Friday 23 June 2017 – Trump and the Republicans a step closer to passing their proposed replacement for “Obamacare”


Above: Senate majority leader Mitch McConnell after a Republican meeting yesterday on the health care bill


After seven years of promises that the Republicans will repeal and replace President Obama’s Affordable Care Act, generally known to one-and-all as “Obamacare,” the Senate is perhaps on the verge of passing the proposed replacement – the American Health Care Act (AHCA). Obamacare, despite voracious opposition to it from the Republican party and from Donald Trump during his election campaign, was seen by many as a positive way forward.  It required all citizens to have health insurance, with penalties through the tax system for those that didn’t – it’s primary aim to extended health insurance to the estimated 15% of the population who had none.  Obamacare also required larger companies to offer health insurance and perhaps most importantly prevented health insurers from discriminating against those in the population with pre-existing conditions such as diabetes by refusing to cover them with insurance policies.  Obamacare also tried to offer users freedom to shop around and compare quotes – whereas previously many people were restricted to just one or two potential insurers in their State.  President Obama’s health care plan allowed young people to remain on their parents’ policies until they were 26 and expanded the eligibility to receive the State-funded Medicaid plan for the poor and elderly.  Over time, it was argued, Obamacare would have reduced the overall spending on healthcare in the United States – which despite the fact that healthcare is funded through private insurance, is still the highest of any Government in the world.


Above: simplified breakdown of the differences between the ACA and AHCA.  read more here.


Obamacare was far from perfect and certainly a long way from the feared socialised healthcare that many Americans seem to be so irrationally afraid of, but with the opposition to the Affordable Care Act from President Obama’s detractors, it was perhaps the best that the former President could achieve.  However, any steps towards socialised  medicine – perceived and real – were too much for the reactionaries in the Republican party and especially with the alt-right elements in the party.  They saw it as an intrusion into the affairs of businesses and individuals – the so-called threat of big government.  They also argued that Obamacare would be a “job-killer.”  Estimates, to the contrary, suggest that jobs in the healthcare sector have actually risen by 9% since the Affordable Care Act was implemented in 2010.


Obamacare has faced problems since it was implemented. The Supreme Court in 2012 ruled that the ACA’s attempts to force States to increase the coverage for Medicaid beyond the poor was unlawful and allowed States to opt out of participating in  Medicaid. This led to poor and working families who don’t qualify for Medicaid having to pay for their own private insurance.  Some insurance companies stopped participating in Obamacare because fewer Americans were signing up than anticipated. That forced insurance prices up, which then increased the numbers not signing up.  Some better off families were choosing to pay the fines for not getting insurance than taking the subsidies available under Obamacare, which were too small to make it worthwhile.  Premiums under Obmacare have risen by an estimated 25% by this year.


The Republicans tried many times to delay and block Obamacare during the administrations of President Obama.  After years of attempts, they are now on the verge of succeeding in repealing and replacing the ACA with a new American Health Care Act (AHCA).  The new proposed bill was unveiled at the Senate yesterday.  It’s focus will be to make massive cuts to Medicaid and to end the mandate that Americans will have to have health insurance or that companies have to provide it.  It will create tax credits to help people pay for health insurance and will offer States the ability to opt-out of major areas of healthcare coverage – including, astonishingly, emergency care, maternity care and mental-health care – all of which are covered under Obamacare.  Despite offering some compensation for the spiralling cost of insurance, the AHCA would lower the limit at which subsidies are available to about $42,000 for an individual.  It was previously set at 400% of the poverty level but will now be reduced to 350%.  Under the AHCA older people would be paying up to five times more for their insurance coverage than younger people – as older people use the services more.  Under Obamacare it is three times as much.


The new proposals would see massive cuts to Medicaid. Not only would eligibility decrease, but Medicaid would effectively be restricted to a fixed budget – ending an open-ended entitlement that exists under Obamacare.  The AHCA will repeal most of the tax increases imposed by the ACA to help fund the expansion of Medicaid.  This will hand a massive tax cut to the more affluent and would see billions of dollars lost to Medicaid funding.  Medicaid is currently used by one-in-five Americans, and not just poor Americans but – for example – two-thirds of people in nursing homes.


