Do Not Resuscitate the American Health Care Act
Republicans get credit for trying to resuscitate the American Health Care Act (AHCA). What was flat-lined two weeks ago, now has a pulse. A good thing, right?
Wrong. What I've learned from 13 seasons of watching “Grey’s Anatomy” — and a few additional seasons on the sidelines in Washington — is that it’s important to act fast when the patient is crashing, while taking a care to make sure your treatment won’t kill the patient. Unfortunately, this new bill just isn’t the right prescription.
First of all, because this particular Obamacare replacement shifts decision-making onto state governments and the U.S. Department of Health and Human Services, it’s anything but permanent. This is even worse than a 10-year reconciliation expiration date, as the entire health-care system in a given state could shift every four years along with the political winds.
More specifically, the bill allows state governments to apply for waivers from certain Obamacare regulations, such as essential health benefits (EHB) and price controls. Not all states will apply for waivers, especially those with Democrats at the helm. But even when states do secure waivers, because the federal executive branch will issue them, these waivers can be reversed easily under a new administration. In other words, the next time a Democrat is elected president, Nebraska or Alabama or Texas will be stuck with Obamacare all over again — no matter who is governor.
Last year’s Republican candidates campaigned on complete and permanent repeal of Obamacare. This bill breaks that promise.
The resurrected bill also asks President Donald Trump to abandon another critical campaign pledge: not to deny coverage to our most vulnerable populations. The new ACHA breaks that promise by allowing states effectively to deny coverage to sick Americans with pre-existing conditions by making health care cost prohibitive.
Trump campaigned on covering pre-existing conditions for a reason: Americans — including the GOP base — like the idea. The president is quickly losing ground in opinion polls; this won’t help. President Trump wasn’t the only Republican to make this promise. Many House members did as well.
The newest version of AHCA also breaks Republican pledges to help address opioid abuse. Drastic cuts in the bill will exacerbate this epidemic since the majority of opioid-dependent Americans receive treatment through Medicaid. Lawmakers must rein in entitlement spending and reform Medicaid. But before passing this version of the AHCA, they should consider the cost of opioid abuse. A 2011 paper found that U.S. societal costs of prescription opioid abuse totaled $55.7 billion, including $25.6 billion in workplace costs, $25 billion in health-care costs, and $5.1 billion in criminal-justice costs. That was six years ago. The costs have surely grown, and Medicaid must play a role in addressing the opioid epidemic.
The opioid epidemic was a quiet, but pivotal issue in many state elections last year. It will be again in 2018. GOP lawmakers who ran in 2016 responded to pleas for help with empathy and an open ear. The new ACHA would undermine Republicans’ hard-fought credibility on this issue.
The final problem with the resuscitated AHCA is that it was hammered out behind closed doors. Remember the criticisms we Republicans levied against Obamacare? That it was rushed through, that no one had a chance to read it? We were on solid ground then, and the American people rightly rallied around us. The backdoor, slapdash nature of the Affordable Care Act helped launched the Tea Party movement and handed Republicans back the House in 2010.
The right path to Obamacare repeal is not the Obamacare playbook.
In 2011, Paul Ryan told a Democratic White House: “We need solutions. And we don’t need to keep punting to other people to make tough decisions.” Republicans deserve credit for trying to undo the mistakes of Obamacare. But in our pursuit to do so, we cannot leave a permanent solution to future generations.
Kerrie Rushton, a freelance writer, served in the White House Office of Strategic Initiatives from 2007 to 2009 and at the Republican National Committee from 2003 to 2007.