ACA Repeal Passes the House: What Does This Really Mean?

In a 217-213 vote, Republican members of the House of Representatives managed to pass a bill yesterday (May 4th, 2017) that will supposedly begin the process of repealing and “replacing” the Affordable Care Act. While the President and members of Congress are celebrating their symbolic victory, it is important to pay attention to the big picture. The first noteworthy subject is the Senate, which has promised a deliberation process that will last upwards of six weeks and include a proper evaluation by the Congressional Budget Office. There have also been hints from more than one Republican Senator that the bill that the Senate will vote on will look little, if at all, like the bill that exited the House today. Now, given whose hands this is in, that’s not necessarily encouraging in itself– a new bill doesn’t necessarily mean a better bill. That said, the new bill would then have to return to the House for approval, and given what happened the last time the House had a more moderate healthcare bill in front of them, one can imagine that negotiation process will be…difficult, at best. Assuming the Senate passes a bill, it will then most likely go to committee for debate and compromise before coming to a vote in both houses once again. In short, this is far from over.

That should not, however, serve as an excuse to be anything less than acquainted with the nature of the bill as it presently stands. Most notably, the classification and management of individuals with pre-existing conditions has been at the forefront of conversations, and rightfully so. While we do not fully know what is and is not funded by the bill yet–neither do many Republicans who voted for it– we have had several glimpses into its contents. First, an amendment to the bill proposed by Representative Tom MacArthur (R-NJ) will allow states to petition the federal government for the right to charge individuals with pre-existing conditions more. States who take advantage of this will be required to maintain a so-called “risk-sharing” plan, which will be partially subsidized by the eight billion dollar amendment that was added yesterday, May 3rd, to help cover the cost. The AARP, among others, have described this funding as inadequate. The bill also does not define pre-existing conditions that would qualify for the waiver– meaning any condition identified by insurance companies would likely be at risk. Here are some examples:

  • Mental Health: Anorexia Nervosa, Bipolar Disorder, Bulimia Nervosa, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Schizophrenia, etc.
  • Behavioral/ Developmental Health: Autism Spectrum Disorders, Down Syndrome,   Attention Deficit (Hyperactivity) Disorder, Tourette’s Syndrome, etc.
  • Chronic Physical Health Conditions: Arthritis, Asthma, Blindness, Cancer, Deafness, Diabetes, Epilepsy, Heartburn, Hepatitis, Heart Disease, HIV/ AIDS, Migraines, Obesity, Osteoporosis, Paralysis, Tooth Disease, Ulcers, etc.
  • Women’s Health: Cesarian section, Endrometriosis, Menstruation, Ovarian Cyst,  Premenstrual Dysphoric Disorder (PMDD), Postpartum Depression, Polycystic Ovarian Syndrome (PCOS), as well as surviving domestic violence or sexual assault, etc.

For a full list of conditions, see below, courtesy of Igor Volsky:

Now, first and foremost, health insurance absolutely is a game of odds: many of these disorders do carry a higher risk of needing health care, and some would argue that that means it is reasonable to ask those people to pay more. This might seem fair in the absence of context, but looking closer reveals the myriad problems with such a mentality. First, many chronic and deadly diseases disproportionally affect minorities in this country, particularly people of color as systemic inequalities in socioeconomic status make access to adequate nutrition, as well as preventative and responsive care more difficult. This reality is further complicated by the decreased likelihood of adequate government intervention in minority-prevalent and low-income areas facing public health crises. Flint, Michigan, a city in which more than half of residents are African-American and the average resident is living below the poverty line, tells this story as well as anywhere: residents remain without clean drinking water three years later. So, minorities are more susceptible to disease and less likely to receive federal aid to manage public health crises. Now add the likelihood of facing discrimination when seeking care, and subsequent inequities in the care provided to people of color, individuals of low socioeconomic status, non-heterosexual individuals, transgender or gender non-conforming individuals, women, individuals with low levels of education, and people with disabilities– a likelihood high enough to compel the CDC to begin issuing annual reports on the subject. Finally, consider that the people most disproportionally affected by these diseases, and the most likely to receive discriminatory and unequal care, are also individuals most heavily impacted by financial inequities– namely, the wage gap, and discriminatory hiring practices, assuming they have the necessary documentation and ability to work in the first place. It is also important to note that, regardless of minority status, many of these diseases would make it difficult for a person to work full time, or at all. So, is it reasonable to demand higher payment from these individuals, or from people who are healthy and making more money than average? Maybe it’s the liberal in me, but it seems two things should be clear: 1) if the United States is going to continue to tout the myth of American Exceptionalism, we need to get on board with other leading nations in recognizing healthcare as a fundamental human right– not a right of the wealthy, or even a right of citizenship; 2) if changes to the Affordable Care Act need to be made, it is because the ACA does not do enough to progress healthcare in the United States towards a single payer system, not because it does too much.

One would imagine it is for this reason that Democrats in the House of Representatives sang “Na Na Na Na, Na Na Na Na, Hey Hey, Goodbye” at House Republicans yesterday following the passage of the bill, with the obvious implication being that those who voted to take healthcare away from their constituents will have a difficult time getting re-elected. So, while Republicans gleefully celebrate the first step in reversing human rights progress, it is our job to ensure our Democratic representatives were correct, and to fight against this bill–or whatever version of it emerges from the Senate–with all of our efforts. It is no understatement to say that there are millions of lives on the line.