The American Health Care Act will go before the Senate next week.  If passed, President Trump could see his much-vaunted replacement for Obamacare become law within hours of the debate.

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Above: Former President of the USA Barack Obama


President Obama has often been reluctant to make political comments since his administration came to an end in January, but yesterday he wrote about the proposed Republican bill.  He urged people to demand compromise from their lawmakers and said, on his Facebook page:


“The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else.”


Opposition to the bill exists not only amongst the Democrats in the Senate, but some Republican Senators are expressing their concerns.  Majority leader Mitch McConnell, who will be responsible for mustering the forces to pass the AHCA, said:Obamacare is collapsing around us, and the American people are desperately searching for relief.”  Senator McConnell, however,  knows that it would only take the loss of three Republican votes to scupper the bill.  A loss of just two would force a tie – assuming all the Democrats vote against it.  The Vice President Mike Pence would then have a deciding vote, presumably in favour.  Many are concerned that the bill has ben drafted in secrecy, without a single drafting session or public hearing.  Many Republican senators are looking to their States and seeing concerned constituents who are worried about the roll-back of Medicaid and the other measures of the AHCA and are facing pressure from them and from their State Governors.  The Budget Office estimates that the AHCA would leave 23 million Americans without insurance within the next decade as subsidies to the States are phased out and Medicaid is slashed. As this happens, States may struggle to fill the gap in funding and the situation will get worse.  States may choose as a consequence to opt out of certain requirements now mandatory under Obamacare.  While people with pre-existing conditions will still be able to get insurance, their treatment may be refused through State opt-outs or waivers, therefore increasing the out-of-pocket costs for individuals.


At least four Republican senators have said they will oppose the AHCA without changes.  They are Rand Paul (Kentucky), Mike Lee (Utah), Ted Cruz (Texas) and Ron Johnson (Wisconsin).  They said in a joint statement: “It does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.” Other senators, such as Dean Heller (Nevada) and Rob Portman (Ohio) have expressed doubts. Various health organisations have also expressed their concerns, including the American Association of Retired Persons (AARP), the American Hospital Association, the American Cancer Society Action Network and the Association of American Medical Colleges.  The latter wrote:


“We are extremely disappointed by the Senate bill released today. Despite promises to the contrary, it will leave millions of people without health coverage, and others with only bare-bones plans that will be insufficient to properly address their needs.”


President Trump said he was “very supportive” of the bill, though earlier yesterday he described the cutting of Mecicaid as “mean”, fuelling some speculation that Trump was not 100% behind the bill. This seems contradictory as this bill has been spurred on by the President’s campaign pledges to repeal Obamacare and his own federal budget would slash the funding to Medicaid.  A White House spokesman, Sarah Huckabee Sanders declared yesterday:  “I don’t believe that the president has specifically weighed in that it’s right to cut Medicaid.”  This conflict of message will only hinder the passing of the Senate AHCA bill.


I find it deeply disturbing and astonishing that the richest country in the world is in the situation it finds itself in in relation to healthcare.  It is the only country in the developed world that does not have some system of nationalised healthcare – or socialised healthcare as many Americans often dismiss such systems.  President Obama, as had other presidents before him, have tried to reform the system for the better but the AHCA seems to be set to drag the American system back towards being run solely for the benefit of the private insurance companies, drug companies, private health providers, lobbyists, and politicians who benefit financially or politically from maintaining control over health insurance in the United States.  As a consequence millions of Americans will again face the dilemma of not being able to afford health insurance and those who can may find that their coverage is drastically less than they expected when it comes to needing treatment.  It seems that only in America is that perceived and accepted by so many as normal and acceptable, and indeed desirable over a comprehensive government or state-funded system of social healthcare.


Many Americans seem to think that socialised healthcare equates to socialism – the great evil in American right-wing ideology.  We even see people decrying the message that the Government should  keep their hands off their Medicaid – seemingly ignorant that the Government is the one paying for their Medicaid.  The United States Government spends the most of any nation in the world on healthcare, yet that is somehow not seen as social healthcare.  The United States is rightly proud of many of its achievements in the world, from its Constitution to its cultural dominance in the world, but the often-vaunted idea that America is the greatest nation on Earth is so far from the mark to be laughable when we see another American waving the Stars and Stripes and chanting U-S-A.  For many outside your country we find it repulsive.  You are not the greatest nation on Earth – by a long way.  On many social and economic measures you rank far down world league tables – on everything from literacy to life expectancy and quality of life.  This also applies on healthcare.  The Legatum Institute in 2017 compiled a list of the 16 best healthcare systems in the world, the USA didn’t make the top 16.  The World Health Organisation complied a similar list and the US came in at 37th, behind countries such as Costa Rica, Morocco , Oman and the United Arab Emirates.


