“If you don’t buy this magazine, we’ll kill this dog.”
So said a cover of National Lampoon back in 1973. We’re reminded of the infamous cover when we reflect on the ignoble fate of the American Health Care Act (AHCA), which was meant to replace the widely disliked Affordable Care Act (ACA), aka Obamacare.
Republicans in Congress were faced with a similar choice last week. While the Republicans gained a majority based largely on the promise of overturning Obamacare, polls showed the AHCA was also unpopular. A Quinnipiac University poll found that only 17% of American voters approved of the AHCA, while 56% opposed it.
About one in a thousand voters knows what’s in the American Health Care Act, but given media propaganda about Americans being left to die without government-subsidized health insurance, it’s understandable why the act was unpopular.
It didn’t help that the Congressional Budget Office predicted that the proposed legislation would result in 24 million Americans lacking health insurance by 2026 (note: the CBO also predicted that, thanks to Obamacare, the individual market would enroll 26 million by this year. Instead, enrollment is just 10 million).
The ACA Death Spiral
Meanwhile, the Affordable Care Act has become the Unaffordable Care Act, as premiums increased by an average of 25% this year. The website created to enroll people for health insurance didn’t work, and individual exchanges throughout the country have shut down as insurers have pulled out after losing billions.
The CEO of Aetna has said that Obamacare is in a “death spiral.”
Young, healthy people were supposed to buy insurance to balance the high cost of treating unhealthy Americans, such as those with pre-existing conditions, but they’ve chosen to pay a penalty instead. As a result, the cost of newly insured Americans has been higher than expected. But millions of people are being subsidized by taxpayers and the cost of Obamacare is escalating.
Under Obamacare, you can’t keep your doctor, you can’t keep your plan because it doesn’t exist anymore, your choices are becoming increasingly limited and the government is playing a larger role in healthcare decisions.
So the Affordable Care Act is unaffordable, unworkable and unpopular. But we’re stuck with it, because Republicans in Congress failed to band together and vote for the American Health Care Act.
What’s In It?
The act, virtually everyone acknowledges, was far from perfect. As House Majority Leader Paul Ryan pointed out, it was meant to be part of a three-step process for dismantling Obamacare:
- Use the budget reconciliation process to replace the Affordable Care Act with the American Health Care Act.
- Use administrative action through the Department of Health and Human Services to further deregulate the market.
- Draft additional legislation to make further improvements.
Yet it would have provided a positive first step, while demonstrating that the Republican party can be decisive and hang together. It would have given states control over Medicaid again, repealed the taxes and mandates inherent in Obamacare, and enabled states to set up risk pools to cover individuals with pre-existing conditions.
Unfortunately, though, once government creates an entitlement, it is nearly impossible to eliminate it. Obamacare has been a policy disaster on many levels, adding ever more bureaucracy to an already bureaucratic system. And now, Obamacare will remain in place – probably for years to come.
Democrats vs. Republicans
Ryan chose to pull the AHCA without a vote on Friday, because it didn’t have enough support.
Currently, the House includes 237 Republicans and 193 Democrats, with five vacancies (four resulting from Republican members of Congress who took positions in the Trump Administration). In spite of this significant majority, which was elected largely based on voter desire to dismantle the Affordable Care Act, Republicans chose to follow the polls and not support the AHCA.
The non-vote demonstrates a clear difference between Democrats and Republicans.
Democrats voted for the Affordable Care Act unanimously. There wasn’t a single dissenting vote, even though few if any members of Congress had even read the 2,700 pages of legislation that produced the law.
The Democrats vote in lockstep. You could argue that the party showed discipline. Or you could point out that when a party acts in unity without regard for what’s best for the country, it’s the start of fascism.
Republicans, meanwhile, are independent, but often put personal gain over political reality. The 29-member Freedom Caucus wanted repeal of Obamacare without replacement, which would have been a political disaster of the highest order. Many in Congress were also swayed by poll numbers and the CBO report about the number of uninsured that would have resulted from AHCA.
By failing to support AHCA, the fractured Republicans have not only enabled Obamacare to remain in place, they have paved the way for eventual replacement with an even worse healthcare system – most likely a “single-payer” system; aka, socialized medicine.
With their non-vote, House Republicans have enabled the Democratic Party to make a comeback, emboldened Democrats to pursue their filibuster of Supreme Court nominee Neil Gorsuch, and endangered tax reform and other planned reform measures.
As a result of the non-support and non-vote, Obamacare remains in place. But two years from now, the Republican majority may not.