Gage Skidmore
The Republican attempt to dismantle our health care system has experienced a series of major setbacks. The cumulative effect has been so devastating that, over the weekend, Senator John McCain, Republican of Arizona, proclaimed that the bill is “probably going to be dead.”
For those millions of Americans concerned about the possible loss of their health care coverage, it’s too soon to celebrate. A House bill to repeal the Affordable Care Act (ACA) was also deemed dead—until Republicans mustered enough votes to pass it. Still, the news for Senate Republicans, led by Majority Leader Mitch McConnell, is hardly encouraging.
First, the Congressional Budget Office (CBO) reported on June 26 that the Better Care Reconciliation Act, as the latest version of the Republican bill is known, would take away insurance from 22 million people by 2026. A Harvard team found those coverage losses would mean 18,100 to 27,700 additional deaths annually by 2026.
That same week, the Center on Budget and Policy Priorities reported that the Republican bill would substantially raise out-of-pocket costs for individuals buying insurance under the Affordable Care Act, particularly for older Americans. For example, the premium for a 64-year-old with $26,500 annual income would rise from $1,700 to $6,500 a year. A quarter of the people now buying insurance through the Affordable Care Act are between ages 55 and 64 and most of them would see similar rate hikes.
The Republican bill would also drastically cut Medicaid, the program that insures 60 percent of children with disabilities and nearly two-thirds of nursing home residents. It would start by taking away Medicaid from the nine million people who get it through the ACA. Then it would blow up the traditional Medicaid funding formula and replace it with a block grant formula, essentially forcing states to cut Medicaid benefits and expel people from coverage.
Amidst this poor publicity, McConnell found that he could not line up a Senate majority to pass the Republican’s bill. No Democrats or independents would vote for it; some Republicans thought the bill was mean; others said it wasn’t mean enough.
While most Republican Senators hid from their constituents during the Fourth of July recess, McConnell and his allies worked behind the scenes to get enough votes to pass their bill.
To win over more moderate Republicans who thought the new bill was too mean, McConnell may promise to slow down how quickly those who get Medicaid through the Affordable Care Act would lose it. He may promise to revise the block grant formula so that it delays how it cuts benefits and denies Americans eligibility.
According to reports, he’s promising additional funds for treating opioid addiction. He may also divert some Medicaid funds to the states of certain “moderates,” and offer them inducements on unrelated matters. For example, he could woo Lisa Murkowski, Republican of Alaska, by offering to open up the Arctic National Wildlife Refuge to oil drilling.
McConnell has turned to Senator Ted Cruz, Republican of Texas, to win over the Republicans who seemed to think the GOP bill isn’t mean enough. But Cruz is one of the top two Senators taking insurance industry campaign contributions. And while he has said that the Republican bill doesn’t go far enough to “repeal Obamacare,” his main ideas would actually preserve the ACA plans through which insurers get government subsidies.
In May, House Republican leaders managed to get the votes they needed to pass an Obamacare repeal bill by adding Republicans who wanted the bill to be meaner. That could be how McConnell and Cruz do it in the Senate. But with the Republican plans for the ACA and Medicaid tanking at the polls and more than a few “moderates” on the fence, those votes may not be enough for the Republicans to turn Medicaid’s money into a honeypot for billionaires.
In the end, the Republicans may have to work with Democrats to preserve health-care access, not destroy it. They may have to find other ways to fund tax breaks for the rich.
Ramón Castellblanch is a professor of health education at San Francisco State.