Republicans have attempted to revise several aspects of healthcare laws since the beginning of the Trump administration, and Congressional stalemates are giving way to executive actions.
President Donald Trump campaigned on promises to swiftly repeal the Affordable Care Act (ACA), but after seven failed attempts in Congress, the President has turned to the executive branch. The administration released new rules which allow employers to stop offering contraceptives through health insurance plans for religious or moral reasons.
Shortcomings of Graham-Cassidy bill
The Graham-Cassidy bill was Congress’ most recent attempt to reform health care legislation, introduced by Republicans on Sept. 13, days before their deadline. The bill proposed state control of healthcare with discretionary block grants allocated to each state.
Graham-Cassidy would not have required employers to provide healthcare to workers, or to meet minimum-coverage provisions, according to Time. Under the bill, Americans would not be required to buy health care.
The urgency of the Graham-Cassidy bill remained a source of contention as Republicans tackled their deadline. The Congressional Budget Office (CBO) did not have time to release estimates on the long-term effects of the new healthcare system, and Georgia State professor Erin C. Fuse Brown said that a vote without the projected effects would be “completely unprecedented.”
“They [senators] didn’t know what it was going to cost because they didn’t have a CBO score. It is a terrible way to make policy in an area that is as complex as healthcare,” Brown said.
Graham-Cassidy was opposed by healthcare experts and hospital associations and was condemned by patient advocate groups like the AARP, according to Time. The bill ultimately lacked the support necessary to garner a simple majority in the Senate.
The defeat of the Graham-Cassidy bill marks a temporary end to Congressional attempts to repeal and replace Obamacare. Dr. Jeffrey Lazarus, associate professor of Political Science at Georgia State, attributed the failure to partisanship.
“Republicans have locked Democrats out of the decision-making process, and [are] pushing bills which Democrats will not and politically cannot support. This leaves Republicans with a very slim margin of error, because there are only 52 of them in the Senate,” Lazarus said. “At least 50 of them are needed to pass any bill. So once three Republican senators are opposed to a bill, it’s dead.”
While Lazarus said he does not believe the ACA will be repealed in current Congress, he believes healthcare will remain a priority within the legislature.
“[Everyone] uses health care at some point and it’s expensive, so it’s a very salient issue among voters. Republicans have spent the past seven years promising their voting base, and perhaps more importantly, promising their donors, to repeal Obamacare. Failing to do so makes them look ineffective,” Lazarus said.
Fuse Brown said that voters’ main concerns remain to be more affordable and accessible health care.
“The Republican proposals would have made insurance cheaper for those who are healthy and young, but that’s not the people who really care about coverage,” Brown said.
She added that cuts to Medicaid, which provides health insurance to low-income Americans, remains the most catastrophic provisions of the repeal and replace legislation.
“It was easy to vilify the ACA before the election, but I think poll takers are finding that public opinion has swayed—for the first time since the passage of the ACA, the majority of people approve of it,” Brown said. “Even among Republican voters, the number of people opposed to repealing the law has crossed over to the majority, which is very telling.”
Georgia Senators on healthcare
Both Sen. Johnny Isakson and Sen. David Perdue have voted in favor of each repeal and replace bill posed to the Senate, according to The New York Times.
Representatives for Sen. Isakson said that Obamacare is quickly collapsing, citing new data from the Centers for Medicare and Medicaid Services (CMS), part of the Department of Health and Human Services (HHS).
Isakson’s office said that block grants under the Graham-Cassidy bill would have given states the necessary flexibility to provide for the unique needs of their citizens while allocating funds more equitably to lower-income individuals in each state.
His office said that the same process of reconciliation applied by Republicans to repeal and replace Obamacare was used in 2010 to finalize the Affordable Care Act.
Marie Gordon, Press Secretary to Sen. Isakson, cited the new CMS data to dispute the accuracy of CBO scores. While these scores remain the “gold standard in Congress”, their estimates are not reliable, according to Gordon.
“This is partly because CBO uses a model of the health insurance marketplace that assumed that Obamacare’s requirement for all individuals to purchase coverage or pay a tax would be much more effective than it has proven to be in practice,” Gordon said.
While Sen. Isakson expressed disappointment that the Senate has not yet resolved healthcare issues, he is working to create more affordable policies for Georgians in 2018. His office said that affordable healthcare that guarantees coverage for people with pre-existing medical conditions remains to be Isakson’s priority.
Sen. Perdue said that a stronger health care system remains a priority in Congress. On the Senate floor, Perdue said that steep fines and high costs of coverage harm middle-class American families. Perdue mirrored the phrasing of his senatorial colleague, saying that current health care rates create a system “collapsing under its own weight.”
Perdue attributed the failure of the Graham-Cassidy bill to a “complete lack of Congressional leadership.”
“From the get go, three Republican Senate Chairmen failed to support our efforts to repeal and replace Obamacare as we have all promised to do. Today, political interests have again outweighed our national interest,” Perdue stated.
His support for the Graham-Cassidy bill did not hinge on CBO scores, which the Senator dismissed as unreliable.
“I haven’t seen a number come out of the CBO that I would depend on yet,” Perdue said.
New executive actions
Trump issued an executive order on Thursday, Oct. 12, that ends federal subsidies to insurance companies. These subsidies include $7 billion a year that support low-income individuals, according to The Hill.
The order also promotes association health plans which allow small businesses to band together in purchasing healthcare. Trump’s order undermines policies in the ACA and is meant to increase competition among insurance companies while decreasing the costs of coverage. Insurance companies experienced decreases in stock in the days following the order.
Understanding healthcare and the congressional defeat that led to new birth control policies