The Republicans in the Senate finally admitted failure in crafting a new healthcare bill to replace ObamaCare. It was doomed from the beginning because of the American public. Millions of people demanded that ObamaCare be repealed but a significant portion of that number had no idea what they were asking.
I have said over and over that anytime the government gets involved in something as large as healthcare there will be winners and losers. What ObamaCare did was create three distinct classes in the purchase of healthcare:
- If you are employed and your employer provides some sort of healthcare you become pretty neutral in this fight. You may have to pay a portion of the cost of the healthcare and there will be copays when you go to the doctor or hospital but you know you have coverage and it Is what you are used to having. You could keep your doctors, as Obama promised, since you plan changed very little.
- If you are working for a company that does not provide healthcare or you are self employed and you have to purchase your own healthcare you are a loser in this equation. A typical family of four is seeing a 17% increase in their premiums this year and the deductible is over $12,000. You could be paying a monthly premium between $1000 and $15000 but you are not really buying healthcare insurance with the high deductible, you are buying catastrophic care insurance. By that I mean you will be paying for your healthcare out of pocket but will be protected from some major illness or accident bankrupting you.
- If you are not working or working and not earning very much money you are a winner under ObamaCare. You will be able to purchase healthcare under this system because you are getting either a subsidy or healthcare fully provided. This is because of the expansion of Medicaid under the plan.
The third category is the problem for Republicans. Medicaid has exploded under ObamaCare and millions of people have flocked to the rolls. More people went on Medicaid than projected under the legislation and fewer people purchased insurance on their own than projected. States had to decide what to do and 31 states have expanded Medicaid and many of them have Republican Governors and legislatures. This is really Politics 101. A classic example is Nevada and why Sen. Dean Heller has been on the fence on a new bill. His governor, Brian Sandoval, expanded Medicaid and once you give a significant number of people something they like it is very difficult to take it away from them. Sen. Heller has been taking his cue from Gov. Sandoval on what is acceptable in Nevada and what is not. You can replay this scenario in states like Alaska and West Virginia, both Republican strongholds, and you see the problem Mitch McConnell and the Republican leadership were facing.
To pay for all of this you had to raise taxes and this irritated the conservative wing of the Republican party. They viewed it as another case of redistribution of income by taxing one group to pay for a benefit for another. The moderates in the party looked at the impact in their states and refused to budge on the Medicaid issue since it would be political suicide. The Opioid epidemic was indicative of how it was playing out. The leadership was willing to add another $45B to the bill for this problem in an effort to bring Senators like Rob Portman (R-OH) and Shelly Capito (R-WV) to the table supporting the bill. In the end they were not able to satisfy enough disparate interests to get the needed support.
So what do we do now? I have maintained from day one that passing a bill of this magnitude by a strict party line vote is an invitation to failure. The Democrats did it with ObamaCare and the results were massive losses in the next election. Politically the Republicans have bludgeoned Democrats for the past 8 years with the demand to repeal ObamaCare. The rules of the Senate will limit what the Republicans can do since they have to use the reconciliation process since the Democrats will not cooperate in anyway. If you want to better understand the Reconciliation Process clink the link below:
One thing everyone should clearly understand is that most Democrats know that ObamaCare is failing. They know that premiums and deductible are skyrocketing. They know that the costs of healthcare are spiraling upward. But as long as President Obama was in office they were unwilling to make changes and lacking the votes to override a veto the Republicans were powerless to do anything. Now the Democrats will sit back and allow the Republicans to twist in the wind and take to the airwaves with predictions of dire consequences if anything is changed in ObamaCare. Not what I would call responsible reactions to something they know is fraught with problems but this is politics and they see the opportunity to use this issue as a wedge to win voters and hopefully elections.
What we should do is repeal as much as possible of ObamaCare and then try and force the Democrats to the negotiating table. This is a huge opportunity for President Trump to take the lead and actually become Presidential. If I were advising him I would have him direct Sen. McConnell and Speaker Ryan to repeal as much as they can and then immediately address the nation in an evening speech. That speech should call for a bipartisan solution to our nation’s healthcare problems. The next day he should call the leadership of both Republicans and Democrats to the White House and tell them he is prepared to sign a bill that is negotiated by both sides. He should also direct them to start paying attention to the cost of healthcare, not just the cost of healthcare insurance. Why do thinks cost so much? That is a question that has to be part of the discussion. That will have to be followed by a massive public relations telling the public to demand that both parties work together to find solutions and quit the bickering.
This means that both Republicans and Democrats have to acknowledge they will be compromise and not get everything they want. They should also commit to delivering strong majorities of both parties in voting for a compromise. This is critical so that one party cannot use the bill as a political weapon against the other. In the Senate a new bill should pass with 85+ votes. In the House it should pass with 380+ votes. Then we might finally get a bill that start addressing real healthcare reform and actually start bringing down the costs of healthcare.