While the United States provides some of the best and most advanced healthcare in the world, that provision is hugely  dependent on a  person’s individual wealth or their ability to pay for insurance themselves or through their employer.  For countless millions of poor, elderly and people with chronic and pre-existing conditions access to the best healthcare is restricted by simple financial implications.  This is a travesty on a country that has rightly inspired many other nations around the world with its ideals of freedom, democracy and the American Dream.  Many countries aspire to elements of American life and society but none aspire to emulate your healthcare system.  Every other developed country in the world provides a measure of social healthcare – some directly funded by the Government, such as in the UK, others with a combination of insurance and government funding, such as in Australia.  All aim to have systems were people have access to treatment – free at the point of service – for all its people irrespective of income.  It is unimaginable in those countries that you would have to prove your eligibility for treatment before receiving that treatment.  It is seen as inhumane to turn people away because their insurance doesn’t cover a particular treatment or drug.  Why don’t you?


On a purely political level it astonishes me that the right in the Republican party in the US seem so intent on destroying Obamacare, and their opposition to it seems so much more about ideology and attacking President Obama than it ever had to do with their concerns for the healthcare system – or, God forbid, the people of the United States.  The notion that you can take healthcare away from the poor to fund tax cuts for the affluent is just plain obscene.  Such perverse redistribution of wealth exists around the world, including here in the UK, and it is a damning indictment on today’s political mentality of so many politicians.


It is the measure of the civilised nation how you treat your poor and vulnerable.  Denying millions healthcare simply because they are poor, old, have a pre-existing condition, or – as is proposed in the AHCA – because they are pregnant, is simply barbaric.  As an outsider living in the UK under  a system that funds its healthcare directly from taxation, it defies belief that the American system can even exist.  The UK’s National Health Service (NHS), founded in the late 1940s,  has many problems, including under-funding, but most people don’t believe that ending the NHS in favour of private insurance is a good idea and most Briton’s would be happy to pay a little more tax in order to ensure the NHS is funded adequately.  For example, at the Brexit referendum a year ago today at which the electorate decided that Britain should leave the European Union (EU), many voted to leave in the belief that the money saved from not having to pay our contributions to the EU budget would go into extra funding for the NHS.  They were lied to by right-wing politicians and any money saved will not reach the NHS, but it shows that the public are happy for more taxpayers’ money to go to the NHS.


Many Americans seem to think that all taxation is bad.  However, without taxes you don’t get public services.  While taxes should be maintained at a reasonable level and your ability to pay them should be taken into account at how much you pay, you need taxation to sustain a healthy society.  Most countries in the developed world accept this and in return for their taxes they demand public services.  In America you seem to have the notion that the taxes are being stolen from you by the Government.  Who do you think pays for your public schools, your police, fire fighters, Medicaid – and so on?  You do, through your taxes.  Instead of complaining about Government interference in your life and them taking your money in taxes – you should perhaps be demanding that those taxes are spent on your health system and public services rather than on wars and tax cuts for the rich.  I know that many of you already are and this is fantastic, but sadly many of you – including the very people who are worst affected by cuts in public services –  are going along with the right-wing ideology that is driving this drive to a smaller Government.  Trump and the Republicans aren’t interested in protecting you, they are only interested in creating more wealth for themselves and their business cronies. Do your taxes go down when your public services are cut?  I guess for most they don’t.  The taxes of the affluent and businesses go down at your expense.  The AHCA is a classic example of this.


The future of the American healthcare system is now in the hands  of the US Senate.  The passing of the AHCA will setback what little progress you have made – perhaps for another generation.  Some 20 plus million people will again become uninsured and again the rest of the world will watch on in disbelief, anger, frustration and disgust.

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