The Republicans go over the cliff: the losing case to replace Obamacare

John Frey

doi:10.3399/bjgp17X691421

After opposing healthcare reform and Obamacare for 8 years, like the dog that finally caught the car, the Republicans realised they had to propose an actual bill instead of just vetoing the Affordable Care Act (ACA). They took a month to come up with ‘America’s Health Care Act’ and managed to alienate almost everyone in the Republican Party as well as most of the country, particularly those in the Republican-voting rural and Southern regions. The bill was pulled even before having a vote in the House of Representatives. A headline during that fiasco said, ‘Middle-schooler who wrote G.O.P. Health-Care Bill claims he has not been paid.’¹ Then, after ignominiously failing to even get a vote from their own party, the Republicans began talking with each other again and came up with a bill that ‘saves money’ by making insurance unaffordable for the working poor as well as dropping low-income families and sick children from Medicaid. That proposal passed the Republican House of Representatives with no Democratic votes.

Before he left office, President Obama outlined his perspective on what was yet to be done to make the ACA more effective and comprehensive.² Small businesses and the self-employed — still the largest jobs sector in the country — were not signing up because of the complexity of the guidelines and the costs. Younger people also stayed away from signing up, taking a tax penalty instead. Clearly, more work needs to be done.

SUPPORT FOR THE AFFORDABLE CARE ACT

Then along comes Donald Trump and threatens to cut off subsidies for low-income Americans, ostensibly as a method to force Democrats in Congress to come to the negotiating table. A New York Times editorial summarised it: ‘It sounds more like a two-bit Hollywood villain promising carnage if he doesn’t get his way.’³ Holding his own voters hostage to prove a point is not really the best political move for someone elected by a combination of low-wage workers from rural and industrial America and high-income families. But the Republican health plan — what pundits are labeling Trump–Ryan care (after Paul Ryan, the speaker of the house) — advocates decreasing financial support for those worse off while decreasing taxes for the rich. And just to top it off, support for the ACA is currently at its highest point ever with 55% of Americans approving of it — a complete reversal prior to the November election.⁴

Even one of the most conservative columnists in the Washington Post, Charles Krauthammer — a non–practising psychiatrist — wrote a column in April where he admitted that the ACA had ‘changed the zeitgeist. It is universalising the idea of universal coverage. Acceptance of its major premise — that no one be denied health care — is more widespread than ever.’⁵

Now, how is that for progress!

‘EVERYONE SHOULD HAVE ACCESS TO HEALTH CARE’

It seems inconceivable that, well into the 21st century, Americans still have not agreed upon universal coverage as the principal goal of any health plan. Lacking that belief has handicapped the Republicans since the 1940s. The Secretary of Health and Human Services, Thomas Price MD, who, as an orthopaedic surgeon, artfully tried to change universal coverage to universal access, stated that ‘everyone should have access to health care’ to which Bernie Sanders retorted, ‘I have access to buying a $10 million home but don’t have the money to do that.’⁶

The low point of the entire Republican healthcare ‘repeal and replace’ fiasco may have come when President Trump said at a press conference: ‘Nobody knew health care could be so complicated.’⁷

For starters, he might have asked his doctor first. Or maybe not. His doctor of over 25 years, in an interview with Scientific American, famously opined: ‘If something happens to him, then it happens to him. It’s like all the rest of us, no? That’s why we have a vice president and a speaker of the House and a whole line of people. They can just keep dying.’⁸

So, maybe not so complicated after all.