The Reality of Healthcare Reform
The Affordable Care Act (ACA) was passed without a single Republican voting in favor of it. Repeal and reform will be accomplished with the same partisan process; this time, Republicans will vote in favor and Democrats will vote against.
But Republicans face a different challenge than their Democrat counterparts of seven years ago. Unwinding a law is somewhat more complicated than enacting one, especially if fewer than 60 senators are committed to passage of applicable legislation. (The ACA passed in the Senate by a 60-39 vote.) But before the bill, known as the American Health Care Act (AHCA) gets to the Senate, it has to pass in the House.
Currently, The Freedom Caucus, (a group of conservative Republican representatives) has pledged to vote against the AHCA unless several “essential benefits” are eliminated. In so doing, the Caucus is essentially targeting the bill for defeat as the changes it is demanding all but assure the bill will stall in the Senate.
Why so complicated?
In the case of repealing and replacing the ACA, Republicans don’t have the 60 votes necessary to prevent a Senate filibuster. Consequently, to move legislation forward at a reasonable pace, they need a multi-part process, each of which can be accomplished with a simple majority (51 votes).
A first step in passing the AHCA (which begins the unwinding of the ACA) can most easily be accomplished through reconciliation, a budgeting process that requires only a simple majority. The key phrase here is “budgetary process,” which refers strictly to the amount of money spent by the federal government, and that falls outside the rules for reconciliation. If healthcare reform can’t be accomplished with 51 votes, it won’t be accomplished at all.
Another complicating factor is widespread acceptance of some provisions of the ACA, such as children being allowed to remain on their parents’ policy until the age of 26 and disallowing denial of coverage for preexisting conditions. Although some conservatives disagree with those provisions, it’s unlikely a replacement healthcare bill would pass without them.
At the heart of the divide between Republicans and Democrats are widely differing philosophies regarding responsibilities and freedoms. Republicans largely believe individuals should have the freedom to decide whether to purchase health insurance or not, and the level of coverage they want.
As demonstrated by the ACA, Democrats believe the government should dictate not only the purchase of health insurance, as effected by the individual mandate, but the coverage provided by the policy; hence the requirement that single men purchase maternity coverage.
In defense of their position, Democrats state that millions of people would lose their coverage under the proposed Republican plan. That may or may not be true, but what is left unsaid is that many people with coverage can’t – or won’t – use it because their deductible is too high.
While supporters crow about the millions of people who were able to “afford” health insurance after passage of the ACA, they fail to mention that the legislation has not reduced (and may have increased) the number of people seeking emergency room care who are unable to pay for it, since they can’t cover their policy’s deductible amount. If the ACA has had one resounding success, it’s been in increasing the number of people who have health insurance but are unable to use it.
So what’s the solution? Obviously, there isn’t one that will satisfy both Republicans and Democrats. And Congress isn’t alone in its divide. Readers commenting on media reports appear to be even more radically split than the legislators in Washington. Many on the left see healthcare as a right that should be provided by the government; their preferred solution is a single payer system administered by the federal government. Those on the right want the government completely out of the healthcare business.
The ultimate legislation will probably be somewhere in between. And while that’s all but guaranteed to make just about everyone unhappy, it just may be the only viable solution.