House Speaker Paul Ryan and other supporters of the unpopular American Health Care Act (AHCA) face an uphill battle as the bill is scheduled to hit the House floor for voting on Thursday, March 23. That date marks the 7-year anniversary of the passage of the Affordable Care Act (ACA), the law that Republicans have been keen on repealing since the start.
If Trumpcare replaces Obamacare – a feat that is very unlikely in the bill’s current form – then significant changes to the healthcare industry are in store for millions of Americans. According to an analysis released by the Congressional Budget Office on March 13, about 24 million more people would be without insurance by 2026 under Trumpcare compared with the uninsured rate under the ACA.
Fast Action from the GOP
Despite widespread displeasure with the AHCA from both Democrats and Republicans in Congress, as well as most of the American population at this point, Paul Ryan and other GOP lawmakers are pushing the bill through at lightning speed, hoping to secure the votes that they need in time for Thursday’s vote. As of the time of this writing, 24 Republican members of the House vocally oppose the bill. The AHCA needs 216 votes to make it to the Senate, which means that no more than 21 Republicans can oppose it. Right now, it appears that Republicans are short at least three votes.
Ryan, President Trump, Secretary of Health and Human Services Tom Price, and Director of the National Economic Council Gary Cohn (a top economic adviser to the president) have all been pushing Republicans to get on board with the new bill. So far, rigorous campaigning has only served to further alienate far-right conservatives, moderates and Democrats alike.
Members of the Freedom Caucus, whose ideology aligns with Tea Party voters, complain that the bill doesn’t go far enough in repealing Obamacare. Moderate conservatives and Democrats aren’t pleased with the AHCA’s potential impact on Medicaid and other funding aspects. As should be expected, Democrats also object to Trumpcare on ideological grounds.
Good Points about Trumpcare
AHCA supporters are attempting to rally moderate conservatives to their side with mere hours left before the House votes on the bill Thursday night. Republicans are using three major arguments to drum up support: Obamacare is failing, Trumpcare is the best chance they have of replacing the ACA, and rightwing lawmakers need to get on board or risk losing their seats. It seems clear at this point that the Trump administration is desperate to push the unpopular bill through Congress, but there are several good points about the Republican proposal that could work for the American people – if other portions of the bill are weighed more seriously and considered more carefully. Trumpcare:
- Keeps protections for young adults and people with pre-existing conditions: So far, the AHCA maintains protections for people with pre-existing conditions by preventing insurers from using medical underwriting to deny coverage. There would be limits to this, however, in that people who failed to maintain continuous coverage would be subject to underwriting and a potentially higher premium rate once they re-enrolled in a plan. The AHCA also allows adults up to age 26 to stay on their parents’ plans, which is allowable under Obamacare.
- Institutes age-based tax credits that would benefit younger, healthier consumers: While this measure is a negative feature for older, sicker enrollees, younger people without health problems – the target demographic for insurers – would be granted premium reductions that could make insurance even more affordable than it is now. Premiums are expected to increase sharply over the next two years if Trumpcare gets passed, but after that, rates will drop by about 10 percent for young, healthy consumers. This may encourage that demographic to sign up for health insurance, which might also drive down rates nationwide. That’s what GOP lawmakers are hoping and counting on, anyway.
- Removes individual and employer mandates: The ACA mandates forcing individuals to have coverage and businesses to offer it were unpopular, and they didn’t work as intended. Removing the mandate will initially lead millions of people to exit the individual insurance market, but Republicans are hoping that customizable plans and lower premiums for young people will offset the loss from voluntary leaving.
- Keeps in place many of the ACA’s current provisions (for now): In its original form, the AHCA kept in place Obamacare’s requirement for minimum essential coverage, including preventive care and other aspects of healthcare that make ACA-compliant plans robust (and expensive). Recent amendments indicate that this provision may be eliminated as well, which isn’t technically allowed via budget reconciliation. Republicans would need to introduce different legislation to accommodate this change, but they don’t have the votes to push through repeal legislation using traditional means thanks to filibustering rules.
On March 20, GOP lawmakers introduced several amendments to Trumpcare in an effort to make the bill more palatable to on-the-fence and opposing conservatives. Changes included giving states more flexibility in designing Medicaid programs, measures that would effectively force more people off of the Medicaid program, and repealing Obamacare taxes a year earlier (pushing most of them up from 2018 to 2017). However, there is still strong opposition from moderate conservatives, particularly those from states that expanded Medicaid.
In fact, the AHCA has been wildly unpopular with Democrats, some Republicans and the American people at large. Only 28 percent of Republicans strongly support the bill compared with 40 percent of Democrats who strongly oppose it, according to a poll conducted by Politico last week. Along party lines, the approval rate for Trumpcare is 62 percent among Republicans. In general, 36 percent of respondents believe that the AHCA will make healthcare worse than it is now.
Support is waning, too, as the debate wears on over whether this bill actually accomplishes what Republicans have been trying to do for seven years. The Politico poll revealed that 43 percent of Republicans think Congress is “moving too fast” with their efforts to push the bill forward, and much of the country appears to agree. Republicans are attempting to fulfill a key campaign promise by repealing and replacing Obamacare, but it would seem that even among their own voters, more time would benefit everyone. As we head into the vote on March 23, Republicans still lack the support that they need to move the bill through the lower chamber. Last-ditch efforts notwithstanding, the AHCA may be DOA for tonight’s vote.