Guest opinion: This is about politics, not health care |

Guest opinion: This is about politics, not health care

Robert Semro

The U.S. health care system provides critical services that hundreds of millions of Americans rely upon for their lives and well-being. One in eight Americans is employed by that system. In 2015, the United States spent $3.2 trillion on health care, roughly 18 percent of the nation’s economy. According to one 2016 study, the average American family spends 10.1 percent of its income on health care.

So why not turn that massive and critical system, which millions of people depend on, into a political dog bone? What could possibly go wrong?

The political battle over health care tells us more about the way our current political and congressional system actually works than it does about anything else. Actual health care is secondary. It’s really about the next election cycle. It’s about promises that political leaders made that they thought would win the last election. It’s about tribal politics and ideology. If the health and economic well-being of countless Americans gets in the way, so be it.

To be strictly nonpartisan here, remember that Democrats passed the final version of the Affordable Care Act under the reconciliation process in 2010 without a single vote from the other side. Under reconciliation you can pass a bill with 51 votes as opposed to 60 under filibuster rules. Ironically, that’s the very same process that Republicans are using in 2017 despite their visceral condemnation of it seven years ago. And one could easily argue that Republicans would never have voted for any version of the ACA, given their political calculus at the time. Nevertheless, the die was cast.

Republicans voted to repeal and replace the Affordable Care Act more than 60 times before the 2016 elections. Yet when the time came for an actual repeal that could stick, the party couldn’t seem to fully agree on what to do our how to do it.

According to Newsweek, the Graham-Cassidy health care bill, which will be voted on next week, is the 71st ACA repeal bill to be introduced. Virtually every one of them seemed to leave more people uninsured, with large groups, especially older and rural Americans, paying ever higher costs.

It hasn’t always worked this way. In the past, there was very strong resistance to the passage of Social Security, Medicare and Medicaid. In spite of that opposition, those programs still exist, although they look a lot different today. Those original laws have gone through massive legislative and regulatory amendment that often required bipartisan compromise. For example, the Ronald Reagan-Tip O’Neil deal in 1983 that averted an impending fiscal crisis for Social Security.

Now days, such long-term pragmatism, statesmanship and legislative competence seem to be a thing of the past. In order to avoid any semblance of bipartisanship, Senate leaders will try to push Graham-Cassidy though before the window for the reconciliation process closes on Sept. 30.

In order to meet that deadline, the entire process is scheduled to take 72 hours, including one hearing and a partial Congressional Budget Office score that will not include the number of Americans that could potentially lose coverage. Since the Graham-Cassidy bill is considered as an amendment to the previous repeal and replace bill, the Better Care Reconciliation Act, it could technically be passed with a minimum 90 seconds of debate on the Senate floor. In contrast, there were 25 days of floor debate and 44 public hearings and events in the Senate alone before the passage of the ACA.

In an interview with, Sen. Pat Roberts, R-Kansas, was quoted as saying: Graham-Cassidy “is the last stage out of Dodge City. I’m from Dodge City. So it’s the last stage out to do anything … this is not the best possible bill — this is the best bill possible under the circumstances. If we do nothing, I think it has a tremendous impact on the 2018 elections. And whether or not Republicans still maintain control and we have the gavel.” That pretty much says it all.

To be bipartisan once again, Senate Democrats would almost certainly refuse to support any legislative effort that included a repeal of the Affordable Care Act or eliminated key provisions of that law.

True bipartisan legislation that significantly addresses the problems facing our health-care system seems unlikely at best. And some Democrats may even secretly hope for the passage of Graham-Cassidy because it might help them in the 2018 midterms given the amount of political blowback that will likely follow.

The bottom line is that our elected representatives seem to have taken the least responsible path toward governance instead of one that holds the welfare of all Americans as its highest priority. It’s all about party, elections, ideology and keeping the base happy. What about all the rest of us?

Robert Semro is a former health policy analyst for the Bell Policy Center, legislative and senior advocate.

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