroy Obamacare and Medicaid have become this decade’s Iraq war vote.

The healthcare votes Friday morning in the Senate and weeks before in the House were the most consequential votes affecting most American households in years. A string of Republican bills and amendments threatened to take away coverage from tens of millions. Despite the fact that nothing passed in either chamber, the GOP’s chaos has led to projected double-digit premium hikes for 2018 as insurers ruthlessly protect their profits.

Comparisons with the Iraq war vote are not just analogous to former President George W. Bush’s cry, “you’re either with us or against us.” As with the leadup to the Iraq war vote in 2002, the Republicans have fabricated a bogus sense of urgency around Obamacare. They’ve cut legislative corners, suspended procedure and debate and flat-out lied about the threats and solutions posed.

The Iraq war lie concerned weapons of mass destruction. The Obamacare lie concerns its impending so-called implosion. Yet the Affordable Care Act is still covering multi-millions of people, and 83 percent of individuals buying policies on its insurance exchanges receive federal premium subsidies.

Let’s not forget that Obamacare has been under attack since the day it was signed into law. As Louise Norris noted in a detailed piece for HealthInsurance.org, most of Obamacare’s woes can be traced to GOP obstruction, which has led private insurers to withdraw from rural states because they can’t create big enough pools. Congress could address that issue, just as it can address inflation-ridden prescription drug costs—if there was political will. But there isn’t, at least not among enough Republicans in the immediate aftermath of the Senate vote. The leadership now wants to turn to tax reform.

Democrats, meanwhile, have shown they are a united opposition party. In the Senate, everyone from West Virginia’s Joe Manchin to Vermont’s Bernie Sanders (a Democrat for voting) was on the same page. That’s not the same as agreeing to systemic solutions, however, as Maryland’s Ben Cardin in one speech listed all the marketplace tweaks that private insurers want, while Sanders espoused a Medicare-for-all approach that would bypass insurers entirely.

Nonetheless, looking ahead to 2018’s elections, the healthcare votes are the biggest test for candidates. They share a fundamental feature with the Iraq war votes, where yes votes were siding with a wilfull decision to wreak havoc based on a fabricated threat.

There’s another reason why the Obamacare/Medicaid stances are today’s equivalent of the Iraq war vote. Republicans are not a party that forgives or forgets. As Trump tweeted after the Senate vote, “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!”

Andy Slavitt, who ran Medicaid and Medicare for Obama, tweeted: “We are not out of the woods. I’m already hearing vile things like ‘McCain won’t be here forever’ & threats made to [Alaska Sen. Lisa] Murkowski/ [Maine Sen. Susan] Collins. I feel like we will be in continuous battle with this President so am not great at letting my guard down. A lot at stake…”

In other words, despite the distractions of the Trump circus, everybody who opposed what Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan wanted to do to health safety nets should heed these seminal votes. They epitomize and cap the Republican efforts over the past seven years to sabotage Obamacare.

Norris’ piece in HealthInsurance.org lists 10 ways the GOP has been trying to destroy the Affordable Care Act since it became law. Here are brief sketches:

1. Co-ops short-changed. The ACA envisioned $10 billion in grants to create non-profit co-ops for individuals and small groups. Insurers and the GOP blunted that competition, changed the grants to loans, and then cut the loans. Only five of the 23 original co-ops are still operating.

2. Day-one legal challenges. The day the ACA was signed into law, 14 red states started filing lawsuits to challenge the mandate that everyone be covered or pay a tax penalty. That grew to 26 states, leading to a U.S. Supreme Court ruling by a conservative majority in 2012 that upheld the individual mandate (pleasing for-profit insurers) but saying states did not have to expand their Medicaid programs to get all federal Medicaid funds (hurting the logical building block toward single-payer).

3. No Medicaid expansion. Even though the federal government paid for all of the state Medicaid expansion for the first three years and most after that, 19 states haven’t taken the money—leaving 2.6 million people uninsured who could be covered.

