A Senate healthcare bill drawn up hastily in a dark back room seems a fitting conclusion to the roller-coaster ride we have had in healthcare over the past eight years. It’s a culmination of everything the Republicans set in motion when they first stood in united opposition to the passage of the Affordable Care Act, a piece of legislation based on a policy proposal from the Heritage Foundation – a Conservative Think Tank.
From that moment on they had drawn their lines for battle, they would not rest until the legislation was repealed. On some 60 separate occasions they voted to repeal the Affordable Care Act in one form or another, always knowing that even a repeal-bill that gained enough support to make it’s way to President Obama’s desk would never be signed into law. They spent eight long years of Obama’s Presidency running their campaigns on repealing and replacing Obamacare, convincing their base that they could fix the healthcare problems that the country faced. There are legitimate problems with the Affordable Care Act, the insurance exchanges are starting to collapse (though not at the rate Republicans are suggesting) and premiums are spiralling out of control in places, but none of the measures put forward by the Republicans legitimately address these concerns. Their base has put faith in them to deliver a better, perhaps more fiscally conservative, more efficient and better priced healthcare system – something they promised time and again.
It became one of the central tenets of Trump’s Presidential campaign, promising the “repeal and replace of Obamacare” on 68 separate occasions. It was meant to be one of the central focuses of his administration, to repeal Obamacare and replace it with “something much much better”, Trump was adamant that his bill would take care of everybody, lower premiums and deductibles, and stop the collapse of the health exchanges.
After two failed attempts the House Republicans managed to pass a bill that the Congressional Budget Office (CBO) has predicted would take health insurance away from around 23 million people over the next few years. The bill’s passage was a victory for Trump, having struggled to cobble together a coherent coalition of factions within the GOP before previous votes on the bill. After the bill was pulled before a vote on the second occasion he told CNN “Lots of different groups. Lots of factions and there’s been a long history of liking and disliking within the Republican Party long before I got here”.
Aside from Trump, the bill is an obvious victory for the so called, “donor class” of Americans. An analysis released by the Joint Committee on Taxation predicted that the House bill would cut taxes by $662 billion over the next decade, primarily through repealing Obamacare taxes on the wealthy and health care industries. It seems telling that the main issue that a fractured Republican party can get behind is a tax cut for the wealthiest Americans. So why pass a bill at all if you don’t have anything better to offer than the status quo?
Republicans have spent eight years voting to repeal Obamacare because their was no way that any bill they put forward would be signed. There was no need for them to concern themselves with how they were going to replace it, but after years of obstruction they finally have the House, the Senate, and the White House in their hands and no more barriers to achieving their goal. Yet they seem like a party bereft of any ideas of how to improve the healthcare system in the US that is compatible with their own free-market/low tax ideology. They faced two choices, turn on their ideologies and rhetoric, or push through whatever they can get the votes for, regardless of the consequences. They chose the latter.
The Senate version of the AHCA bill is being written in secrecy, completely bypassing the committee process, Julie Rovner, a Washington Healthcare writer since 1986, condemned the processed commenting that “the extreme secrecy is a situation without precedent, at least in creating health care law”. The process stands in stark comparison to the gruelling 15 months of hearings and debates that gave America the Affordable Care Act. It is important to note that whilst Bernie Sanders and other Justice Democrats have been gathering behind a single payer, medicare for all program, the Democratic establishment are yet to drill down on how they would fix US healthcare.
Whatever Republicans attempt to push through on a Senate vote will be the result of eight years of opposition rather than progress. At this point they cannot back down and vote against Obamacare repeal, through their own obstruction and rhetoric, and President Trump’s refusal to be “betrayed”. No matter how horrific the consequences of the bill, no Republican wants to be the first to take a stand against Trump, or no one that could put the bill’s passage in jeopardy. If one Senator decides to jump ship, the Congressional support for such a toxic bill might start to fall away. However, Trump’s popularity with the base and the near decade of anti-Obamacare rhetoric mean that the backlash would have to be monumental for Republicans to consider voting against both their own mandate and the loyalty obsessed leader of the country.