Health Care

After many hours of uncertainty, Republican leadership announced that H.R. 1628, the American Health Care Act of 2017 had been pulled from the floor. No vote was taken Friday, even after President Trump demanded one and vowed that if the bill didn’t pass Friday, he was moving on to other issues. Late Friday afternoon Speaker Ryan announced that the bill had been pulled at the President’s request. The President struggled to convince some dissenting Republicans, including conservative, libertarian, and dubious moderates. The powerful Chair of the Appropriations Committee was also skeptical. H.R. 1628 is a fatally flawed bill that would leave 24 million Americans without health coverage and will greatly increase cost for older persons.

The President’s political maneuvers have been interesting to watch. First, he had an “unnamed highly placed White House source” say that they never should have allowed Speaker Ryan to lead the effort … clearly laying the groundwork to blame him if the bill failed. Then he issued an “ultimatum” to his own party members that it would be this bill or nothing — so if the bill passed he could declare himself the master negotiator and take personal credit. It would be funny if it were not so tragic.

The last accommodation for the so-called “Freedom Caucus,” the most conservative of the House Republicans, was a retreat from the Affordable Care Act’s commitment to “essential benefits” that a health plan must offer to be eligible for public subsidies. This decision on what health care is “essential” would have been left to the states, so, a state legislature could decide, for example, that maternity care is not essential and need not be covered. It could decline to cover mental illness, substance abuse treatment, mental illness, or even emergency room treatment. Each state would have been allowed to make its own decisions, so if you moved, your health coverage could get worse.

The drama may be over for now but we cannot declare victory and move on. The House may not take up health care again next week but I fully expect that in the months ahead there will be other efforts to undermine the ACA. There may or may not be more legislative proposals, but there will certainly be regulatory actions that will undermine the ACA. Remember, after his defeat the President was quoted as saying let the ACA “explode”. That ONLY happens if his Administration allows it either by malicious action or callous inaction. We must continue to be vigilant.