The Senate is about to vote on legislation affecting the health and welfare of millions of American families. Even the disastrous hurricanes, which changed the lives of so many people, won’t have the broad impact of the vote to replace the Affordable Care Act with the latest version of Republican health care thinking.
The outcome is uncertain. This new law could stand or fall by one vote. It’s a Republican-only bill, designed without public hearings or Democratic input, and they can spare at most 2 “no” votes. So all the attention is on the possible “no” Senators. What is swaying them one way or the other?
There’s no reason to mention their names. They have gotten enough attention to their political and moral agonies. What about the 50 or 49 other Republican Senators who are all in?
Barely anyone in America likes this legislation outside of Republican politicians. For most of its life, a majority of Americans have expressed opposition to “Obamacare”. Its approval rating has been below 40% since 2011, the year after it passed. But in March, approval reached 49%, finally beating out disapproval. At that time, a majority of Republican respondents approved of its major provisions and favored spending more money on health care.
In June, many polls showed that Americans rejected the “replace and repeal” version passed by the House, called the American Health Care Act (ACHA), by a more than 2-1 margin. Only about one third of Republican voters approved.
Another detailed survey, which informed respondents about current and proposed laws, found that one quarter of Republican adults found the Republican health care bill “unacceptable”. Combined with overwhelming Democratic and Independent rejection of the legislation, a majority of voters even in the most Republican districts said “unacceptable”.
In July, another poll found that people preferred Obamacare to the Republican alternative 2 to 1. Nearly three times as many people preferred that our government “provide coverage for low-income Americans” rather than “cut taxes”.
More directly personal, a poll found that more than half of Arizona voters were less likely to vote for Republican Sen. Jeff Flake because of his support for various Republican plans. A majority approved of the opposition to Republican health care by the other Senator from Arizona, John McCain.
The only poll thus far about public reaction to the latest version, the Graham-Cassidy health care bill, shows less than a quarter of Americans like it. Another way of putting that is that ordinary voters reject it by 2 - 1, with another quarter still unsure. Big majorities understood exactly what Graham-Cassidy would do: costs for most people would rise; fewer people would be covered; protections for people with pre-existing conditions would be scaled back. By 3 - 1, people wanted Congress at least to wait for a detailed analysis by the Congressional Budget Office. By an amazing 5 - 1 margin, Americans agreed to two principles: “no one should be denied lifesaving healthcare coverage for themselves or their families because they can't afford to pay,” and “changes to the health care law should be bipartisan and should include hearings that take into account the views of experts, patients, and providers like doctors.” Even most Trump voters agreed with those ideas.
The unanimous voices of the people who take care of our health have consistently rejected the Republican bills. In March, the American Academy of Family Physicians, the American Nurses Association and the American Medical Association scorned the AHCA. In June, the AMA, the American Hospital Association, the Association of American Medical Colleges, and the Federation of American Hospitals opposed the Senate bill that later died. Now all major organizations of doctors,the whole health insurance industry, plus organizations of hospitals, the Catholic Health Association, the AARP, and dozens of other organizations oppose Graham-Cassidy.
The health care numbers can be confusing, especially when each side chooses the numbers they talk about. So let’s get specific about my demographic, old people. The CBO explained in May how the AHCA would affect people over 64 who earn $26,500 a year in 2026. That’s the median income of seniors. Instead of paying $1700 a year in insurance premiums under current law, premiums would rise to over $13,500, more than half their income. For a person with an income of $68,000, the numbers are very different: premiums fall from $5100 to under $2000 for a 21-year-old; from $6500 to under $3000 for a 40-year old; and remain about the same for a 64-year-old. Unless you are well off, you would be deeply hurt.
Why don’t most Republicans in Congress worry about voting for such an unpopular policy? It’s not voters who matter, but donors. Senator Cory Gardner of Colorado told his Republican colleagues, “Donors are furious. We haven’t kept our promise.” Big Republican donors are angry that the Republican majorities have accomplished little. Republican politicians are worried about money they could raise for the 2018 elections, not about depriving millions of their health care. Their donors want to slash Medicaid, so that’s what they’ll vote for. Republican senators apparently don’t even know in detail what their bill contains.
The devil is in the details. Will the billionaires win, while the rest of us lose?
Published in the Jacksonville Journal-Courier, September 26, 2017