For 7 years Republicans have railed against the Affordable Care Act or Obamacare. In the just completed 2016 election Republicans ran against the plan by promising to “Repeal and replace it.” Now they are stuck with that promise and it may harm their efforts.
If the promise had been to repeal without the replace element they might have had an easier time because most republicans agree that it should be repealed. Replace Obamacare is a little more difficult than it sounds because there are so many different views. Some conservatives would prefer just repeal. Some Moderate Republicans favor a broader approach, one in which they could keep Medicaid but place limitations on it. Still other members of the GOP fear the repercussions of taking healthcare away from people who had it under Obamacare could be disastrous, and all of them know that whatever they pass, they will own and that criticism of Obamacare will be replaced by criticism of the new law. Even the word replace is controversial because many believe that it means nothing will change. At the bottom of it all is the Republican philosophy that says if we provide any coverage it must be fiscally sound and not drive us deeper in debt and there’s the rub. There are no guarantees. The entire bill is based on theory, not practicality so thee’s no way to guarantee any result. The new bill as explained by House Speaker Paul Ryan pretty much guts Obamacare but leaves some parts of it intact. Still, his bill and the one that bears the former President’s name are not the same, not by a long shot. Here are some basic differences.
- Tax credits to help buy insurance
Republican supporters say Ryan’s bill uses the market, rather than government control, to provide healthcare. It will provide refundable tax credits based on age and income to help that individual purchase coverage if insurance isn’t available at work. If you are under age 30 you will get $2,000 a year; if over $60 the amount is $4,000. Wealthy people (don’t know how wealthy is defined yet) will not be eligible for tax credits.
- No more limits on healthcare savings
Obamacare placed limits on how much money you could have in a health savings account, the new act doubles the amount. Also, no one will be forced to have health insurance and many employers will not be required to insure their employees.
- You can’t be fined for being uninsured
Obamacare would fine people who didn’t have health insurance and required that large companies provide coverage. Under this new bill there would be no fines but insurance companies would be allowed to charge a 30 percent premium if coverage lapses for 63 days or more.
- More pricing freedom for insurance companies
That means older people could pay five times more than younger insured people.
The expansion of Medicaid will get gradually rolled back. It is the program in which mostly federal funds support insurance for the most needy like those in deep poverty and the disabled.
- Many deep cuts in women’s healthcare
The GOP plan would cut federal funding for Planned Parenthood. Hospitals fear they too will suffer: Obamacare reduced the amount they had to write off from uninsured patients, with unpaid bills.
6.The cost of the Ryan plan
The Congressional Budget Office is scheduled to release cost and other figures on Monday, March 13. Usually, those numbers have an impact on the fate of the bill. But, true to form the Trump administration is attacking the numbers before they are released by saying the CBO figures just aren’t accurate and cannot be trusted. That’s a risky venture because if the CBO comes back with a favorable estimate, Trump and company will have lost a valuable ally. And, if in fact we can’t trust the CBO numbers then we really are in the dark as to the effect of the bill. Only after it has been in effect for a year or two would we be able to evaluate it and by then…well we won’t speculate any farther.
Will the Ryan Bill pass?
No one knows for sure but what we do know is that in the highly volatile and complicated legislative process few if any bills resemble the original language if and when they pass and this bill has some serious opposition from within the Republican party. At town hall meetings all over the country congressmen and Senators are running into harsh opposition to any changes to Obamacare. Some elected officials have already modified their stands on the issue.
In the house, the Freedom Caucus which is made up of Tea Party members, has already voiced their opposition to the bill on the grounds that it is “Obamacare light.” To pass the bill in the house Republicans need all 52 members of the party to vote “Aye.”
Opposition in the Senate seems just as strong. GOP Sen. Tom Cotton tweeted Thursday morning: “House health-care bill can’t pass Senate without major changes. To my friends in House: pause, start over. Get it right, don’t get it fast.”
Sen. John Thune told CNN that there are “lots of ways to fix and amend” the House bill in the Senate.
“I just think you have to have an opportunity for members of the Senate to have their input,” Thune said.
Sen. John McCain, who has long urged his fellow GOP colleagues to take things slow on health care reform, said this week that the two chambers are fundamentally different.
“I think (the House Obamacare bill) is a good blueprint but we have a lot of examination to do,” McCain said. “And that’s why we’re the Senate and they’re the House.”
In the meantime, both Paul Ryan and President Trump are saying that this is the party’s big chance to dump Obamacare and replace it with something more fiscally responsible and more responsive to patients. It seems, though, that not everyone is buying that argument and the process of passing a bill can be very complicated.
For the sake of argument let’s assume house members make more changes to the Ryan bill and finally pass it and send it to the Senate. The Senate will no doubt make their own changes. At that point, you will likely have two bills with significant differences. If that happens, the two bills will go to a Senate/House conference committee to pound out a compromise solution. If they are successful, the bill then goes back to the two houses for a vote before it can be sent to the President. Finally, of course, the President has to decide if he likes what the congress passed. He has four options, two each for passage or veto.
- If congress is in session and the President does nothing for ten days a bill automatically becomes law. A president might do this to tell congress and Americans that the bill does not have his complete confidence but it is better than nothing.
- His second option is simply to sign it.
The President also has two options for vetoing or killing the bill
- If the Congress is NOT in session the President can exercise a “pocket” veto which means he didn’t stamp “Vetoed,” on it, he just stuffed it in his pocket, so to speak and did nothing. A president might do this to tell Congress and Americans that he didn’t hate the bill, but he didn’t like it either.
- He could stamp VETOED on it. If that happens and the congress still wants to pass the bill over the President’s veto they can gather their members and call for another vote. It takes a two-thirds majority to override a President’s veto. Once done it automatically becomes law and the President does not have another chance to take action on it.
Republican leadership is doing its best to ram this bill through with as few changes as possible but that isn’t easy and the process is getting negative feedback already as some elected officials are calling for Ryan and company to slow down.
Finally, there is always the unpredictable President Trump. He could at any time offer some totally unexpected solution to the problem. As long as he’s in office, all bets are off on predictions. During the campaign President Trump said he was working on a bill that covered all Americans, everyone, he said. Well, where’s his bill? This one was
During the campaign, President Trump said he was working on a bill that covered all Americans absolutely everyone. Well, where’s his bill? This one was developed by Ryan and Friends and it certainly does not cover everyone unless they mean us to think that access to care for everyone means coverage. Access just means it is there if you can afford it. For example, I have access to a Rolls Royce but I don’t have one.
Hang in there friends and remember that you can count on this. There are lots of surprises yet in store and whatever health care bill we get won’t be what we’ve talked about here.
And from where I sit, that’s the truth