Thursday 4 May 2017 – Trump scores first major policy breakthrough with his Obamacare replacement Bill

Note: some elements of this article, such as quotes by Bernie Sanders and Hillary Clinton, were added to article on Friday 5 May 2017


Both the President Donald Trump and Speaker of the House of Representative Paul Ryan (above) are celebrating today after the House narrowly passed the President’s American Health Care Act, his long-heralded replacement for the Patient Protection and Affordable Care Act –  the so-called Obamacare, which is how I will refer to it for the rest of this post (read the Act). President Obama’s 2010 Bill has been much maligned by the Republicans and Donald Trump made repealing it a cornerstone of his election campaign last year. Partly because it is seen by many as an inferior option to Obamacare, the American Health Care Act has struggled to get this far and has yet to get past what will be a difficult vote in the Senate. Today, however, the House voted in favour of the Bill by 217 votes to 213. Some 20 Republicans voted against their own President’s Bill and no Democrats voted for it. When it passed the Democrats mocked the Republicans by singing the 60s song Na Na Hey Hey (Kiss Him Goodbye), perhaps suggesting Republicans could be in for a rough time in their districts if the Bill proves unpopular.


The President took to Twitter before the vote, as per usual, to post of his plans to celebrate: “If victorious, Republicans will be having a big press conference at the beautiful Rose Garden of the White House immediately after vote!” Today’s success comes just weeks after the same Bill failed to get through the House after which Paul Ryan admitted that moving from opposition to governing had its “growing pains.” At that first attempt the Bill failed because the Republican leadership failed to garner enough support from their own party. Today there seems to have been enough rallying around to get it through the House, even though 20 Republicans still rebelled against Donald Trump’s flagship policy.  Compromise was reached, assisted behind the scenes by New Jersey Congressman Tom MacArthur and Mark Meadows, who is the arch-conservative chairman of Freedom Caucus. Also speaking before today’s vote, Mr Meadows said:


“It’s real easy to be unified when your vote doesn’t matter and you’re in the minority.


It’s much more difficult to be unified when you’re in the majority, and that’s what we’re seeing. But I think we’re making a big step forward today.”


Not everyone was so keen to see the Bill passed, with no Democrats voting in favour.Some post-vote reaction by Democrats include comments by Bernie Sanders, who ran for the Democratic presidential nomination against Hillary Clinton. He said: “Thousands of Americans would die because they would no longer have access to care.” While Mrs Clinton herself said on Twitter: “A shameful failure of policy & morality by GOP today. Fight back on behalf of the  millions of families that will be hurt by their actions.”.  Democrat Congressman Jim McGovern expressed his outrage, to wild cheers from other Democrats: “To have a healthcare bill that throws 24 million people off insurance – you should be ashamed.” The Democrats are vowing to make the issue the core of their 2018 midterm campaigns, and no doubt they are hoping that if the American Health Care Act passes and becomes law it will prove more unpopular than Obamacare it would replace.  One element that may prove deeply unpopular is the rights of individual states to opt-out of the requirement in Obamacare that insurers can’t exclude people with pre-existing conditions from coverage. This was common before Obamacare, but was outlawed as part of President Obama’s Bill. If states don’t choose to opt-out it will probably result in higher premiums for those with pre-existing conditions. The new Bill has assigned an additional $8 billion for  a fund for so-called high-risk patients, as a compromise to Republicans who objected to the opt-out clause. That amount though seems woefully inadequate when, according to the Guardian, “an estimated 27% of Americans under 65 have pre-existing conditions, which include chronic illnesses such as cancer, heart disease and diabetes, that were not covered prior to the ACA.” The Bill will also defund the women’s healthcare organisation Planned Parenthood and cut some $370 billion in a decade from Medicaid – the consequences of which will be catastrophic.


Republicans faced criticism for rushing the Bill through after years of criticising how the Democrats did, what they claim, was the same in 2010 under President Obama. The text of the American Health Care Act wasn’t published until last night and a timetable for the House wasn’t agreed upon by Mr Ryan until he knew that he had the votes ahead of a two-week recess due to begin tonight. Paul Ryan and the leadership feared delaying could give Republicans the chance to change their mind. Mark Meadows wasn’t having the claims of hypocrisy: “I have read the bill no less than six times. If they haven’t read the bill it’s because they haven’t the spent the time to do that.”


Today’s success for the President comes just days after he marked 100 days in office, and marked it without a single campaign pledge in place with the exception of appointing a Supreme Court Justice. Mr Trump was celebrating in the Rose Garden today with the Republican leadership (above).  Nevertheless, Mr Trump has declared Obamacare “dead,” adding: “Make no mistake, this is a repeal.” Yet his health care  Bill now goes to the Senate where it  will face tough opposition with the Republicans having a smaller majority. The Senate is expected to make changes to the Bill before they vote on whether to approve the Bill. The fight to repeal Obamacare isn’t over yet and the President and the Republican leadership may yet regret their White House celebrations today. To read more about the key differences between Obamacare and the American Health Care Act of Donald Trump, click HERE. To read a New York Times article on who will benefit and lose under Mr Trump’s healthcare Bill, click HERE.


