By Basil Wilson for Carib News –
The Town Hall meetings when House and Senate Representatives find the courage to face anguished constituents, vividly portrays the concern of the American people in regards to health care. We are presently in a state of purgatory with a bill passed by the House of Representatives and an ad hoc Committee in the Senate busy trying to concoct its own alternative to the American Health Care Act and the extant Affordable Care Act.
Health care in America has become a political football. Immediately after the Affordable Care Act was passed in 2010, Tea Party members flooded Town Hall meetings protesting the government takeover of health care. The passage of the ACA was President Obama’s signal legislative achievement yet the rancor surrounding the legislation was a critical factor in the Democrats losing control of the House and subsequently the Senate.
Now the shoe is on the other foot. Democrats sense that not only the ineptitude of the Trump administration but the confusion surrounding the American Health Care Act have created the necessary condition to take back the House of Representatives in 2018 and an outside chance of squeezing out a majority in the United States Senate. Despite the lack of clarity concerning the ACA and the AHCA, the debate on health care is shifting to a majority of Americans supportive of universal health care and it is the responsibility of the Federal government to provide that universal coverage.
America is the oldest standing democracy but it slowly and begrudgingly gravitated to universal suffrage and even today the skullduggery of gerrymandering and the barriers to voting in some states attest that the democratic ethic is not universally accepted in the political culture.
Rich white men had the prerogative of voting at the beginning of the Republic, then white men with or without property. Senators were not directly selected until the early twentieth century. Black men were not given the constitutional right to vote until after the passage of the thirteen, fourteenth and fifteenth amendment in the aftermath of the Civil War. Women were given the franchise shortly after the turn of the twentieth century and the civil rights movement partially shattered the Jim Crow undemocratic praxis that had been institutionalized with the rise of segregation and Dixiecrats in the remnants of the fallen Confederacy.
America, like its democratic processes, has been backing into the expansion of health care for all its citizens. It was President Lyndon Johnson who was instrumental in enacting into law Medicare for senior citizens and permanent residents domiciled in America. There was tremendous resistance to providing the elderly with health care. Right wing ideologues kicked and screamed that it was not the role of government to provide Americans in their golden years with affordable health care.
The same contentiousness occurred over Social Security in the 1930s when President Roosevelt enacted legislation that resulted in the era of the Great Convergence. Today, Social Security and Medicare, are programs administered federally and considered sacrosanct.
The design of the Affordable Care Act was to provide health care to Americans who were not receiving those benefits from employers or who were under the age of 65. Even before the ACA, Congress had passed legislation that expanded children’s access to health care. Medicaid, a federal program also, provided health care for those living below the poverty line.
The ACA provided Americans of modest incomes with subsidies to partially cover insurance premiums. The original intent of the law was to expand Medicaid to all states and that would encompass health care to the poor but the Roberts Supreme Court ruled that states had the constitutional right to buy in or abstain from that provision on Medicaid. Many Republican governors and state legislatures opted out of the Medicaid expansion.
The ACA also mandated all citizens and residents to have health care or pay a penalty to the IRS. Insurance companies had to offer what became known as Essential Health Benefits which included maternity care, cancer treatment, mental illness and drug addiction. The community rating component meant that folks with a pre-existing condition could not be discriminated against and had to be offered the same premiums as other Americans who did not have a pre-existing condition.
The uncertainty concerning the ACA and the elimination by the Republican Congress of the billions of dollars set aside for the Risk Corridor caused insurance companies to not offer coverage in some counties of the country and was a factor in rising premiums.
The Republican alternative to the ACA, the American Health Care Act that was passed in the House has opened up a can of worms. Tax credits replace subsidies and there are billions of dollars set aside for what is called Patient and State Stability. Additional billions have been set aside for the treatment of mental illness and drug addiction. But to cajole the Freedom Caucus and to muster the 217 votes to pass the Bill, the states will be eligible to provide waivers to insurance companies to eliminate adherence to Essential Health Benefits and to Community Ratings. This invariably means that people with pre-existing conditions can be isolated and put into a special pool in which premiums will be unaffordable. The waiver for EHBs means that coverage for healthy clients will be more affordable but will worth very little. The suggested House bill returns us to a state of health care darwinsim.
Also of immense significance, the AHCA ends the Medicaid expansion in 2020 and concocts a new federal/state formula which will limit the capacity of the states to accommodate the needs of the disabled, the poor and long term care recipients, which is approximately 70 percent of the Medicaid budget.
The Republican House has rescinded the surtax on the wealthy which was in part used to make the ACA deficit neutral. Almost $900 billion of the surtax has been rescinded with the intent to provide the wealthy with a subsequent windfall in taxes.
The Senate Republicans will now try to concoct a bill that will be palatable to at least 50 Republicans. Were it not for the politicization of health care it would have made more sense to fix the weaknesses of the ACA but in contemporary American politics, political expediency “trumps” political rationality. The ACA federalized health care in the same vein as Social Security and Medicare. The AHCA resorts to state’s rights and aims to plunge Americans into the quicksand of fifty varying forms of quality health care.