GOP keeps promise to begin Obamacare repeal; will Trump’s chameleon stance on universal coverage matter?

thekurupi / Pixabay

With Republican leaders pressing to dismantle the Affordable Care Act, possibly within weeks, moderate Senate Democrats reached out on Thursday to Republicans, appealing for them to slow down the repeal efforts and let lawmakers try to find acceptable, bipartisan changes to make the existing law work better.

Republican leaders pressing to dismantle #Obamacare despite efforts to find a bipartisan plan Click To Tweet

Democrats also had new reason to hope for possible Republican defections after Speaker Paul D. Ryan of Wisconsin said that the repeal measure would cut off federal funds for Planned Parenthood, says The New York Times.

But for now, Republican leaders are holding firm. Senator Mitch McConnell of Kentucky, the majority leader, denounced the law, President Barack Obama’s signature domestic achievement, as “a lesson to future generations about how not to legislate.”

A possible pressure point is the effort to end funding for Planned Parenthood in the same measure that guts the health law. Already, that has raised questions about the support of two Republicans, Senators Susan Collins of Maine and Lisa Murkowski of Alaska. “

We ought to be talking about reform,” Senator Tim Kaine of Virginia, who led the group of Democrats who reached out to Republican leaders, said on Thursday. “And if Republicans want to call it ‘replace’ and we want to call it ‘reform’ or ‘improvement’–I don’t care what we call it.” Kaine, who was the Democratic vice-presidential nominee, added, “There’s so much we can improve, but by pushing an immediate repeal through a partisan budget process, we won’t have the opportunity to work together to build on that common ground.”

Senate Republicans plan to muscle through a budget blueprint this week that clears the way for the repeal of major parts of the Affordable Care Act without the prospect of a Democratic filibuster. The House plans to take up the blueprint as soon as the Senate approves it.

House and Senate committees would then have until January 27, 2017 to produce legislation that eviscerates a law that has extended health coverage to 20 million Americans and protected millions more from discriminatory insurance practices. But it has also been plagued by rising premiums and limited insurance company participation.

On Friday, putting pressure back on Republicans, President Obama pledged to publicly support repealing Obamacare if Republicans come up with something better, but cast doubt on the GOP’s ability to develop a viable alternative, according to the Associated Press.

Obama beseeched his opponents not to pursue a two-step approach where the Affordable Care Act is repealed first and replaced afterwards–perhaps years later. He sought to lay the groundwork for Democrats to pile on Republicans for taking health care away from millions of people if the replacement never materializes.

“I am saying to every Republican right now: If you, in fact, can put a plan together that is demonstrably better than what Obamacare is doing, I will publicly support repealing Obamacare and replacing it with your plan,” Obama said. “But I want to see it first.”

Steve’s Take:

Hard as it is to contemplate at the moment, not all Republicans on Capitol Hill are wildly enthusiastic about repealing Obamacare. As a GOP senator or representative you’ve been required to consider Obamacare and abject “failure,” and “repeal and replace” is your motto. The idea is to project a united, unanimous front.

That’s been the GOP script since the enactment of Obamacare in 2009. But cracks in that facade were already showing last week as the gavel came down at the opening of the 115th Congress, says The Guardian.

Senators passed a resolution to repeal Barack Obama’s signature healthcare reform, one that sets in motion legislative machinery to end taxes and spending associated with the law. All Republican senators voted in favor, with one exception: Rand Paul, Kentucky senator and one-time Republican presidential candidate.

“If Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of Obamacare,” Paul wrote in an op-ed before the vote on Wednesday. “For, mark my words, Obamacare will continue to unravel and wreak havoc for years to come.”

Paul warned that keeping popular regulations, such as those requiring insurers to issue policies to the sick, could cause a “mass bankruptcy” of insurance companies, according to The Guardian.

Last Wednesday (January 3, 2017), he explained his vote on the Senate floor. While he said he supported repealing Obamacare, he said the GOP’s current proposal would increase the government’s debt by $9.7 trillion over the next 10 years. “Is that really what the Republican party represents?” he asked.

Republican senators Lamar Alexander and Susan Collins also voted yes but have previously expressed concerns about the rush to repeal without a replacement plan.

In Tennessee, Alexander’s home state, insurance exchanges are in deep trouble. Just one insurance company covers Tennessee, and that company had to raise premiums significantly in 2017. Still, around 163,000 people purchase insurance through those Obamacare exchanges.