The sad thing about the American Health Care Act and the way in which Donald Trump and the Republican right have maligned Obamacare is that Mr Trump’s Bill is likely to end up much worse and will end up costing more than Obamacare – less for more as many are suggesting. Less people will be covered. Millions won’t be covered at all, as was the case before Obamacare drastically reduced that number (see graph below). Those covered may pay more for less benefits and the proposed cuts in Medicaid are an obscenity to decency and basic humanity. President Trump boasts of making “America great again,” but this Bill if it becomes law will do nothing to improve America. A country cannot hope to call itself great, or even civilised, if it remains the only Western country without some level of universal healthcare. My heart bleeds for the poor and sick of America who have suffered at the hands of health insurers for decades and, under this Bill, will continue to suffer. For many that suffering will only get worse. Shame on you, America. Far from creating an image of greatness to the world, this Bill reinforces the image that America is going backwards and, for many, makes your country a laughing stock.


On a personal level, as someone with diabetes and kidney disease and having recently had a heart attack, it beggars belief when I think what someone in the United States in a similar position and doesn’t have the financial means or adequate insurance would do.  Here in the UK we have the National Health Service (NHS) which is paid for by for from general taxation. It costs a fortune to maintain, and even then not enough money goes into the NHS, but for what we get it still works out vastly less expensive per head for taxpayers than the private American system. Everyone pays taxes, even those out of work are paying VAT and indirect taxes, while those in work also pay National Insurance contributions and Income Tax.  Whether we are working or not, whether we are rich or poor, we can use the NHS at any time and pay nothing for its services – whether you have a splinter removed or a heart transplant. If you are working you will pay a fixed fee for prescriptions (£8.60 / $11.19 per prescription)j and will pay for dentist work and some other incidental things – but that is it. However, if you are out of work, under 16, over 60, a full-time student aged 16-18, a  mother with a child under 12 months, a prisoner or someone with a chronic illness such as diabetes, you pay nothing for prescriptions and dentistry either. When you use the NHS whether as an emergency or as an outpatient you pay nothing, no matter what treatment is required. Your doctors will prescribe treatments on a medical-need basis, not on whether you can afford them or your insurance will cover them.  It is not uncommon for some people to go their whole lives without once paying a penny in charges to the NHS. Of course, those people are paying through their taxes, but in times of need you don’t have to worry about how to avoid going bankrupt to pay for your medical care.


Clearly, the NHS has many problems – most notably underfunding and often long waiting times in emergency rooms and when waiting for appointments. Many people also have problems arranging convenient or quick appointments with their own doctors, or General Practitioners (GPs) as we know them in the UK.  These problems have been getting worse in recent years and that is damaging the reputation of the NHS and can be deeply frustrating and distressing for some. Nevertheless, despite all these problems, the NHS is there when you need it – from cradle to the grave as was envisaged when the NHS was created in the 1940s – using, ironically, American post-war loans as part of its original funding.  After the terrible years of the Great Depression and the Second World War, the people of Britain voted in a socialist Labour government in 1945 – ousting wartime Prime Minister Winston Churchill who deeply opposed the creation of the NHS and other social policies of the post-war Labour government of Clement Attlee.  The people of the UK in 1945 wanted a country truly fit, not only for heroes but for everyone. They had the promise after the Great War, but that only led to Depression and more war.  The post-war Labour government set up the National Health Service, creating  a universal healthcare system that survives – warts and all – to the present day. Sadly there are people in UK politics who would love nothing more than to get rid of the NHS and replace it with  some sort of system of insurance. Even those people, I suspect, wouldn’t wish to go as far as Donald Trump’s American Health Care Act will go or as far as the American healthcare system did in previous years. Some think this is already being worked towards by Conservative politicians by means of backdoor privatisation – by letting private companies operate elements of the NHS (although those services continue to be funded by the taxpayer), or by de-funding the NHS to the point where there will be a clamour for change – to the extent that people will except radical departure from the whole notion that the NHS is funded from taxation.  The NHS is often cited in polls as the most valued British institution. Such radical change would be a deeply sad day for Britain if it was to happen.


Clearly, the United States is never going to have a universal healthcare system to the extent of that in the UK and other European countries.  The insurance companies and their lobbyists are too powerful to let that happen, and sadly too many American politicians seem to be intent on ensuring that any notion of socialism cannot be tolerated in the States. Your fear of social policies and bizarre notion that you expect public services but don’t want the Government to tax you is just crazy – where do you think public services come from? Fair enough if you have high taxes and no public services, but no public services and low taxes is a recipe for disaster for vast numbers of people in your country.  Some of the most successful countries in Europe, in terms of standards of living, etc., all have high taxes. They also have great public services, education services, healthcare and those less fortunate are looked after and treated with compassion.  I guess in America the legacy of rampant capitalism and greed have taken over and people care less about the poor, sick, disabled and weak than they do about having as low taxes as possible and as little so-called socialist public services as a consequence.  Sadly, the UK is far from free from this sort of mentality and, in recent years, many of our politicians have swung drastically to the right and implemented savage austerity and public spending cuts on the public. Our current Prime Minister seems intent, for example, on a path of right-wing extremism – especially in her attitudes to Europe and our country’s decision to leave the European Union – known as Brexit.