4. Obstructing enrollment. Red states that didn’t expand Medicaid or set up insurance exchanges tried to block federal exchanges from reaching their residents. By January 2014, 17 states passed laws restricting the ACA employees—“navigators”—from helping residents enroll. In late January 2017, Trump scaled back advertising efforts for open enrollment, leading to reduced numbers via Healthcare.gov compared to states that set up their own exchanges.

5. Trying to block subsidies. Seven states—Indiana, Oklahoma, Alabama, Georgia, Nebraska, South Carolina, West Virginia—all joined suits trying to challenge the ACA’s premium subsidies, despite 1.16 million people in those states receiving subsidies in 2017. (Nearly 83 percent of those buying insurance as individuals on the exchanges received subsidies; the remaining 17 percent did not—facing average premium increases of 25 percent for 2017.)

6. House lawsuit against subsidies In 2014, House Republicans sued the White House, challenging the executive branch’s authority to reimburse insurers for those buying coverage on the exchanges. In 2016, the subsidies cost $7 billion. Last year, a federal district court sided with the House, but the Obama administration appealed and the subsidies continued. Just what Trump will do is unclear. So far, he’s said he would hold them hostage to get Democrats to negotiate. Insures have seized that intransigence as a rationale to project major premium hikes in 2018.

7. Not reimbuising unplanned care. The ACA had more than just subsidies for private insurers. It set aside several billion to offset unexpected costs for newly insured people, who would address unattended medical needs in the early years of having coverage. Republicans have passed amendments in budget bills to greatly reduce those reimbursements, $2.87 billion in 2014, for example. That further undermines the insurance industry’s participation in the exchanges.

8. Trump’s first executive order. His first order was to tell every federal agency to stop implementing the ACA. That included telling the IRS to stop going after people who didn’t say on their tax forms whether they had insurance. Moreover, Trump hasn’t said whether the federal government will keep paying Obamacare subsidies.

9. The American Health Care Act. As everybody knows, this House-passed bill gutted Obamacare, cut federal Medicaid spending by a quarter and repealed the ACA taxes on the wealthy and selected medical industries. The Congressional Budget Office said 4 million people would drop their insurance in 2017 if this became law.

10. Refusing bipartisan fixes. A majority of Republicans didn’t just ignore the Democrats in drafting House and Senate healthcare bills this year. They have been doing that for the past seven years, as they’ve written and passed dozens of bills repealing the ACA. All were vetoed by Obama. The lack of bipartisan cooperation prompted Sens. McCain, Collins and Murkowski to vote no on Friday, derailing the Senate’s so-called skinny repeal. That would have lifted business and individual coverage mandates and repealed some Obamacare taxes, leaving 15 million people without coverage over the next decade, according to the CBO.

So Where Are We?

The dust has yet to settle from Friday’s Senate vote. It’s not clear that McConnell and Ryan would have any willingness to take up health reform as a bipartisan effort. On Thursday, they released a joint statement with the White House that said they wanted to turn to tax reform. That was followed by Trump’s tweet about letting Obamacare “implode…watch.”

It’s not going to implode; it’s going to be the continued target of GOP sabotage. House and Senate Republicans have shown they have no substantive alternative. Progressives, of course, want national single-payer—a Medicare-for-all plan. But with Republicans, the past is prologue. There’s no sign that the GOP’s seven-year-war on Obamacare is over.

That’s why everyone seeking genuine healthcare security—meaning greater access and lower costs—must consider 2017’s House and Senate votes as this decade’s equivalent of the Iraq war vote. There is no equivocating here. There is no middle ground. This was a willful decision to wreak unnecessary havoc based on a made-up threat, with collateral damage affecting tens of millions.

Steven Rosenfeld covers national political issues for AlterNet, including America’s democracy and voting rights. He is the author of several books on elections and the co-author of Who Controls Our Schools: How Billionaire-Sponsored Privatization Is Destroying Democracy and the Charter School Industry (AlterNet eBook, 2016).