IS OBAMACARE DEAD?

The recent narrow House of Representatives Republican victory to repeal and replace Obamacare means much more than just that. There are tsunami political implications that will reverberate with what is on its face is a loss of healthcare for at least twenty- four million Americans and a refusal to pay Planned Parenthood for their services for two and a half million women. Most significantly is the threat of either denial or massive increase of premiums for up to thirty percent of Americans, with pre existing health problems, as well as citizens between fifty and sixty - four years old. This is all coupled with the threat that the legislation would result in the closure of droves of Rural Hospitals that would be deprived of the fees that the newly insured were providing. The immediate beneficiaries are the wealthiest two percent who receive a three hundred billion dollar tax reduction - that being the additional tax they have been paying to cover the costs of Obamacare these past eight years. 

REPUBLICANS WENT AHEAD WITH REPEAL REGARDLESS OF CONSEQUENCES

When one reflects on the overwhelming protests to the introduction of the repeal and replace of the Affordable Care Act, (ACA) with the Affordable Health Care Act, (ACHA)  bracketed with the fact that every possible professional and service organization protested the change it boggles the mind that the GOP went ahead like lemmings marching to the sea. There had to be compelling reasons why the Republican leadership rushed into this legislation, especially when the influential American Association of Retired Persons that represents over thirty - eight million paid up members and the American Medical Association with every other medical professional body publicly opposed it, These organizations were supported by the American Hospital Association, The American Cancer Association with all other bodies that represent a disease interest together with all those institutions that raise money for the ill and disabled such as “March for Dimes” all campaigned against this legislation .

It is little wonder that several cynical Democrats were hoping that the House Republicans would do what they did. They hobbled together a Bill with amendments that could win over all factions of the Party, regardless of the fact that it rendered the AHCA unworkable. All this in their obsession to pass a Repeal and Repeal Obamamcare Act which they have been attempting to effect for seven years They deliberately did not wait for an evaluation of their effort from the non partisan Congressional Budget Office that had evaluated that the first more moderate GOP legislative attempt reporting that it would result in twenty four million people losing healthcare and would “save” $337 billion.

PERCEPTION IS REALITY SO WATCH OUT TRUMP

From the word go Obamacare was attacked by the Republicans as fatally flawed care while pushing up the costs. The annual increase in everyone’s insurance premiums, which coincided with the rolling out of the ACA was argued to support the seven year old Republican narrative that Obamacare was a ‘disaster’. This mantra became a ritual as the Republican controlled House of Representatives repealed the ACA sixty times in the full knowledge that their then vote could not become law. In addition like all major revolutionary changes there was plenty that was not working with ACA. In certain States, insurers, especially where the populations were sparse, did not find it cost effective to continue. Providers too were reluctant, in some instances, to treat so many additional low paying patients. 

To up the anti on the repeal and replace process, the President made it a cornerstone of his campaign. However what he defined as what needed to be done is not remotely close to what the AHCA does. The Donald campaigned that he would not touch Medicare and Medicaid nor the ACA provision that enforced insurance companies to insure those with previous illnesses at no extra cost. The new Act does the opposite. The Donald promised that he would provide better health care for all Americans for less cost. Like in so many other spheres Trump was operating in his alternate reality. The problem for the GOP is that The Donald’s base voted for the Trump’s election manifesto, an interpretation that he is still sticking too. So in the aftermath of the electoral promises the Republicans and Trump, if they were to have any credibility, had to go ahead as quickly as possible, with the AHCA, regardless of the fact that it only had a seventeen percent approval rating.

Not only do the GOP legislators have to live with what is in this act so does Trump. As the Democratic leader in the House, Nancy Pelosi, gleefully announced the Republicans that voted for it have their vote tattooed on their foreheads. The verdict on the two celebrations following the passage of the AHCA is still out. The Democrats singing Goodbye to the Republicans and Trump and the Republicans celebrating at the WhiteHouse on a piece of legislation that has a long long way to go before it becomes law.

OTHER MOTIVATIONS FOR THE AHCA

There were philosophical reasons to axe Obamacare as well. The GOP chief ideologue, House Speaker, Paul Ryan believes in small government and market forces. He does not agree that it is the Government’s responsibility to provide health care for all. Others, even more rigid, outright state that Healthcare is not a right and if you cannot afford it that is just too bad. This archaic Republican position if fully articulated would be very unpopular with the electorate. 

