Repeal and Replace Vote Put on Ice

Santa Barbara Congressmember Salud Carbajal made yet another statement from the House floor on Friday, denouncing the Republicans’ health-care bill, but he never got a chance to vote against it. That’s because President Donald Trump and House Republican leader Paul Ryan pulled the American Health Care Act before Congress could act on it, knowing it lacked the votes needed to pass.

The bill failed because of unanimous opposition from Democrats coupled with defections by two key factions within the Republican Party. One — the arch-conservative Freedom Caucus — objected the Republican bill did not go far enough in dismantling Obamacare; the other, the more moderate Tuesday Group — objected it went too far. Neither Ryan nor Trump — who touted his prowess as consummate dealmaker during his campaign — could muster the necessary votes in a last-minute frenzy of intimidation, charm, and emotional cajolery. Nor did it help that the bill — which enjoyed a national approval rating of only 17 percent — had been opposed by every mainstream organization representing doctors, hospitals, and health-care advocates.

Rather than call for the vote — as President Trump had vowed to do the day before — the American Health Care Act was tabled indefinitely. Carbajal, never shy about criticizing the bill — called Friday’s non-vote “a victory for the American people,” but cautioned, “It’s a near-term, short-term victory, but it’s not necessarily final.” Procedurally, Ryan can bring the bill back if and when he thinks he has the votes. But given the intensity and intransigence of the opposition, that’s not expected any time soon.

For Trump and Ryan, Friday’s action marks a political setback of epic dimensions. Both had made “replace and repeal” a centerpiece of their legislative agendas. Republicans had introduced at least 60 bills to repeal the Affordable Care Act since its passage seven years ago. Ryan explained Republicans are still adjusting to “the growing pains” attending the transition from being an opposition party to being the party with a majority in the House, Senate, and White House.

Carbajal, however, credited the intense backlash to the Republican health-care plan that erupted in town hall meetings in every congressional district of the country coupled with a tsunami of letters, phone calls, and emails. “The American people roared and it made a difference,” he said. “Don’t stop calling. Don’t stop speaking out.” Even with Carbajal’s opposition in the bag, more than 400 people packed a town hall forum he organized in Santa Barbara on health care two weeks ago. Carbajal’s offices received 3,187 calls, emails, and voicemails on the Republican health care proposal. Of those, 99.98 were opposed. Only 73 were in support.

The Republican alternative would reduce the number of insured Americans by 24 million by the year 2027, according to a report issued by the Congressional Budget Office. The same report concluded that the proposal would favor the younger, the healthier, and the more affluent at the expense of the rural, the older — between 50 and 64 — and the whiter. While Trump and Republican leadership dismissed the report, it intensified concern about the American Health Care Act among diverse constituencies within the GOP. Staunch, ideological, free-market conservatives with the Freedom Caucus objected the bill didn’t go far enough to cut off benefits and entitlements, dissing it as “Obamacare Lite.” Moderate Republicans with large numbers of voters benefiting from coverage under the Affordable Care Act worried about committing political suicide by repealing former president Barack Obama’s signature bill. To the extent Trump mollified the Freedom Caucus by cutting benefits, he further alienated the Tuesday Club, and vice versa. Neither, in the end were won over.

Complicating matters greatly was the exceptional haste with which Ryan sought to push the bill through. From start to finish, the Affordable Care Act took 18 months — and multiple hearings — to secure passage. By contrast, the Republicans sought to win passage in just three weeks. Democrat staffers expressed gape-jawed incredulity that on the eve of the House vote, members of Congress had not been given the text of the legislation to peruse.

In the initial stages, the health-care bill draft had been so kept under wraps that only Republicans could see what it said, and then, they had to show up in person to read it in the leadership offices. Several weeks prior, portions of the bill had been leaked to the press. This intense secrecy elicited bipartisan scorn. Senator Rand Paul, the flamboyant conservative from Kentucky, engaged on a dramatic search for the documents while TV news cameras rolled. Minority leader Nancy Pelosi literally called out the hounds — a pack of beagles — to track it down.

Last-minute changes designed to win over recalcitrant factions were written in haste, leading to inadvertent insertions that would effectively deny 7 million military veterans any of the tax rebates proposed in the Republican bill to help underwrite the cost of insurance premiums.

House Speaker Ryan acknowledged the defeat was serious and warned that the worst defects of the Affordable Care Act — spiraling premiums, insurance companies dropping out, and lack of providers — will soon be felt. In the meantime, however, he said the Affordable Care Act will “remain the law of the land.”

Under the Affordable Care Act, the number of uninsured dropped by 20 million nationwide, and by more than 5 million in California. In Santa Barbara and San Luis Obispo counties — Carbajal’s congressional district — it dropped from 16.5 to 9.4 percent. In California, the vast bulk of the new enrollees were signed up through expanded Medicaid eligibility included in the Affordable Care Act. Formerly, Medicaid was restricted to those making $12,000 or less. Under the new rules, people making up to $16,000 could be covered. The new rules also allowed single, able-bodied adults. Before, such coverage was restricted to the disabled, women, and kids. In Santa Barbara County, this program expanded by 30,000.

Speaking of Friday’s non-vote, Bob Freeman — chief executive of CenCal, the agency administering Medicaid in the two counties, commented, “It removes uncertainty as to the continuation of health-care coverage for thousands of people in Santa Barbara County.” Dr. David Dodson, head of the central Coast Medical Association, was more outspoken, stating, “The American Health Care Act was breathtakingly horrible, and its defeat is a reprieve for tens of millions of Americans,” adding, “Contrary to the Republican mantra, the Affordable Care Act is not a disaster.”

Dodson did acknowledge Obamacare could be improved upon, suggesting that the single best way would be to require the 19 states that opted out of the Medicaid eligibility to opt-in. Likewise, he argued, in states where there’s only one provider, a government plan needed to be provided to create some semblance of competitive pressure on prices. This option had been considered in earlier iterations of Obamacare, but failed to make the final cut. Likewise, he argued in favor of stricter penalties for those who did not sign up for insurance under the much debated “individual mandates.” That would increase the number of younger healthy participants in the insurance pool, thus balancing out risks and reducing costs.

Carbajal expressed rhetorical hope that a bipartisan effort to improve the Affordable Care Act — rather than repealing it — might now ensue. One reform that might get support from both sides of the aisle, he suggested, was curtailing the high cost of prescription drugs.