Republicans divided over whether millions of Americans should lose government-subsidized health coverage
By Noam Levy
January 26, 2017, 11:10 AM - LA Times
Quizzed about the fate of millions of Americans who depend on the Affordable
Care Act and its insurance protections, President Trump invariably offers bold
but vague assurances.
gI want to take care of everybody,h he said in an interview with ABC News this week, a pledge GOP lawmakers
and Trumpfs nominee for Health secretary have echoed in recent weeks.
But as Republicans scramble for a strategy to repeal and replace the
healthcare law, they are reckoning with a fundamental question the party has
never settled: whether to foot the multi-trillion-dollar bill to ensure millions
of Americans retain the coverage they obtained under Obamacare.
GOP lawmakers for years ducked that issue as they unified behind cries to
roll back the program, but were assured President Obama would block them.
Now, the power to actually repeal and replace the law is exposing deep
divisions in the party.
On one side, fiscal conservatives, many of whom never wanted to expand
government-subsidized health coverage in the first place,
insist Congress must dramatically cut healthcare spending. This wing
of the party is concentrated in the House.
On the other side, some GOP governors and senators argue
Republicans must protect coverage for vulnerable Americans. Many are
worried about a political backlash if millions of Americans lose health
insurance.
gItfs going to get really ugly on the Republican side,h predicted one former
GOP congressional aide, who asked not to be identified discussing tensions
within his party.
At stake is coverage not only for Americans who use insurance marketplaces
created by Obamacare, but also for tens of millions more who rely on safety-net
programs such as Medicaid and Medicare, which many Republicans — including
several slated for senior posts in the Trump administration — have long
targeted for cuts.
The 2010 healthcare law has extended coverage to more than 20 million
previously uninsured Americans, driving the nationfs uninsured rate to its
lowest level.
At the same time, the lawfs financial aid and consumer protections
— including bans on annual and lifetime benefit limits and guaranteed
coverage, even for people who are sick — have eased financial pressure on
many households, even though high premiums continue to vex some.
The share of adults who skipped care because of costs dropped by nearly
one-fifth between 2013 and 2015, according to a recent report from the nonprofit Commonwealth Fund.
But the new protections arenft cheap. Over the next decade, the price tag for
the healthcare law is expected to reach nearly $2 trillion, the Congressional Budget Office projects. That amount, which
reflects the astronomical cost of medical care in the U.S., is offset with a mix
of taxes and other spending cuts.
But many conservative Republicans — including Trumpfs pick for Health
secretary, Rep. Tom Price (R-Ga.) — say the Obamacare spending, on top of
trillions of dollars that Medicaid and Medicare already cost the government, is
unsustainable.
gThe health and retirement security of millions of Americans is in jeopardy,h
Price warned in his 2017 budget blueprint. Price, an original member of the
tea party caucus and a leading advocate for slashing federal healthcare
spending, crafted the budget in his role as chairman of the budget
committee.
His budget, which is modeled on a similar program developed by House Speaker
Paul D. Ryan (R-Wis.), would repeal Obamacare and the subsidies it provides to
nearly 10 million low- and moderate-income Americans to help them buy health
insurance.
The budget also would cut federal Medicaid spending by close to 40%
over the next decade, leaving states with some $2 trillion less in federal aid
to run their safety-net programs. Medicaid provides coverage to about 70 million
poor Americans, including children, the disabled and the elderly.
Price and other fiscal conservatives say that with new flexibility to
redesign their healthcare programs, states will fashion less costly ways for
Americans to get health insurance.
But even some conservatives acknowledge eliminating that much aid will
inevitably force millions to lose coverage because healthcare remains too
expensive for most low- and moderate-income Americans to afford without
assistance.
gThe fact is we have a considerable number of people in the party who arenft
that interested in covering the uninsured,h said John Goodman, a health
economist who has been working with a group of GOP lawmakers on an alternative
to Obamacare that would preserve the lawfs financial aid.
Preserving that assistance is gaining support among Republican elected
officials, who now face the prospect that millions of their constituents
suddenly could become uninsured if Obamacare is fully rolled back without a
viable alternative.
Over the last several weeks, GOP governors whose states have expanded their
Medicaid programs through the law — including Arizona, Michigan, Nevada,
Ohio and Massachusetts — have voiced opposition to federal Medicaid
cuts.
And Tuesday, the bipartisan National Governorsf Assn. sent a letter to House
Republicans warning against any healthcare proposals that would saddle states
with a greater share of Medicaid costs.
At the same time, a new Obamacare alternative that would largely retain funding
in the current law and give states the option to maintain Obamacarefs coverage
system or design something else is gaining support in the Senate.
The legislation, authored by Sens. Bill Cassidy (R-La.) and Susan Collins
(R-Maine), now has the backing of Sens. Shelley Moore Capito (R-W.V.),
Johnny Isakson (R-Ga.) and Lindsey Graham (R-S.C.).
gWe hope that our approach will expand the number of people who are covered,h
Collins told CNN this week.
The GOP interest in preserving coverage reflects public opinion.
While Obamacare remains deeply divisive, many of its key provisions
are popular, even among Trump supporters.
Eight in 10 Americans in a recent Kaiser Family Foundation poll support federal aid to
states to help them expand Medicaid coverage for the poor. A similar majority
back the lawfs system of insurance marketplaces — such as HealthCare.gov
— where people who donft get coverage through an employer can shop for
health plans and get subsidies to offset their premiums.
At the same time, a growing share of Americans say the federal government has
a responsibility to ensure that all Americans have healthcare coverage. Six
in 10 backed this view in a recent survey by the Pew Research Center, up from 42% in 2013.
The rise in support has been particularly pronounced among low- and
middle-income Republicans, Pew found.
But the divides within the GOP remain deep.
Conservative lawmakers, such as Sen. Rand Paul (R-Ky.), are still demanding
Obamacarefs taxes be rolled back, which would make it virtually impossible to
maintain coverage.
And the Cassidy and Collins health plan has received a cool reception from
some conservatives.
gThe Patient Freedom Act, as introduced, replaces Obamacare with ...
Obamacare,h Jason Pye, director of public policy at the advocacy group
FreedomWorks said in a blog post this week. gIf Republicans are serious about
repealing Obamacare, they, you know, actually have to do it. Introducing a bill
that effectively preserves Obamacare does nothing to further this effort.h
For his part, Trump hasnft weighed in on the debate within his party. But he
continues to offer sweeping promises.
gWefre going to have a much better health plan at much less money,h the
president told ABC News on Tuesday. gWe will unleash something thatfs going
to be terrific.h