R.I.P. American Health Care Act, we hardly knew ye
by Michael Jack O’Brien
Features and List Co-Editor
When this article was started, I planned on laying out a list of possible scenarios in which we could see a replacement or modification to the Affordable Care Act. However, this plan was quickly thwarted, because as of Friday afternoon, the American Health Care Act (AHCA), sometimes called Trumpcare, Republicare, or even Ryancare, is no more. On Thursday, March 23rd, Donald Trump offered house Republicans an ultimatum which stated that either the AHCA be passed, or the legislation would be shelved for the foreseeable future. The next day, the latter option happened; despite the GOP having a majority in the House and Senate. Speaker Paul Ryan rushed to the White House to tell Trump that there weren’t enough votes to push the legislation through. As a result, Ryan later announced that the bill would be pulled from the House, and that there were no plans to try again. So, where did it all go wrong?
To many, the failure to repeal the Affordable Care Act (ACA) is a sign of deep divisions within the GOP’s various factions. While more moderate center-right groups, such as the Tuesday Group, supported the bill, far-right factions within the party including the Freedom Caucus rebelled against Trump’s healthcare plan, stating that they wanted the ACA repealed and scaled back even further. Additionally, many Republican representatives who represented districts where Hillary Clinton won or was extremely close to winning in the 2016 elections were hesistant to support the bill. All of these factors together resulted in the ACHA being largely doomed from the start. In order to pass the bill, House Republicans could afford to lose around 22 votes from their own party and still pull it through. However, by Friday, the number of possible “no” votes totaled to over 50 representatives.
It’s hard to understate just how unpopular this bill was on both sides of the aisle. The bill was first criticized by the nonpartisan Congressional Budget Office. The CBO stated that while the ACHA would reduce the deficit by $151 billion (less than half of what was it was projected to save), over 24 million Americans could be uninsured compared to the current system. Even after being revised, the legislation featured large cuts to essential services such as prenatal care, mental health services, and even Medicaid, an extremely vital service to many of Trump’s supporters.
For both Democrats and Republicans, there was a lot to hate about this legislation, and it showed. According to FiveThirtyEight’s estimates, the polling average for the bill was 30% favorable and 47% unfavorable. To add to the bad news for Republicans, favorability on Obamacare actually increased after Donald Trump’s election. 2017 was the first year since the ACA was enacted that more Americans supported the program than opposed it, and that margin is growing. One can only speculate as to why this is, but perhaps the threat of losing the benefits for many Americans, including an extremely large percentage of Trump’s voter base, swayed opinion on the matter.
And so, the American Health Care Act has quite ironically died on the floor of the house (yes I stole that joke from Conan O’Brien, sue me). So where does that leave Donald Trump? All we know for certain at the moment is that Obamacare is here to stay. In what form, however, is a different question entirely. While Trump might be incapable of amending or cutting away from the legislation itself, keep in mind that the Department of Health and Human Services has the ability to make their own judgements on the implementation of the programs in question. Moreover, Tom Price, Trump’s Health and Human Services Secretary is a fervent opponent of the ACA. Price could make significant changes as to what services are considered “required services”. More specifically, the secretary can make changes as to what is included in these necessary services. For example, the bill requires insurers to include coverage for mental health care, but whether or not this includes services such as behavioral therapy or occupational therapy for children can be changed by the Secretary. Some of these changes have already been put in place, such as the pulling of enrollment advertisements from the media, which experts speculate has caused a drop in enrollment by young adults. Despite this, it is estimated that 11 million more people will join Obamacare in 2017, and it is very unlikely that Trump and Price will stand idle and keep the ACA’s programs as they are.
In addition to this, there is a more important lesson to be learned, one that Trump must embrace very quickly if he hopes to push any legislation through Congress: the deep ideological rifts within the Republican party that were made clear through this bill’s failure will not go away anytime soon. The fragmented nature of the party, which Trump is expected to lead, should serve as a harsh wakeup call to the president that the West Wing is a different world than that of a business. While Trump might like to believe that his word is final, reality couldn’t be further from this. In the case of this bill, large amounts of opposition came from factions like the Freedom Caucus, with 22 out of the 50 possible “no’s” coming from the group. In addition, the health care vote uncovered large rifts between Senate and House Republicans. The AHCA was drafted by House Speaker Paul Ryan, without any input from prominent Republican senators such as Tom Cotton and Rand Paul. Trump’s first large legislative failure should make it increasingly clear that in order to pass legislation moving forward, such as the budget or raising the debt ceiling, the president must be capable of working with these various groups within his party. Until very recently these groups had been united in opposition to President Obama’s policies, but now too many are perceived as directionless and at war with themselves.