The Trump White House and Republican leaders in the House of Representatives are scrambling to come up with the 216 Republican votes needed to pass a revised version of the administration’s bill to repeal and replace Obamacare.
The amended version of the Trump administration’s American Health Care Act would impose an even more savage attack on health care for millions of people—and more of a windfall for the insurance companies and big business—than the original version, which was aborted in March as a result of opposition from the extreme right-wing Republican Freedom Caucus, which deemed it too generous.
Both versions of the Republican measure build on right-wing, pro-corporate features of the Obama administration’s Affordable Care Act, but go even further in cutting health care costs for big business and the government while reducing benefits and increasing out-of-pocket costs for millions of working people.
Last week, the House leadership introduced an amendment complying with the basic demands of the Freedom Caucus, some three dozen House members, to gut the original bill’s provisions requiring insurance firms to cover people with preexisting conditions without raising their premiums and include in all policies they sell a set of essential benefits. During his election campaign and after taking office, President Donald Trump had promised to retain these provisions of Obamacare.
While securing on this basis the support of the Freedom Caucus, the administration has added to the ranks of so-called moderate Republicans who are opposing the broadly unpopular bill, largely out of fear of the electoral repercussions of voting for it. In a recent NBC News poll, half of respondents said they had “little or no” confidence that the bill would make their health care better, up from 34 percent in February.
With all 193 House Democrats expected to vote against the measure, the Republicans can afford no more than 22 defections, but as of Tuesday, various media outlets were reporting 21 Republicans already in the “no” column and as many as 24 others still undecided. White House officials had been pressing for a vote on the House floor as early as Wednesday, and both Vice President Mike Pence and Health and Human Services Secretary Tom Price have been meeting with Republican House members in the Capitol to secure the needed votes.
As of this writing, however, no vote had been scheduled. This is despite a closed-door meeting Tuesday morning at which Republican Speaker of the House Paul Ryan addressed the entire House Republican caucus to shift members currently opposed or undecided. At a press briefing following the meeting, Ryan and other leading Republican House members shamelessly lied about the health care bill, claiming it did not weaken the guarantee against insurance companies discriminating against individuals with preexisting medical conditions.
They were following in the footsteps of Trump, who said in a Sunday interview on CBS News’ “Face the Nation” program, “Preexisting conditions are in the bill. And I mandate it.”
Two major defections prompted by the amendment gutting protections for people with preexisting conditions underscored the shaky prospects for the bill’s passage. On Monday, longtime Trump supporter Rep. Billy Long of Missouri came out in opposition. On Tuesday, Fred Upton of Michigan, until recently the chairman of the Energy and Commerce Committee and author of many previous Republican bills to repeal Obamacare, told a radio station in Holland, Michigan that he would vote against the current measure. He said the new amendment “torpedoes” the previous provisions on preexisting conditions.
The amendment undermines Obamacare provisions on preexisting conditions and essential benefits by allowing states to apply for waivers to opt out of these requirements. States could let insurers charge older customers more than the original bill allowed—at least five times more than younger ones, beginning in 2018. They could also allow insurers to charge higher premiums for people with preexisting conditions who have had a gap in coverage of at least 63 days in the prior year.
States that opted out would be required to establish “high-risk pools” and similar programs that would supposedly provide insurance to people with serious conditions unable to obtain it in the private market. However, the bill calls for the federal government to allocate only $13 billion a year for such programs, enough to insure only a small fraction of the people who would lose coverage.
States would also be allowed to opt out of the Affordable Care Act’s essential health benefits clause, which requires insurers to cover a set of key benefits including hospitalization, prescription drugs, maternity care, emergency room visits, mental health and substance abuse treatment, lab tests, screenings and vaccines, pediatric services, and treatment for chronic conditions.
Last March, the Congressional Budget Office estimated that the earlier version of Trumpcare would strip 14 million people of health coverage next year and a total of 24 million by 2026. It would cut health care spending on net by $1.15 trillion and slash Obamacare taxes for the wealthy and for health corporations by $999 billion.
The CBO estimated that the March version of the bill would cut $880 billion from Medicaid alone over the course of the next decade. The current version retains all the antisocial and regressive provisions of the earlier bill, and adds to them.
It effectively dismantles Medicaid, the government health program for the poor, currently covering some 74 million Americans, ending its status as an entitlement program. It terminates, beginning in 2020, expanded federal funding for Medicaid carried out under Obamacare. Instead of guarantees of benefits for all eligible recipients, the American Health Care Act would send the states a fixed amount of money per enrollee, referred to as a per-capita cap.
States could also opt to receive federal Medicaid funding in a block grant for adults and children in the program, where they would receive a specific amount of money, regardless of the number of enrollees.
States could also seek approval for imposing work requirements for Medicaid recipients and charging them copays and other fees.
Taken as a whole, these changes would end Medicaid as a guaranteed social insurance program based on need, creating conditions where millions of beneficiaries would be ejected from the rolls or have their benefits sharply reduced.
The bill also repeals Obamacare subsidies to help low- and middle-income people pay for coverage purchased on the Affordable Care Act marketplaces from private insurers. Subsidies would be replaced with annual tax credits based on age, not income, but with credits phased out for those at higher incomes.
It would repeal, effective in 2020, cost-sharing subsidies to insurance firms to lower deductibles and copays currently available to individuals earning less than $30,000 a year to help pay for out-of-pocket medical costs.
It would abolish the requirement that companies with at least 50 employees provide insurance for their workers.
It is a virtual certainty that most of the reactionary provisions of Trumpcare, including the de facto termination of Medicaid as an entitlement program, will eventually be enacted. The Democrats have reacted to the Republicans’ difficulties in passing their bill by offering to collaborate in working out a “compromise” to further slash costs for corporations and the government at the expense of the general population.