“Why can’t Republicans fix health care?” -Mr. Aughta Know
I get this question often, and I wish there was an easy answer. Read on to find out why an enormously complicated policy matter impacting 1/6th of the nation’s economy can’t be solved in a divided Republican caucus.
Republicans were seemingly given a mandate to repeal the Affordable Care Act when their party retook the White House. As they soon found out, while a promise to repeal Obamacare may have been a good talking point at a political rally, the reality is that tens of millions more Americans have health insurance because of it. Oops!
In addition, Obamacare took more than a year to hash out in the legislative branch. It’s over 1,000 pages long and filled with all sorts of pilot projects to test ways to save health care dollars. It had two very popular provisions: no pre-existing conditions and the ability to keep kids on their parents’ health insurance until age 26.
While the end of insurance limiting coverage or charging more for pre-existing conditions was a huge win for pretty much everyone, it came with a price: in order to keep the insurance business profitable for insurance companies, everyone had to have insurance. That way people with no health issues would pay money in and not take out insurance dollars to cover health care.
Now, I’ve talked before on my blog about how much this drives me crazy. If you are an insurance company and the only way your business model works is when you have a huge chunk of your business from people who never need that insurance, sell life insurance. That’s just not how health insurance works now.
Obamacare included the “individual mandate” that everyone must buy health insurance or pay a penalty. That penalty was a couple hundred dollars but made some people like Sarah Huckabee Sanders absolutely bonkers.
When Republicans started drafting repeal legislation, they dropped the individual mandate in the first sentence. But given that the primary issue with Obamacare is unaffordability, removing in individual matter sets up a conundrum. If you drop the mandate, costs will go up for everyone else, beyond current rates which you already think are too high. But if you’re a Republican who talked about freedom with respect to health care, how do you justify keeping a mandate to purchase health insurance? Uh oh.
And that is just one part of the complex puzzle of health care policy.
Major Part of American Economy
Enter the Republicans’ second issue: dropping those sixteen million or so people who gained care under the Affordable Care Act means pink slips throughout the health care sector.
This is not a small nut to crack. Taking away health insurance from millions and tanking the economy for a campaign promise is a great way to get voted out of office.
Each time the Republicans have introduced progressively shitty repeal bills, you’ve seen the entire health care community, from the American Medical Association to the phlebotomists come out against the bill four seconds later. The first reason is obviously that patients will die. When you’ve dedicated your life to healing patients, you don’t support limiting access to care for millions.
The second reason is a whole ton of people are going to lose their jobs. I can’t even begin to estimate how many, but if twenty million people stop going to the doctor, it’s going to mean a huge number of jobs lost. Thus the health care contingent has been a hard oppose on every repeal bill.
Republicans are Split
Republican lawmakers trying to craft repeal legislation that would be able to appeal to the ultra conservative wing of their party with the handful of moderates and the pretty conservative members had a Herculean task.
The ultra conservatives believe that Medicaid should be repealed in whole, including the expansion under the Affordable Care Act. So they feel none of the repeal bills go far enough.
The so-called moderates (only Senator Susan Collins is truly moderate) who are almost all still enormously conservative think that taking millions of Medicaid in their state is going to get them voted out of office. Seriously, if everyone in every other state was taken off the Medicaid rolls but their state’s residents remained, they would be fine with that. And those are the votes Republican leaders have been trying to vote. Because they have a price.
While Republicans may find a way to pass some repeal bill this week, they cannot fix health care with their far right Tea Party caucus elected officials.