Some commentators are convinced that the AHCA was essential in order to effect tax reform. The nearly four hundred billion tax dollars saved from the ACA would be needed for tax deductions proposed in Trump’s tax reform plan. Some pundits argue that this was the greatest motivation for the AHCA and maintain that without it tax reform would be dead in the water. There is little doubt that the Democrats are going to run on “You lost your health care for a tax break for the rich”.

There are the purely internal political motivations for this vote. The moderate Republicans that have everything to lose were persuaded by the following logic - while the strongest GOP support for the AHCA is from the far right they are the majority of the few voters that pitch up for the Republican Primaries and are most effective at getting their people the nomination. Necessity being the mother of invention these moderates were persuaded that if they were ousted in the Primaries whether or not they would lose they seats in the midterms was irrelevant as they wouldn’t be around to contest them. 

Other political objectives were achieved in the leadership sphere. For better or for worse Trump is ensconced as the Republican leader as he became intimately involved directly and indirectly in the arm twisting to sneak this bill through. Mike Pence virtually took up residence in the House to get the guys “To take one for team Trump”. It didn’t seem to matter that the concessions needed to land the right wing Freedom Party and the eight billion dollar sop to the moderates wouldn’t jive in the real world. The Trump team and Ryan cobbled together this boondoggle as only the end result mattered. Ryan finally put his stamp on his leadership of the House but how long this will all hang together will be put to the test again and again and more specifically if and when Trumpcare returns from the Senate.

THE OUTCOMES 

There is little doubt that the short term victory is Ryan and Trump’s. The problem is that the Act is interpreted differently by the two. Trump is not remotely interested in ideology and will do and say whatever he feels he needs to. In fact he will declare victory regardless of the outcome. 

The bottomline is that there is no way that the bill can be interpreted as fulfilling Trump’s election promises and this will be played out in the midterm 2018 elections. As Pelosi has stated the GOP members have their votes tattooed on their foreheads and this may well result in the Dems retaking the House. The Trump electorate voted for a health care act as enunciated by him and far more in line with the Democratic vision. 

Republican Opposition

The GOP Senate, which has only a tiny Republican majority has served notice that they are starting de novo on Health Care. It is certain that there is no way that whatever emerges from the upper house would pass in the House of Representatives without Democratic support. That leaves two alternatives either Obamacare remains as is or Trumpcare will represent Obamacare “fixed up”. Republican Senators Cassidy and Collins have already drafted legislation that they maintain passes the “Jimmy Kimmel test”. The latter refers to a late night comic whose new born son was treated with a live saving operation. An emotive Kimmel argued that it should be apolitical that money should not dictate whether or not one’s son should live. He emoted further that if legislation allowed insurance companies to exclude patients with preexisting conditions his son could never be eligible. The video went viral receiving over ten million hits within a few days. Collins has stated in, so many words that she wants to plug the holes in Obamacare and provide care for the still twenty - eight million Americans not covered.

The tip of the iceberg of the GOP that has thus far defected, 20 in the House of Representatives and at least 7 Governors, led by Governor Kasich, face a real boost in the Senate where, as yet, not one Republican Senator has come out in support of the House Resolution. 

Health Act Can Spillover Into Battle for Control of GOP

All this could put into play the long put off battle for the heart and soul of the GOP between the Freedom Party - the former Tea party, and the moderates and what is left of the Bush passionate conservatism. The “middle of the road” pure ideological Ryanism cannot take hold in a society where even the Republicans, as Trump cottoned onto, want their Medicare, Medicaid and Social Security. They also want their Obamacare. This “socialism” doesn’t fit into Ryan’s fiscal conservatism and decentralized government. It is off the charts for the Freedom Party.

So the biggest beneficiaries of this battle will in all probability be the Democrats and maybe, just maybe, the whole healthcare system itself will get a total overhaul. A system that does not treat all Americans and costs nearly double of those countries that do, needs to go. As Trump argues Australia’s health care system with their single payor administration, is much better. The only problem is that he says anything and it invariably means nothing.

AT THE END OF THE DAY

 For the foreseeable future Obamacare is alive and well and living in the USA.  If Russiagate could be Trump’s nemesis Ryan’s obsession with Obamacare may be his.