As you may know the American Healthcare Act, the Republican or Grand Ole Party (GOP)’s plan to replace the Affordable Care Act (ACA) or Obamacare did not make it to a vote, and is essentially dead. While the bill made it through different committees almost unanimously each time, the House did not have the requisite number of votes needed to pass a bill like that.
Before I go more into why this bill failed, a refresher on the ACA and the voting process is necessary. As stated by School house rock, https://www.youtube.com/watch?v=tyeJ55o3El0 a bill gets introduced, then it must go through committee, and each committee must approve. In the case of the recent bill, the American Healthcare Act, there three committees in the house that had to approve it, and did. The ACA went through the same committees and passed. The ACA then passed the House with the required 265 votes, with all Democrats voting yes, and all Republicans voting no. The bill then went to the Senate where it passed with the required 60 votes, all democrats and had 39 votes, all GOP, voting No, with one vote abstaining.
While there are many people who loved the ACA, there are just as many who dislike it, and the GOP took over most the Senate and the house mainly because of the ACA and tax reform. Thus, with this mandate, it should be easy to pass the changes to the ACA.
As we have seen though, there is no real agreement, and the new American Healthcare Act failed to make it to a general vote on Friday. Why did this happen? The simplest answer is the house did not have the minimum required votes of 216 to pass the bill and send it to the Senate. While the Republicans have a majority in the house, they needed 216 votes to pass the bill, and there were over 40 votes that they were not going to get form their own party.
A big voting block is the Freedom Caucus, this is a group of GOP congressmen, whom subscribe to the Tea Party ideology, and vote as a block These Congressmen, are not considered to be part of the establishment, but they play establishment politics as well. The Freedom Caucus, an extremely conservative group, holds most people hostage with their ideas because of their unity. However, they were not the only ones that did not like this version, there was another group of 25 moderate Republicans, who represent districts in heavily Democratic States and are in considered swing districts, that could not vote for this bill either. The GOP has been railing against the ACA for seven and a half years and yet their response when they finally had an opportunity to change it, was a bill that would raise premiums more than the ACA, although would reduce government costs, according to the Congressional Budget Office (CBO) over 14 million Americans that are covered now would not be covered in the next five years if the American Healthcare Act was passed. Most these losses would come from the rollback in extended Medicare coverage afforded by the ACA, but several others would opt out of coverage. The CBO was wrong about the effect of the costs of the ACA by over two trillion dollars (they were low) thus the American Health Care Act estimate really could have been in the 30 million range on uninsured which would be worse than we were before the 2009 ACA vote.
The reasons are numerous to the reason the American Healthcare act failed, here are some of them:
1. The American Healthcare Act (AHA) was written by a small group of Republican Leadership, Speaker Ryan, Secretary Tom Price (Health and Human Services) and a couple others wrote the bill behind closed doors. The bill was written hastily and without real input from all the different accuses and groups, or even the healthcare industry.
2. The AHA focused on weakening the current law, rather than a straight repeal or making substantial changes, both of which would require higher vote thresholds. Instead this plan of attack was meant to get a lower threshold of votes in the House and Senate just to fulfill a campaign promise, rather than really help reform the American Healthcare system.
3. The establishment leadership were trying to do a three-pronged approach to the healthcare system, the AHA which would gut the ACA but still leave it essentially in place while still cutting everyone from coverage and raising premiums drastically due to the elimination of the mandate, drop in requirements of coverage, yet still requiring the insurance companies to cover many things in their plans. Currently Insurance Companies are losing money as there are administrative caps on their policies, price raise caps, and that the companies cannot charge a sick person more than a healthy person, even though they need more care. Thus, with the AHA, these would have been eliminated and those that bought the insurance could have gone from 2,200 a year to 18,000 a year or more. This increase is needed anyways or at some part of increase as the insurance system is failing. According to the American Physicians Association (APA) 47% of primary care doctors in 2015 have severely limited or eliminated insurance carriers from their practice and by 2020 expect over 95% to be cash only and concierge. Other doctors are following suit like Dentists, Dermatologists, and several others. Psychologists, led this trend 10 years ago with now over 98% of Psychologists and Psychiatrists not accepting insurance anymore, going cash only and then allowing the patient to submit for reimbursement from their insurance. The ACA required insurance companies to cover mental health, but if the doctors do not take it, the reimbursement rate is low, thus you are paying for a benefit that most do not use.
4. The AHA eliminated the extended Medicare coverage. The ACA extended limits for Medicare and Medicaid. While the Supreme Court struck down the requirement for States to adopt this, many States chose to accept. The AHA eliminating this extension is the sole reason why moderate republicans did not sign on. Their districts are elderly and poor, the two largest voting groups, and to lose this coverage would mean most their constituents would be without coverage, which means in 2018, they might lose their jobs as Congressmen by being voted out.
5. The Freedom Caucus did not get everything they wanted.
6. The AHA did not eliminate the 10 mandatory health concerns of coverage. According to healthcare.gov (https://www.healthcare.gov/coverage/what-marketplace-plans-cover/ ) there are 10 essential benefits. Most of these benefits are for women’s health. Unfortunately, women’s healthcare costs are higher than men due to the complexity of women’s bodies and the amount of complication and lack of Doctors in the specialty thus increasing costs and limiting access for all. The AHA did not eliminate these mandatory coverages but also eliminated the mandate to buy insurance that would then force insurance companies to raise premium costs for all to cover care that may be used.
7. The Mandate to buy would have been eliminated by the AHA. A lot of discussion has been focused on the mandate. While the mandate was eliminated in language, it really was not. There would have been a surcharge, in the AHA, on premium if someone went without insurance for more than 63 consecutive days and the surcharge would be applied to the premium. The surcharge would go to the insurance company, whereas the penalty went to the Government through taxes. Something that the Freedom Caucus and the Moderates did not agree with.
8. There is a lack of leadership in the Senate and the House to get people together. Ideology has taken over our lawmaking process. President Trump, who was elected to “Drain the Swamp” sat back on this one letting the establishment do their thing, because as a business owner he trusted “his people”. Expect him to be more involved going forward on this issue and other priorities, as he has realized with this process the government is probably more broken than thought.
9. The AHA did not focus on reducing health care costs and weakened coverage. In healthcare, there are two sides to look at, Care and Coverage. Health Insurance only provides coverage. Having coverage is important and that is what we pay premiums for. However, coverage that no one (Medical Professionals) will take, people will not buy to lower premiums (Adverse Selection) and that has high deductibles is not coverage at all. I had a health scare last year myself, and we have decent insurance, but we were still out of pocket in the 5-figure area last year with our physician deductible, hospital deductible, copays, prescription costs etc.… Many households are finding the same problem, and the AHA did not fix this problem nor did they reduce premium costs, and when it came down to it, our Congress people were not going to create something worse than is already out there.
10. The AHA did not address the rising prescription drug cost problem.
These are 10 reasons why the AHA failed to be voted on, however, there are thirty more reasons. Bottom-line is the AHA was a hastily crafted bill, much like the ACA was in 2009, but this time we had lawmakers who realized this is a complicated problem and that we needed to create a bill that would gather large discussion and be robust and help the American Public, instead of one that at surface level met a campaign promise, but really harmed Americans.