The American Health Care Act, spearheaded by Speaker of the House Rep. Paul Ryan (R- WI), has failed. For now.<\/p>\n
AHCA was characterized as nothing short of a public health crisis by Democrat critics, dubbed \u201cObamacare lite\u201d by conservative Republican critics, tweaked time and time again to pacify moderate Republican critics, and deconstructed by everyone \u2013 from media pundits to thousands of citizens \u2013 until in the end the bill satisfied nobody.<\/p>\n
On March 24, Ryan called the vote off, informing President Donald Trump he didn\u2019t have enough Republicans to pass the bill which would have restructured President Barack Obama\u2019s Affordable Care Act.<\/p>\n
Trump wasted little time moving on to addressing tax reform, a sentiment Republican leadership echoed. Congresswoman McMorris Rodgers (R-WA), chair of the House Republican Conference, for example, is hopeful.<\/p>\n
\u201cAlthough I\u2019m disappointed we couldn\u2019t find consensus on how to repeal and replace Obamacare, I\u2019m optimistic about the agenda House Republicans have proposed,\u201d she said to the Juneau Empire, via email. \u201cI\u2019m eager to continue work on the many issues that are important to people in Eastern Washington and around the country, like lowering taxes and putting the people back at the center of our government.\u201d<\/p>\n
Likewise, Ryan didn\u2019t dwell on the loss. In a tweet following the bill\u2019s cancellation, he thanked the president, House GOP members, and the Secretary of Health. \u201cThere remains so much more we can do to improve people\u2019s live,\u201d he wrote. \u201cAnd we will.\u201d<\/p>\n
The bill\u2019s failure is welcome news for the 11 million Americans who gained coverage under Medicaid expansion in 2014, an option under the ACA, as well as for states who can\u2019t afford to pay for the expansion on their own.<\/p>\n
For the Republican party, though, the failure reveals fault lines.<\/p>\n
Ryan\u2019s proposed bill could not bridge the growing gap between moderate Republicans who accepted certain portions of the ACA and conservative Republicans who hated how little the complicated bill seemed to want to wipe Obamacare out entirely.<\/p>\n
Conservative Republicans refused to budge on the ACA, a signature piece of Obama\u2019s administration that in large part birthed the growth of the conservative Tea Party faction. In the end, they refused to vote at all, even after amendments were added to mollify them.<\/p>\n
If there was a suitable compromise, it was unknown and unreachable.<\/p>\n
\u201cIf you can figure that out, I recommend buying a lottery ticket,\u201d said Marc Williams of the Colorado Department of Health and Human Services in an interview with the Empire.<\/p>\n
The health care dilemma <\/strong><\/p>\n Insurance companies want salvation from the Affordable Care Act\u2019s premium-spiking results. Many Americans are demanding a repeal, having never wanted the ACA in the first place. Meanwhile, states which expanded Medicaid, some now wobbling under budget shortfalls, cannot risk losing the federal dollars Medicaid pumped into their treasuries or the inevitable political blowback of cutting medical coverage for 14 million Americans.<\/p>\n No matter what happens, too much money or too many midterm votes are at stake \u2014 exactly the kind of Beltway politicianship that tends to drive elections and the kind of politicianship Trump and hardline Republicans ran in opposition to.<\/p>\n Repeal, replace, or repair, no legislator would have escaped unscathed. The proposed bill brought out what can be arguably be called a push poll that demonstrated the political cost to Republicans who might endanger coverage.<\/p>\n According to the Quinnipiac University Poll, 56 percent of American voters disapproved of the plan, while only 17 percent supported it. Among Republicans, only 41 percent supported the plan.<\/p>\n \u201cReplacing Obamacare will come with a price for elected representatives who vote to scrap it, say many Americans, who clearly feel their health is in peril under the Republican alternative,\u201d said Tim Malloy, assistant director of the Quinnipiac University Poll.<\/p>\n Hooked on Medicaid <\/strong><\/p>\n In policy, \u201cratchet effect\u201d describes when government programs dial back, but not to the original levels before being introduced. A ratchet for Medicaid may not get the chance, and ironically it was Republicans who cranked it tighter despite making the health care issue a talking point for the last eight years.<\/p>\n According to the Congressional Budget Office, 14 million more people would have been uninsured under the proposed health care law than under Obamacare. By 2026, an estimated 52 million people under age 65 would be uninsured. (Under the ACA, only 28 million would be uninsured by the same year.)<\/p>\n While Republicans agree the current Affordable Care Act is not sustainable, the reasons are not unanimous. Congressional delegations and governors of several states say it\u2019s only unsustainable because of Medicaid expansion – one of Obamacare\u2019s biggest building blocks. After the ACA went into effect in 2014, 31 states, more than half the country, expanded Medicaid, which offers subsidized health care to low income individuals through federal and state funding.<\/p>\n Critics of the ACA claim that these states are now \u201chooked\u201d on federal dollars. Florida Republican Gov. Rick Scott \u2014 whose state opted not to expand Medicaid and is currently supporting a full ACA repeal \u2014 made various statements to this effect.<\/p>\n \u201cWhy would we do that to our citizens – get people hooked on something they didn\u2019t ask for?\u201d Scott said during Politico\u2019s Fifth Annual State Solutions Conference in February 2015.<\/p>\n Indeed, conservative warnings about government program growth have now crystallized. For some of these states, a Medicaid cut could worsen a budget gap or potentially cause one.<\/p>\n The congressional delegations and governors of states including Alaska, Arkansas, Colorado, Michigan, New Hampshire, Nevada, and Ohio \u2014 all but one of which have Republican governors \u2014 opposed any kind of Medicaid restructuring that would either lessen coverage for those in the expanded class or dump more of Medicaid\u2019s costs onto state governments.<\/p>\n Congressmen and state officials in some of the states opposing a Medicaid rollback say treasuries won\u2019t be able to absorb the financial effects of a wide-ranging repeal of the Affordable Care Act, particularly when there are budget holes.<\/p>\n \u201cWith a $3 billion budget deficit in Alaska, we simply cannot absorb a shift in federal responsibility to states,\u201d said Valerie Davidson, Alaska\u2019s Department of Health and Social Services Commissioner.<\/p>\n