Donald Trump’s already badly wobbling presidency just took another major hit thanks to Republican House Freedom Caucus members, who somehow found Paul Ryan’s version of “repealing and replacing” the Affordable Care Act too generous, and are blocking its passage.
Reacting Thursday night like a losing gambler, Trump raised the stakes on health care by threatening to leave the entire ACA in place if House Republicans do not accede to Ryan’s bill. (The frantic Trump has even discarded his own counsel from The Art of the Deal, where he warns, “Never seem desperate.”)
The Ryan bill, contrary to Trump’s longstanding pledge not to cut Medicaid, slashes about $880 billion from the program, but Freedom Caucus members want to go much further. They seek to jettison even provisions protecting those with pre-existing conditions and preventing lifetime limits on coverage, both of which have proven to be intensely popular across a broad political spectrum.
Their intransigence sent Ryan rushing to the White House Friday afternoon with bad news for Donald Trump: despite the President’s arm-twisting, deal-making, and ultimatum, he still didn’t have the votes to repeal Obamacare.
The Freedom Caucus members have badly embarrassed Trump by halting Ryan’s American Health Care Act proposal. The resistance appears extraordinary, given how closely Ryan’s plan meets the ultimate policy dreams of arch-conservatives.
The bill is a $600 billion trickle-down tax cut for the top 1 percent, big drug companies, and other corporate interests, coupled with a sweeping set of proposals that would devastate care for the most vulnerable ACA beneficiaries like the poor, disabled, and elderly. The Ryan plan would produce more deaths by swelling the ranks of the uninsured whose untreated conditions prove fatal.
“The Republican plan to replace the ACA would leave 52 million people uninsured in 2026,” concluded health professionals in an article published in the American Journal of Public Health this week. “We know that will lead to many deaths—at least 41,969 and perhaps many times that number.”
Yet Ryan did not apply the chainsaw vigorously enough for Freedom Caucus members who reject even provisions requiring that insurers cover vital needs like pediatric dental care. They also ignore the viciousness of the plan’s regressive shifts in tax credits—away from older, poorer patients.
For example, the average sixty-four-year-old making $26,500 in one area of Ryan’s Wisconsin district would see a premium increase from $1,598 to an incredible $10,572. It’s no wonder that Ryan has shied away from town hall meetings in his district.
Whatever bill arises from the rubble in the House—if one does—will still face an entirely different set of concerns from Senate Republicans alarmed by the prospect of what Ryancare cuts would mean to their constituents. The loss of fervor for obliterating “Obamacare” reflects a major shift among Republican voters and the general public. Notably, the share of Republicans who believe government must ensure access to healthcare for all has climbed from 31 percent late last year to 52 percent currently. More broadly, American voters now oppose the Republican plan by a whopping 56 percent to 17 percent margin, with 26 percent undecided, according to a new Quinnipiac University poll.
Are we witnessing the emergence of a public consensus that insists the nation build upon, not blindly destroy, the ACA’s gains in providing health care to Americans?
If so, perhaps this might provide some traction for going beyond protecting the ACA to addressing the massive barriers that still exist to affordable, easily accessible, and high-quality care. “Unaffordable under-insurance” afflicts people across income boundaries. As the American Journal of Public Health authors stated powerfully, “The ACA extended coverage to 20 million Americans. But it offered little help to 90 percent of the population, including the 26 million who remain uninsured and millions more with unaffordable copayments and deductibles.”
Ironically, Trump’s failed bet on Ryancare could help push more Americans toward demanding a Medicare-for-all option. Trump has raised the public’s expectations about what American health care should provide, hammering on the pervasive problems of ever-rising premiums and unaffordable deductibles and declaring that “insurance for everyone” is his goal.
The way to get there is clearly not through Ryancare.