22 million – that’s how many Americans would lose their health insurance, according to the U.S. Congressional Budget Office, if the reconciliation legislation approved by the U.S. House of Representative yesterday by a 240-181 vote were to become law.
The U.S. Senate approved the same bill in December and the House adopted it yesterday with no changes, so it is heading to the White House where President Obama is certain to veto the measure. The likelihood that House or Senate Republican leaders could summon the needed votes to override that veto is zero.
It’s easy to dive into the political games involved in this legislation because there are so many. Doing so, though, ignores our responsibility to recognize what this Congress has done – put itself on record to cancel health insurance for tens of millions of Americans and offer nothing, zero, to mitigate the harm to mostly low and lower middle income families.
Here are the bill’s key elements:
- Eliminate the ACA Medicaid expansion
- Eliminate the ACA’s premium and cost sharing subsidies to help lower middle income Americans buy private health insurance
- Repeal the ACA’s individual mandate which helps to ensure a healthy risk pool of enrollees to keep premiums affordable
- Cancel all federal funds to Planned Parenthood
One thing the legislation does not do is eliminate the ACA’s ban on pre-existing condition exclusions, a move which – absent the mandate and subsidies – will make the cost of health insurance premiums skyrocket in all state markets.
Some will say: didn’t the ACA cancel health insurance for hundreds of thousands of Americans who could no longer keep the coverage they had? That is true, and it is also true that every one of those who lost their coverage had a legal guarantee to purchase other insurance – with better coverage and lower costs for many. The vast majority of the 22 million the Republicans now choose to harm would have no coverage options.
Since the fall of 2013, 13.5 million low income Americans have enrolled in state Medicaid programs, most of these because of the ACA. The Republican bill would eliminate coverage for nearly all of them and put nothing in its place.
To be sure, Republican Congressional leaders, particularly House Speaker Paul Ryan (R-WI), are again promising to advance replacement legislation soon. We have heard this many times in the 5 years and 9 months since President Obama signed the ACA in 2010. As Huffington Post’s Jeffrey Young notes: “That should sound familiar, because Republicans leaders have said it before. In 2015. In 2014. In 2013. In 2012. In 2011. And in 2010, as soon as Obamacare became law.” If you want a laugh, watch House Budget Chairman Tom Price (R-GA – member of the House GOP “Doctors’ Caucus”) dodge any answer on Fox News of what a replacement might entail.
Meanwhile, the Republican Presidential candidates offer no better hope. Despite continuous slaps at the ACA, Donald Trump has failed to issue a health platform after promising to do so since last summer. Candidates Jeb Bush and Marco Rubio have paper thin policy platforms that guarantee nothing. No other Republican candidate has even tried to articulate a position.
Meanwhile, over the past two months, we have seen robust interest by millions of Americans, including first-timers, in using the ACA health marketplaces to buy insurance. We see Medicaid expanding in formerly recalcitrant states. We have seen five years of record low rates of increase in health care spending. We’ve seen ACA quality initiatives that have been tied to 50,000 fewer deaths from lowered rates of hospital-acquired conditions such as infections, falls, and medication errors. And a lot more.
What we get from the Republican Congress is the health policy equivalent of their orthodoxy on climate change, gun violence, tax policy, and so much else – heads in the sand. During last spring’s U.S. Supreme Court process on the King v. Burwell case, the deans of U.S. schools of public health estimated that just eliminating the ACA’s private health insurance subsidies would cause an estimated 9800 preventable deaths per year. Put that together with eliminating the Medicaid expansion, and we risk more than doubling that number of deaths.
Some suggest that this ACA legislation is meaningless because of the certain Obama veto. That view is incorrect. By successfully using budget reconciliation (requiring only 51 Senate votes for passage) to win Congressional approval of a bill to wreck health reform, Republicans have proven, without doubt, that if they control the White House, Senate, and House in January 2017 they can – and will – dismantle the most important piece of U.S. social policy legislation since the passage of Medicare and Medicaid in 1965, and do so with no regard or effort to ameliorate the deadly consequences of their action.
At least up until November 8 2016, please remember this number – 22 million.