For several years, the GOP has rallied around a common goal, namely, stripping health carefrom millions of citizens. Now, it looks as if they may be closer to success, with Senate Republicans unveiling a bill that will effectively chip away at the Affordable Care Act.
It took months to debate and later implement the Affordable Care Act, a process Republicans have largely bypassed by putting their bill together in secret, refusing to share details with anyone but the 13 senators (all white men) tasked with writing it.
Despite calling for transparency during the fight for Obamacare, they’re now content with keeping the public in the dark, a move Vice President Mike Pence condemned in 2010 as “It’s simply wrong for legislation that’ll affect 100 percent of the American people to be negotiated behind closed doors.”
Officially released on June 22, the 142-page bill would hit the Medicaid program hard, something Trump previously vowed not to do. In 2015, he’d promised The Daily Signal, “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”
Adding, “Every other Republican is going to cut and even if they wouldn’t, they don’t know what to do because they don’t where the money is. I do.”
But under the Better Care Reconciliation Act of 2017, the 52-year-old program would face deep cuts, with the amount of federal dollars spent per person decreasing. Facing less federal funding, states would be left to fill in the gaps themselves, giving them the option to expand Medicaid or refuse to participate altogether.
With 31 states and the District of Columbia already offering expanded Medicaid care, a loss in coverage could affect millions of disabled and low-income Americans, including the 20 million individuals that gained insurance under Obamacare.
“This is the most consequential change in 50 years for low-income people’s health care. This is a massive change that has hardly been discussed,” explained Joan Alker of Georgetown University.
Nonwhites are especially at risk, many shut out of the Medicaid program altogether by states that have refused to expand coverage. According to Pew Trust, “Fifty-five percent of all African-Americans reside in the 23 states that have not expanded Medicaid eligibility under the ACA.”
Black Americans living in the South are disproportionately denied Medicaid, thanks in part to strict eligibility requirements that have made it harder to qualify for the program. This includes those who are working but not given health care through their employers.
In an Urban Institute report on ACA coverage rates, health economist Lisa Clemans-Cope suggested, “If other states that have so far refused Medicaid expansion expanded it, the Black/white disparity would drop dramatically.”
If Senate Republicans get their way, women, who were notably absent when the bill was put together, would be hit hard as well, reducing coverage in a nation that already has the highest maternal mortality rate.
Planned Parenthood would lose federal funding for a year, dealing a blow to the 2.4 million people seen annually for family planning, preventative care and more. The loss of Medicaid reimbursements could also lead the embattled organization to close more locations, making it harder for low-income women to access affordable contraceptives and life-saving services, including breast and cervical cancer screenings. Also at risk, basic services like maternity coverage.
According to Dr. Hal Lawrence, executive vice president of the American Congress of Obstetricians and Gynecologists, “The bill includes some money to boost community health centers as an alternative, but many of those centers don’t have the trained professionals who can provide long-acting contraceptives and ongoing health-care services that many women need.
“They’re not equipped to fill that gap.”
Voicing their frustration with the bill, the ACOG released a statement that read “ACOG is deeply disappointed by the Senate’s proposed Better Care Reconciliation Act. This legislation deliberately strips the landmark women’s health gains made by the Affordable Care Act and would severely limit access to care. If enacted, this legislation will turn back the clock on women’s health.”
Speaking on the potential long-term effects of the bill, University of Michigan professor Dr. Michelle Moniz explained, “I think we’ll see more people who are uninsured, some by choice and some because they no longer have access to affordable health insurance.”
Said Moniz, “While this can be a gender-neutral challenge, women face distinctive circumstances, particularly around childbirth, that make health insurance coverage particularly essential for them.”
There are other protections at stake, including pre-existing conditions, which states could request they offer less coverage for. And while young adults could still remain on their parents coverage until age 26, older Americans would see a dramatic rise in premiums after Medicaid cuts start in 2021. Not to mention the mental health and opioid addiction programs that would be cut as well.
Ironically — or unsurprisingly, depending upon how you look at it — wealthy Americans will benefit from the new bill the most, thanks to an estimated $592 billion in tax cuts.
Looking to preserve the ACA, a cornerstone of his presidency, former President Barack Obama shared his views about the bill via Facebook, writing, “I recognize that repealing and replacing the Affordable Care Act has become a core tenet of the Republican Party. Still, I hope that our Senators, many of whom I know well, step back and measure what’s really at stake, and consider that the rationale for action, on health care or any other issue, must be something more than simply undoing something that Democrats did.”
He continued, “We didn’t fight for the Affordable Care Act for more than a year in the public square for any personal or political gain, we fought for it because we knew it would save lives, prevent financial misery and, ultimately, set this country we love on a better, healthier course.”
And he’s not the only one in opposition to the bill. It currently lacks the support of four Senate Republicans — with Senators Rand Paul, Ron Johnson, Mike Lee and Ted Cruz refusing to vote on the bill in its current form — unless, of course, additional cuts are made.
Issuing a joint statement, they wrote, “It does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.”
The CBO estimates that the House version of the bill could leave over 23 million Americans uninsured by 2027, with an outlook for the Senate version soon to come. Until then, the public is forced to wait, though that hasn’t stopped protesters from showing up at Sen. Mitch McConnell’s office. Shouting “No cuts to Medicaid,” protesters, including those confined to wheelchairs, were later seen being carried out by police, a state of chaos likely to boil over in the coming weeks.
Of this likely scenario, New York Sen. Chuck Schumer said, “Unless you’re a healthy millionaire, Trumpcare is a nightmare. This report ought to be the final nail in the coffin of the Republican effort to sabotage our health care system.”
First published via Atlanta Black Star, June 2017