There are many reasons that Republican efforts to repeal the Affordable Care Act, and to replace it with inferior plans that would have also gutted Medicaid, failed in Congress. One of the biggest reasons is that Republican leadership, especially in the Senate, tried to pass proposals that were hastily written, had no clear policy goals, and had no objective expert analysis. As a result, those proposals would have harmed millions of American people.
So, it is disheartening, but not surprising, that President Donald Trump is now trying to undermine the ACA through backdoor executive actions, which could have dire consequences for millions of Americans, rather than a bipartisan effort to fix what is really wrong with the health insurance law.
After the last attempt to repeal portions of the ACA, known as “skinny repeal,” failed last Friday morning, done in by “no” votes from Republican Sens. Susan Collins, Lisa Murkowski and John McCain, Trump said he’d let the insurance program fail, to make lawmakers more eager to reach a deal. “As I said from the beginning, let ObamaCare implode, then deal. Watch,” he posted on Twitter.
Trump has suggested that his administration will end payments to insurance companies that encourage them to take on lower-income subscribers by lowering their out-of-pocket costs such as co-pays and deductibles. Without the cost-sharing reduction payments, many insurers would likely increase premium costs and some would drop out of the ACA market.
The administration may also stop enforcing the individual mandate, a much maligned portion of the law, but one that is necessary to bring younger, healthier people into the market.
Congress must quickly step in to stop such disastrous moves. The Senate Health Care Committee announced Tuesday that it will begin holding hearings early next month on how best to stabilize the individual health insurance market. Congress must also appropriate the funds to continue the cost-sharing reduction payments, which are necessary to keep health insurance affordable for many lower-income Americans.
“It really would be detrimental to some of the most vulnerable citizens if those payments were cut off,” Collins told CNN’s State of the Union on Sunday. “They’re paid to the insurance companies, but the people that they benefit are people who make between 100 percent and 250 percent of the poverty rate.”
“So, we’re talking about low-income Americans who would be devastated if those payments were cut off,” she added, noting that “the threat to cut off those payments has contributed to the instability in the insurance market.” The instability increased Wednesday when the administration said it would consider making the payments on a month-to-month basis.
The contrast between Trump’s threats and Collins’ focused problem-solving approach highlights the nasty consequences of the White House’s and Republican leadership’s obsession with ending Obama-era programs, even if it is bad for the American people.
What Trump and many Republicans in Congress miss is that they work for the people of the United States. Therefore, they should not try to pass laws or change policies that will end up hurting millions of them.
Gov. Paul LePage excoriated Collins for not supporting her party in a nasty, fact-challenged OpEd published Wednesday in The Wall Street Journal. He blasted Sen. Angus King, too, for voting against ACA-repeal legislation.
Trump and LePage, who love attention, should take note of the spontaneous support and appreciation that greeted Collins, not because she acted tough or made hollow promises, but because she listened to her constituents, took their concerns to heart and took principled stands to put these concerns ahead of party loyalty.
When Collins returned to Bangor last Friday after rejecting hurried, unvetted plans to gut the ACA and Medicaid, she was greeted by spontaneous applause from fellow travelers at the city’s airport. This was not a staged event with pre-screened attendees and high-priced fanfare, but a genuine, spur-of-the-moment show of support for the difficult work Collins had done.
Bangor is far from the often dysfunctional hubbub of Washington, making it a much better barometer of what real Americans value.