The Inevitable Passage of the ACHA
After fifty-four votes during Obama’s Presidential tenure by the Republican Party that attempted to repeal/defang the PPACA, the AHCA represents eight years of representatives’ opposition politics, not healthcare reform. However, equally important is the content of this bill, while it is not healthcare reform in the sense that it would improve the weak American healthcare system as it exists today, it will cut taxes for the wealthiest in our society and any legislator with an ‘R’ next to their name is one who has cutting taxes for the wealthy at the top of their wish list (see 5). So what if 24 million Americans will lose healthcare, it isn’t like that will kill them, according to GOP congressman Raul Labrador from Idaho (see 6). This claim comes despite peer reviewed evidence from the American Journal of Public Health which shows that, actually, 45,000 deaths were caused every year before the PPACA due to lack of health coverage (see 7). This same report showed that “Uninsured, working-age Americans have a 40 percent higher death risk than privately insured counterparts.” And returning to this dark time in our countries history is apparently a republican fantasy crafted by Paul Ryan and articulated neatly by the President when he says we need to make American great again.
It seems that at the moment, President Trump will have a difficult time getting anything done legislatively due to the ongoing investigation into ties his campaign has had with Russia, but once this cloud passes over, the Republican Party has a clear agenda and they are hellbent on accomplishing it. Number one on that agenda is passing the AHCA, which the Senate will have the opportunity to alter significantly, and number two on that agenda is passing tax reform (cuts). Despite the fact, that the conventional wisdom regarding political parties, public opinion, and the legislative process, would declare this bill was dead on arrival, the conventional wisdom is underestimating the craven nature of the party in power and the lengths they will go to in achieving their top two priorities.
In looking at public opinion, for example, this bill has a remarkably low approval rating of about 17%, and it is no accident that the bill it is trying to repeal, the PPACA, is currently enjoying a record high approval rating of the majority of the American public (see 3 & 2). It would seem that, once people who are not hyper-partisan find out that they, or someone they know has a pre-existing condition, or would go into medical bankruptcy if the PPACA is repealed, they start to express their support for it. Even though the PPACA cut the number of personal bankruptcy filings in half by extending coverage, the Republican Party has the priorities of the wealthiest Americans in mind when supporting this bill, not their constituents’ livelihood (see 1). Clearly, public opinion should be an obvious indicator of the poor chances this bill has of passing, but when the attention is shifted from opinion to the legislative process and political parties, the likelihood of passage is increased exponentially.
As I mentioned previously, the Republican Party in congress spent our taxpayer dollars by trying to repeal or defang the PPACA fifty-four times after its passage in 2010 (see 4), which gives the public a clear indication of where their priorities are, on taxing away coverage for 24 million Americans and giving tax cuts to the wealthy in the process (see 5). Although President Trump is currently experiencing a sinking approval rating, which would typically hinder legislative prospects (which it has), the Republican Party still has until 2018 to get some actual work done instead of just spending their time reversing Obama’s last minute policies. And as the Republican house members showed when they passed the AHCA on its second attempt earlier this month, their top legislative goal is to get healthcare reform done, and if it wasn’t, then those fifty-four votes would have been quite the waste of taxpayer money (see 8). It is a real shame that a political party would work so tirelessly to make life significantly more difficult, and shorter, for millions of Americans, but this is where they have decided their effort is best spent, despite empirical evidence that this will take us back to the good ol’ days when 35 states had high risk pools that cost $2.6 billion to cover 226,000 people (see 9). Meanwhile the Republican Party, who is completely detached from reality, wants to provide only $130 billion to cover the entire country, which doesn’t quite add up even if you ignore the fact that people die when they don’t have health insurance (see 10).
This brings us to the legislative process, a key advantage in the attempt to getting the AHCA passed comes in the form of both chambers of congress being controlled by the Presidents party. The house narrowly passed this bill with 217 votes, but they passed it nevertheless which means the senate gets to ‘start from scratch’ and make it more appealing to the public, and then the two chambers will meet in committee to agree on a final text for the bill (see 11). After the senate gets to customize its own additions and subtractions to this bill, and it gets through the committee stage, there is only one step remaining, Donald Trump’s (or Mike Pence’s) signature, which is nothing except inevitable. The key lynchpin that will see this bill become law lies in the fact that the Republicans in the senate get to create a bill they know will pass, and make no mistake, Mitch McConnell and his senate colleagues were very much present during those fifty-four votes, and they too would be in the electoral hot seat if it fails. Although the current President isn’t overly successful, and the Republicans are therefore likely to pay an electoral price for this healthcare escapade, what matters to them is money, not morals.