Alexander said he thought the individual mandate, a tax penalty meant to encourage people to buy insurance, should be repealed, but first a replacement for Obamacare needed to be ready.

“There are a number of things that need to be repealed, but I think what we need to focus on first is what would we replace it with,” Alexander told Slate about a week after the election. “And what are the steps that it would take to do that?”

Alexander’s comments are significant because he is chair of the Senate’s health, education, labor and pensions committee, one of the committees tasked with developing a repeal plan.

Alexander’s colleague, Collins, of Maine, told the Portland Press Herald a month later that she tended to agree with his “more cautious approach”. Collins went on to say, “You can’t just drop insurance for 84,000 people,” referring to those who had signed up for health exchange plans in Maine.

Many other Republicans who have spoken in support of repealing Obamacare still face difficult decisions at home. Senator Dean Heller’s home state of Nevada, for example, expanded Medicaid as part of Obamacare and newly insured about 187,000 people. In 2016, another 88,000 people were insured through the state’s insurance exchange, which had one of the smallest average increases in healthcare premium costs in the country at just 6%, or $15.

All of that underscores the problem Republicans are faced with: how to repeal a law that touches nearly every facet of American healthcare, and insures an additional 20 million Americans, without shredding a fragile system.

“Both sides are going to have to grow up, because in sensitive races, voters are going to say: ‘A pox on both your houses,’ and you’re going to see incumbents on both sides lose their seats,” said Joe Antos, a healthcare policy researcher with the conservative American Enterprise Institute.

House Republicans are not necessarily immune from political fallout from health law changes either, The Guardian notes. Their willingness to gut the Affordable Care Act and worry about how to replace it later depends on what kind of pressure members may receive from not just residents of their district, but also constituents such as hospitals and doctors.

Because of Obamacare, more than 90% of Americans have health insurance, and state exchanges were busier than ever this fall. But state exchanges are now imperiled. More than one-third of counties have only one insurance option. In most places, premiums are rising, though overall healthcare costs have slowed since Obamacare was implemented.

So let’s pivot to Trump’s chameleon stance on the economy and healthcare.

“In many cases, I probably identify more as Democrat,” Trump told CNN’s Wolf Blitzer in a 2004 interview. “It just seems that the economy does better under the Democrats than the Republicans. Now, it shouldn’t be that way. But if you go back, I mean it just seems that the economy does better under the Democrats. But certainly we had some very good economies under Democrats, as well as Republicans. But we’ve had some pretty bad disasters under the Republicans.”

Trump still attacks plenty of Republicans today, but the comments praising Democrats are in stark contrast to the fiery rhetoric he deployed against them on the campaign trail, including President Barack Obama and Hillary Clinton.

In another interview with CNN’s Blitzer in 2007, he praised her ability to negotiate when asked if she could successfully work out a deal with Iran, notes cnn.com. “Hillary’s always surrounded herself with very good people. I think Hillary would do a good job,” Trump said in another interview with Blitzer.

Turning to healthcare, candidate Trump said he ideally would want the United States to have a single-payer healthcare system such as that in Scotland or Canada, but it wouldn’t work in the US because of state borders, recalls the Washington Examiner.

“I want to see a private system without the artificial lines with every state,” Trump said during the Fox News GOP primary debate. “If I am negotiating in New York or California I have one bidder.”

The businessman then added, “The insurance companies are making a fortune because they have control of the politicians.”

Then there was Trump’s interview with “60 Minutes.” In September, during an interview on the program, Trump was asked by Scott Pelley about healthcare:

TRUMP: “Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, ‘No, no, the lower 25 percent that can’t afford private. But…’”

 PELLEY: “Universal health care.”

 TRUMP: “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

 PELLEY: “The uninsured person is going to be taken care of. How? How?”

 TRUMP: “They’re going to be taken care of. I would make a deal with existing hospitals to take care of people.”

 PELLEY: “Make a deal? Who pays for it?”

 TRUMP: “…the government’s gonna pay for it. But we’re going to save so much money on the other side. But for the most it’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”

As the above examples show, Donald Trump at times has been an ardent advocate of socialized medicine. Forget about Congress for the moment, and remember we really haven’t seen his own proposal. Let’s give him a chance and see what he envisions as the “replace” portion of his current party’s 7-year-old “repeal & replace” fixation.

Steve's Take: We might just be surprised by #Trumpcare Click To Tweet

We might just be surprised by Trumpcare. And if you don’t think it’s going to be called that, you’re in for another revelation.