There is no sugar coating the hard truth: the inability of the Senate Republicans to pass a health care reform bill that in some manner could be portrayed as a repeal of Obamacare (the ACA) is a major political loss and a failure of governance.
The nightly newscast pundits explain that the political landscape around Obamacare has changed, and the growing popularity of the bill is what made Senate Republicans skittish about making major changes. This is rather nonsensical, as the most recent national election we have had put Donald Trump in the presidency in good part because of his clear promise to end Obamacare.
The political spin around the various iterations of Republican Senate legislative reform was deceptive on both sides. Most of these reform efforts actually minimally tinkered with health care without approaching at all the basic structure of Obamacare (please see my column of last month).
Leading Democrats attacked these efforts as being mean and heartless, but avoided publicizing the contents of Republican legislation because to do so would have blunted their political attacks as Obamacare would remain intact. Similarly, Republicans did not defend these legislative efforts, because to do so would have made it clear to their base that their reform measures in no way fulfilled their election promises of repealing Obamacare.
As the Senate Republicans could not agree on an approach, the Oct. 1 deadline for getting legislation passed under budget reconciliation that would allow passage with 51 votes is fast approaching. Hence came the “Skinny Repeal.” This was an amendment with only a few provisions, which was designed for passage so that health care reform would then be hammered out between the Senate and the House through legislative reconciliation.
These provisions were the repeal of the Obamacare individual mandate that forced citizens to buy health insurance by otherwise levying a fine; the elimination for eight years of the mandate that employers provide insurance for employees, allowing the individual states flexibility in the implementation of essential benefits and out-of-pocket spending limits, which thereby reduces premiums; the defunding of Planned Parenthood while simultaneously increasing funding to community health centers; the elimination of the medical device tax for three years; and an increase in the limits for contributions to health savings accounts by individuals.
This last effort by Senate Republicans failed by a vote of 49 – 51, with three Republicans, Lisa Murkowski of Alaska, Susan Collins of Maine, and John McCain of Arizona, voting alongside all of the Senate Democrats. Murkowski explained her vote as one against the legislative process around this amendment. Sen. Collins expressed her support of some of aspects of the Obamacare legislation and the need to fix its failures. These votes were expected, but it was McCain’s vote that was the surprise and has been blamed for the Republican failure.
McCain’s reasoning can be paraphrased like this: I have believed that Obamacare should be repealed and replaced. While the amendment would have repealed some of Obama care’s most burdensome regulations, it offered no replacement. One of the major failures of Obamacare was that it was rammed through Congress by Democrats on a strict party line basis. We should not make the mistakes of the past that has led to Obamacare’s collapse. We must now return to the correct way of legislating.
This is political doublespeak on the part of Sen. McCain. On one hand, he feels the need to burnish his conservative credentials by confirming the importance of the repeal of Obamacare. On the other hand, he based his vote on the desire for re-establishing bipartisanship, and negotiating with Senate Democrats will never lead to the repeal of the Obamacare legislation that McCain himself promised to his Arizona voters during his last Senate campaign of 2016.
Bipartisan agreement on health care reform is unlikely. Senate Democrats have laid down their markers that certain items are non-negotiable — Republicans would have to abandon a repeal of Obamacare and continue the new taxes levied by Obamacare; there would be no rollback of Medicaid to where it was before the ACA; federal subsidies to insurers to stabilize the individual market would have to continue; and the individual mandate could not be touched. Perhaps these are the Democrats’ opening negotiating positions.
For their part, Senate Democrats have called for bipartisanship during this time when they have been completely excluded from discussion of health care reform. Senate Minority Leader Chuck Schumer has acknowledged that Republicans are angry over how the ACA was passed, and that they should not pursue the same process.
The hypocrisy is obvious. No Democratic leader has ever acknowledged that the destruction of Senate rules and the incitement of the nasty political polarization that followed in the passage of that bill was a mistake.
As the structure of the ACA continues to fail in the months ahead, Republicans will try to blame Democrats for obstructing reform efforts, or perhaps in the upcoming midterms they will simply point the finger for their failure at the three rogue senators. Democrats will blame Republicans for their willingness to throw the health care of Americans under the bus.
The wild card in all this will be the response of President Trump, who has the peculiar characteristic of feeling that the promises he made during his campaign to repeal Obamacare meant something.
Regardless of how this plays out, the simple reality is that this legislative showdown is a clear win for the Democratic Party. Even if a bipartisan piece of legislation emerges, Senate Republicans simply could not deliver on their promise.
Jay Fleitman, M.D. lives in Northampton. His column is published the first Tuesday of each month, and he can be reached at opinion@gazettenet.com.