Over the past seven years, Obamacare has consumed Republicans and become our white whale. We’ve campaigned since its passage on amorphous promises to repeal and replace the heavily-flawed program with an amorphous program that was billed as lowering costs, while improving care.
Then 2016 happened and Republicans seized control of the presidency and maintained their majorities in both chambers of Congress, which in turn led to the much-maligned American Health Care Act (AHCA), which the House will vote on Thursday. Just as Obamacare led Democrats to face angry townhalls in 2009 and 2010, the AHCA has Republicans facing them now as their constituents emphatically declare that health coverage is now a right for all.
They are not wrong.
As conservatives, we opposed Obamacare. It was too costly and made the overall health care system worse. But like it or not, its passage made health coverage for every American a right. Even Speaker Paul Ryan admitted this when he stated that Obamacare is an entitlement program, as did Senator Bill Cassidy (R-LA) who took this a step further when he said that the federal government established “the right for every American to have health care.” Yet, some Republicans still have not recognized that the debate has shifted from one over whether or not health coverage is a right, to one about how best to provide health coverage for all while reducing costs.
It is not helping the Republican Party.
Americans of all beliefs and backgrounds do not react well when an established right is threatened with removal. Even the perception that a right is in jeopardy causes people to become very upset (just ask voting rights activists or Second Amendment supporters) and involved in the political process.
Intentional or not, the American Health Care Act would make it harder for Americans to have access to health coverage and, by extension, health care—which, again, is widely seen as a right now. Some 14 million Americans would lose their coverage in the bill’s first year, according to the Congressional Budget Office.
The fundamental flaw of the repeal bill, ironically enough, is one that it shares with the law it would replace: It imposes a top-down approach to health coverage that remains anathema to conservatives. A 60-year-old American would instead receive an annual $4,000 tax credit to buy it, no matter where they lived or the cost of living.
More, as the Kaiser Family Foundation recently noted, in places like Pennsylvania’s Northumberland County, a county that President Trump won with 69 percent of the vote, that same person—who is likely already feeling the crunch of Obamacare raising insurance premiums and deductibles—is currently receiving a $11,150 subsidy under Obamacare.
Other aspects of the AHCA should give all Americans pause. It allows insurance companies to impose caps on medical coverage, which is flat-out immoral. Theoretically, mental health coverage, physical therapy, or even chemotherapy can be stopped mid-treatment because the insurance provider does not wish to continue paying for a costly procedure.
President Trump campaigned on the noble and worthy goal of ending the opioid addiction that now plagues the United States. By allowing coverage caps, the AHCA is directly at odds with this goal. The National Institutes of Health’s National Institute on Drug Abuse has deemed drug addiction a mental illness, that should be treated as such. The AHCA, though, effectively eliminates mental health parity.
Republicans of all stripes and beliefs are coming out against the AHCA as it now stands. Last week, Republican Governors Snyder, Kasich, Sandoval, and Hutchinson of Michigan, Ohio, Nevada, and Arkansas respectively, warned that states could not shoulder the costs the federal government intends to offload onto them.
Despite its many flaws, President Trump has married himself to the AHCA and refuses to divorce it, even though it lacks a key provision Trump promised on the campaign trail: the removal of state lines to promote competition among insurance companies throughout the country, which would in turn lower the cost of coverage due to the free market’s influence.
Republicans would be wise to come together with willing Democrats to produce a real and effective bill that reforms the broken system of Obamacare and respects the Hippocratic oath’s commitment to “utterly reject harm and mischief.” If we do not, our party will suffer the political consequences, while Americans will face the economic and medical repercussions.