Senate Majority Leader Mitch McConnell’s apparent preference is to put legislation to repeal and replace the Affordable Care Act — a bill drafted behind closed doors by McConnell and a handful of Republicans over recent weeks — to a floor vote by next week following its release Thursday morning.
That secrecy and haste betrays a lack of confidence among its supporters that the “Better Care Reconciliation Act” will find favor among Americans or even among Senate Republicans who might have to face their constituents over the week-long Fourth of July holiday recess.
With 52 Republicans in the Senate — and certainly no support from Democrats — McConnell can lose the votes of only two Republicans. As of Thursday morning, The Washington Post was reporting that four Republican senators had indicated opposition and at least eight more had concerns.
There’s overwhelming reason for concern.
The Senate Republicans’ version, in trying to find the sweet spot among conservatives and more moderate Republicans, tweaks some provisions of the American Health Care Act passed by House Republicans. But both versions still amount to tax cuts for the wealthy — repealing the tax increases passed to pay for the ACA — disguised as health care reforms; they seek to cut federal support for Medicaid and insurance subsidies for low-income people and cancel Medicare reimbursements for women who rely on Planned Parenthood for their care.
The most disturbing provisions of both bills are cuts to Medicaid, which provides medical care for nearly 70 million Americans who are poor, seniors or disabled and pays for nearly 1 of every 2 births in the nation. In Washington state, more than 600,000 depend on Medicaid coverage.
The House bill would cut more than $800 billion from federal Medicaid support over 10 years, while the Senate version could decrease funding by even more than the House version, although at a slower pace. Rather than provide direct federal funding, both bills would make block grants or per capita payments to states, but the decreased funding would force states to ration care to their most vulnerable residents, cut funding for other responsibilities or raise state taxes.
More dominoes would follow, of course, as those without insurance will again wait until they are at their most ill to seek treatment in hospital emergency rooms, increasing the cost of that care and reliance on the charity offered by hospitals and other providers, which results in ever-mounting costs for all patients.
This and other potentially damaging effects on America’s health care system were clear in the first few hours after the Senate bill had been released. More scrutiny, including a review by the nonpartisan Congressional Budget Office that is expected Monday, won’t make the legislation any easier to swallow. Recall that the CBO’s report on the House version estimated that 23 million Americans would lose health insurance coverage.
But more scrutiny must now follow. The “Better Care” bill should be subjected to more than a week of review and a few Republican amendments that hope to tip it toward the conservatives or the moderates to get it to 50 votes. Hearings before committees, especially testimony from experts, are the least the Senate can do.
Republicans point out that the ACA failed to get one vote from the GOP. But what the ACA did have was more than 50 hearings, meetings and roundtable discussions before the Senate Finance Committee, 47 more before the Senate health committee, consideration of more than 300 amendments, adoption of more than 150 Republican amendments and a year of consideration before the public.
Having given the “Better Care” bill more review and discussion, Congress then should begin work on meaningful reforms to the Affordable Care Act that preserve coverage for the most vulnerable, help control the cost of insurance premiums to keep coverage affordable, encourage more participation by insurance companies and rein in the price increases of prescription medication.
The Senate GOP’s bill gets one thing right; we had all “better care.”