Republicans have discovered that changing the laws governing US healthcare is far easier said than done. Over the past three weeks, they have failed to pass three versions of a healthcare law to replace or repeal the Affordable Care Act, also known as Obamacare. That means, for now, millions of Americans hold on to their insurance.
Healthcare makes up one-sixth of the nation’s economy, so reform was never going to be easy. Every decision on the subject is a political seesaw between those who finance congressional elections and the people Congress is elected to represent.
This plays out in questions like: how can Congress reduce taxes for the wealthy and still subsidise affordable health insurance? How can they release insurance companies from requirements to cover basic health services and still meet the medical needs of a country where 91 people die each day from an escalating opioid crisis?
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Turns out, they can’t.
Internal divisions
Over the past seven years, Republicans have railed against Obamacare as an infringement on the rights of individuals and businesses. Following this lead, President Trump made the repeal of Obamacare a rallying cry during his campaign.
But he left the complex details of doing so up to Congress. And despite the party holding power in both houses of Congress and the White House, the Republicans couldn’t deliver on that promise.
What went wrong? The House of Representatives successfully passed their version of a healthcare replacement plan in May, so the Senate just needed to make amendments and deliver it to Trump’s desk to be signed into law. But yesterday, they reached a standstill, unable to write a bill that simultaneously pleased the most conservative and the most moderate Senate Republicans.
This is the third attempt at passing a such a bill, yet the different wings of the Republican party still can’t agree on a priority. Extreme right-wing conservatives were unwilling to vote for a bill that doesn’t fully gut Obamacare regulations. More moderate Republicans, many of whom represent states battling an unprecedented opioid crisis, resisted the bill because it would strip their constituents of healthcare.
Dead in the water
Obamacare did initially cause some problems. In some cases, private employers dropped health plans due to rising costs, so some people ended up having to sign up for private insurance. But while this is a legitimate concern, lawmakers ought to be tackling the larger health concerns facing the country – securing funding to treat opioid addiction, among other things – instead of settling old scores.
But President Trump is infamous for dragging out a fight. After the Senate failed to pass its healthcare bill for the second time, Trump responded with a call for a full repeal of Obamacare – without any replacement – a step which the Congressional Budget Office previously found would leave 32 million people uninsured by 2026.
Backed into a corner, Republican leaders had no choice but to pledge to try a third time and hold a vote to repeal the law entirely, starting in 2019. Only fourteen hours later, that had failed as well, derailed by three senators who declared they would not vote for such a plan.
What this means is that, for now, the Affordable Care Act is still law and the Republican repeal-and-replace effort is dead in the water. Their lack of party unity may have inadvertently provided them with the only sensible path forward for the long term.
Republican leaders have said they will attempt yet another vote to repeal the Affordable Care Act next week. Failing yet again would be very embarrassing for those involved, who will be returning to their districts to seek reelection in 2018. But failure for Congress and the White House in this fight is a win for healthcare access in the US.
