Semro column: The party of health care?
On March 26, the president said that “the Republican party will soon be known as the party of health care” and that a new “spectacular” health care bill was in the works.
After Majority Leader Mitch McConnell shot down any near-term plan to repeal and replace the Affordable Care Act (ACA), the president walked it all back saying that the vote wouldn’t happen until after the 2020 election, just as he’d always planned it and after Republicans “win back the House.” Given the timing, the confusion and the walk backs, one might question whether this is really about health care or campaign politics. And maybe, that’s the problem.
Paradoxically, the president made his first statement after ordering the Justice Department to take the most extreme position possible in the case of Texas v. U.S. If the ruling in this case is upheld according to the president’s order, it would strike down every provision of the ACA that became law in 2010.
Those provisions removed pre-existing condition exclusions for millions of policy holders, ended lifetime and annual benefit caps, prohibited or limited higher premium prices based on gender or age, allowed younger Americans to stay on their parents’ health insurance plans, introduced insurance premium subsidies used by 8.8 million Americans, closed the Medicare Part D prescription drug donut hole for seniors, reduced the number of uninsured Americans from over 44 million in 2013 to just below 27 million in 2016 and expanded Medicaid for 12 million adults who were previously excluded. As an aside, the thirteen states that haven’t expanded Medicaid are governed by Republican legislatures.
If the ruling is upheld and no new law is provided as a replacement, those reforms that helped millions of Americans will end and the number of uninsured will dramatically increase.
Ironically, this case was made possible because Republicans in Congress repealed the individual mandate provision of the ACA in their 2017 tax cut bill. Republican State Attorneys General then brought a lawsuit to a district court in Texas, presided over by a judge appointed by George W. Bush and argued that since the mandate was a foundational provision of the ACA the entire law had to be declared unconstitutional.
This is one step in a larger strategy. Instead of fixing problems in the ACA (and there are a number of them), Republicans tried to repeal it 60 times. Their last attempt to replace it, the Graham-Cassidy bill, failed to become law even in a Republican controlled congress. At the time, the bill enjoyed a whopping 24 percent approval rating in public opinion polls.
And let’s not forget that the Trump administration, with help from a Republican Congress, cut open enrollment periods, ended cost sharing reduction subsidies, defunded the reinsurance provision of the ACA, reduced exchange and navigator funding and introduced short-term, limited-benefit plans that cover very little but significantly destabilize the individual health insurance market.
All of this might suggest that Republicans are facing an uphill battle when it comes to persuading voters that they’re “the party of health care.”
So, beyond the president’s legal position on the Texas v. U.S. law suit, what else has he done recently to promote his party’s new health care image?
Well, there’s the 2019 Trump budget. Administration budgets never pass as is, especially in a divided Congress. But they say a lot about what an Administration and its party would do if they had total control. As the old political truism goes, “Show me your budget and I’ll tell you what you value”.
His budget would reduce direct funding for Medicare by $845 billion over ten years, as well as increasing some co-pays for Medicare enrollees.
The budget proposal would cut Medicaid by over $200 billion through the year 2029 and impose a mandatory work requirement for program eligibility. It would also eliminate funding for Medicaid expansion under the ACA, which could effectively end that program in thirty-seven states. Medicaid funding could also be appropriated under a state block grant or a per-person funding cap that could significantly reduce federal funding for state Medicaid programs in the future.
Ironically, candidate Trump promised not to cut Medicare or Medicaid numerous times on the campaign trail. So much for the president’s catchphrase, “Promises made, promises kept.”
In the end, little of this is about actually improving health care. It’s mostly about fulfilling a decade-long campaign promise to end a law that Republicans decided to oppose for political reasons and electoral gain. The president’s latest strategy is about addressing a political weakness in the 2020 campaign and crafting a new bumper sticker slogan. The real thought and the actual policy behind it are about as hollow as a ping pong ball. Until Republicans finally move from a partisan political strategy to positive bipartisan change, few beyond their devoted base are likely to consider them “the party of health care.”
Bob Semro of Glenwood Springs is a former health policy analyst for the Bell Policy Center, and a legislative and senior advocate. His column appears monthly in the Post Independent and at postindependent.com
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