I haven’t spent a great deal of time analyzing the details of the American Health Care Act [AHCA] passed by the House of Representatives on May 4. The reason? It is quite unlikely that this version of a healthcare reform plan [aka Repeal and Replace the ACA/”Obamacare”] will make it through the Senate, so I don’t want to spend a lot of time analyzing it until I see what “it” ends up being [i.e., until a compromised version can get passed by both Houses and sent to the President]. I should also point out that it’s probably safe to assume that Mr. Trump will sign into law whatever that compromised version turns out to be, because he will be actively involved in the Senate process and subsequently in the Conference Committee process [as he was in the House process], so House Speaker Ryan and Senate Majority Leader McConnell will know clearly where he stands on the bill throughout those processes. It’s difficult for me to imagine anything that would be more devastating to the Republican party than for the Republican president to veto a bill they managed to squeak through both the House and the Senate [or to allow the time limit to expire and let it become law without his signature].
I said in my 4/25/17 post that the not-yet-produced House-Senate compromise version I am now referring to again will ultimately fail, and I outlined the reasons I believe that is the case [see that post here: Repealing And Replacing The ACA – A Realistic View]. In a nutshell, those reasons boil down to failure so far for our leaders to recognize that success in this endeavor will require that the starting point be determining first what guiding principles can be agreed upon up front before hashing out of the details even begins [for more depth on this, see the full Some Basics First section near the beginning of my 12/13/16 post at this link: A Realistic View Of The ACA – Part 2].
First Things First
In predicting how this will all play out, all one needs to know are these facts [none of which have anything to do with logic about either what is the best way to maximize access to healthcare for more Americans or to strike the best balance between the cost and the quality of care]:
-  As depicted very well in the cartoon graphic I chose as the image for this post, some level of healthcare coverage is now viewed as an entitlement. In creating that mindset in a critical mass of the population, the ACA has been a booming success. That alone means that the evolution of any future healthcare delivery and financing system in America will be a political process, not a logical one — i.e., Republicans saying they are being realistic, and Democrats accusing them of taking healthcare coverage away from people [the entitlement angle].
-  It will therefore be politics, not honest focus on designing the best healthcare delivery and financing system, that drives the thinking of practically every Legislator during these deliberations. In the end, it may be politics that drives Mr. Trump’s thinking, too, but there is at least a glimmer of a possibility that his nonconformity to tradition will prevail and at least some logic will creep in [I honestly believe he wants what’s best for America].
The reason I’m saying “politics will rule” is simple. … The number of Americans who one popular radio talkshow host calls “low information voters” is several times the average margin of victory in most elections, These are the voters who can most easily be swayed by smear advertising, so whichever party has the most “ammunition” for their smear ads [or is most skillful in using that kind of information, or both] will fare the best in the 2018 and 2020 elections.
-  Anything that contains even a hint of characterization as “repeal/replace the ACA” will receive zero Democrat votes. If characterization terminology is more along the lines of “improve the ACA”, some Democrats may vote for it, but that may not matter if gaining their support causes loss of offsetting Republican support [e.g., due to inclusion of Planned Parenthood funding, more liberal language about religious freedom, etc.].
-  Regardless of the final form the new law takes [assuming “punt” is not the ultimate outcome], both parties will immediately begin factoring their spin into campaign ads and “video/sound/print bites” in the media — Democrats saying Republicans are yanking good policies from the hands of poor people and shoveling the savings into the pockets of rich people, trampling on “women’s health”, picking on black people, etc.; Republicans claiming they’ve saved America from the Obamacare disaster and put healthcare back into the hands of patients and doctors, protected religious freedom, etc.
So, Going On Record — I Predict …
So regardless of the yet-to-be-worked-out details, I think I already have the information I need to go ahead and lay out all the possible paths that lie ahead:
- The Senate fails to reach enough consensus [even among Republicans] on a healthcare bill, so the entire effort essentially dies.
- [A toss-up with #3 as most likely] The Senate passes a bill that differs so substantially from the House bill that a conference committee process reaches an impasse, so the entire effort essentially dies.
- [A toss-up with #2 as most likely] The Senate passes a bill that differs considerably from the House bill, but a compromise is reached in the Conference Committee and the resulting bill is approved by both the House and the Senate, and it is signed into law by the President [or allowed to become law without his signature].
- [Highly unlikely] The Senate passes an essentially equivalent bill with minor adjustments that are easily negotiated into a compromise bill that is approved by both the House and the Senate, and it is signed into law by the President [or allowed to become law without his signature].
- [Extremely unlikely] The Senate approves the House bill as is, and it is signed into law by the President [or allowed to become law without his signature].
If the path that unfolds from here is #1 or #2 [what I referred to above as a “punt”], that will be most interesting to watch — because the ACA will continue to collapse under its own weight, and it’s almost impossible to predict who’ll be blamed for the resulting mess [the Democrats for passing it in the first place, or the Republications for failing to make the necessary “adjustments” to make it absolutely perfect]. I’d bet on the Democrats winning that battle of words for two reasons: 1) they are better at that game than the Republicans; and 2) the overwhelmingly liberally-biased media will always side with them [which yields the equivalent of hundreds of millions of dollars in free air time].
If the path that unfolds from here is #3, #4 or #5, I’m betting that the bill will be something President Trump will sign because he will have been actively involved in the Senate process and subsequently in the Conference Committee process [as he was in the House process], so Republican leadership will know clearly where he stands on the bill throughout those processes — and if they know he’s not with them, that will mean the same thing as knowing that you don’t have the legislative votes to pass it, so there won’t be any option but to “punt” and see if the pieces can be picked up next year or later [and whether or not there will be enough “pieces” to keep them from losing their majorities in the Senate and/or the House in 2018 will depend on how much more visible the ACA’s failure becomes between now and then].
In Closing …
If a path other than one of these begins to develop [very unlikely, I believe], I will take that development into account in future posts on this subject. Whenever one of these paths seems to be clearly developing as the frontrunner, I will spend more time “in the weeds” of that one and offer my thoughts on the future of Healthcare in America under that scenario.
Site Note. I have added an icon at the Repealing And Replacing The ACA page at this site entitled Resources: Content Related To This Page. Clicking on that icon will take you to an index list of links. Clicking on any of those links will take you to the associated item. The first entry in the index is an AHCA Summary that was passed by the House of Representatives on May 4, 2017.
Charles M. Jones