Finally, for your daily dose of irony, I give you this:


Yes folks, that is Representative Jason Chaffetz (R-UT)–who just had surgery for a pre-existing condition in his foot–gleefully rolling into Congress to take away your ability to afford to do the same. Chaffetz also recently announced his decision not to run for re-election in 2018. From the looks of things, that seems like a sensible decision to me.

— This is the ALF, signing off.


Republicans Change Course, Prepare for Healthcare Vote Thursday

Not more than a few weeks after declaring “Obamacare is the law of the land,” House Speaker Paul Ryan and the Republican party are moving forward with a modified American Health Care Act, and have declared their intention to bring the bill to a vote in front of the entire House of Representatives tomorrow, Thursday May 4th.

Discussions to revive the AHCA (Trumpcare, Trump(doesn’t)Care, RyanCare, GOPCare, Zombie Care, take your pick) began shortly before President Trump’s 100th day, in what appeared to be a frenetic search for a campaign promise that would be possible to fulfill prior to the ultimately superfluous deadline. For the majority of that time, however, there has been little indication that these conversations would end any differently than they did the first time around– the common belief has been that the votes simply are not there. The original amendment to the bill was enough to bring the ultra-conservative Freedom Caucus’ votes back on board, but simultaneously  alienated moderates by further stripping protections for pre-existing conditions.

So what changed between late last week and today? The absolute answer is unclear, as the Congressional Budget Office will not be able to compose a cost and effect estimate before the amended bill comes to a vote Thursday. If nothing else, that should make clear exactly how concerned Republicans are about the effects of this bill: they want to ensure it is passed before anyone can figure out what the cost will be– whether in dollars, or human life. That said, what we do know is that the compromise reached today, which brought several “no” votes back into the fold, added eight billion dollars in spending, purposively for offsetting the cost of treating those with pre-exiting conditions. Some Republican moderates say this is enough. The American Medical Association (AMA), American Association of Retired People (AARP), American Cancer Society, and Democratic party leaders do not agree, calling the number woefully inadequate and reiterating the statistic that, if passed, the AHCA will leave 24 million people uninsured in the next nine years. Senate Minority Leader Chuck Schumer also likened the bill to administering cough syrup to a person with stage four cancer, saying the AHCA leaves people as badly off as they were before the passage of the Affordable Care Act.

The question remains, does the Republican party actually have enough votes to pass this bill? Ultimately, this remains undetermined. House Majority Leader Kevin McCarthy (R-CA) has claimed that “the bill was passed,” but also, in the same breath, suggested we all “be optimistic about life,” so take that with as large a grain of salt as you feel it deserves. Minority Leader Nancy Pelosi (D-CA) did not offer an explicit opinion about whether the AHCA had the necessary support, but did emphasize that the Republican party would be hitching its moral and fiscal platform to the bill were they to garner the votes to ensure its passage. This is a fair, if less-than-optimistic point by Pelosi, but it seems there is one more important waiting to be made: even if the bill does squeeze through the House of Representatives, it will–far more likely than not–die on the Senate floor. Senate Republicans do not have the full majority to pass the bill in a partisan vote. Given that House Republicans made no effort to seek Democratic input on the bill, it seems unlikely that they would able to get any votes from them. The only remaining option would be to go nuclear, again, but Senate Majority Leader Mitch McConnell has vowed not to change Senate procedure regarding the passage of bills. Thus, even if Republicans do gain the symbolic victory in the House, it is highly unlikely to amount to anything meaningful. That is not, however, an excuse to become complicit: it is absolutely imperative that anyone and everyone who could be affected by this bill make their opinions about it known to their Representatives tomorrow, and, if necessary, their Senators in the coming weeks. The victories the Resistance has gained thus far have come directly at the hands of millions of people on the front lines, standing up and demanding their elected representatives do their job and represent the interests of their electorate. We cannot grow complacent now, or we risk losing the energy and renewed efficacy within the Democratic party that will drive us forward towards victories not just in resistance, but also in 2018 and beyond.

Finally, it is worth noting that this decision came in the midst of FBI Director James Comey’s second public testimony on the investigation into the Trump administration’s possible collusion with Russian efforts to undermine the election, and a day before Comey and NSA Director Michael Rogers testify in front of the House Intelligence Committee for the second time, in a closed session to allow for the presentation of classified information. It also comes the same day that the House approved a budget that would fund the Federal government through September, but included none of the provisions Trump insisted on. As Rachel Maddow reported last night, the budget is, line for line, effectively a list of Democratic policy goals. (This also led to quite an amusing conference call in which the White House attempted to spin the budget as a Conservative victory, though that is outside of the point of this post). With all this in mind, one has to wonder if this rush to pass the AHCA is nothing more than a desperate attempt to get a victory before anyone notices what else is going on.

It certainly is an interesting time folks. Expect more in the very near future as all of this unfolds.

— This is the ALF, signing off.