Political resistance mounted to the House Republican leadership’s Obamacare repeal legislation Tuesday, with 12 Republican senators criticizing elements of House Speaker Paul Ryan’s plan as too draconian—especially the proposal’s cuts affecting Medicaid, which covers the poor, children and senior long-term care.
Meanwhile, progressive economists and others digging into the Congressional Budget Office’s analysis of the House bill found even more dire predictions that were obscured by Monday’s stunning announcement that the bill, if passed as currently written, would lead to upwards of 24 million people losing coverage within a decade. (The CBO estimated 14 million would lose coverage next year via individuals losing subsidies, and another 10 million would lose their coverage by 2026 due to cutbacks in state-run Medicaid programs. Politico reported Tuesday that the White House’s internal estimate was 26 million.)
Of particular interest to the economists was an unexplained footnote in the CBO report on page 33, predicting Social Security would pay out $3 billion less in the next 10 years if the House bill becomes law. While there was debate about whether the law’s passage would mean employees might see higher wages but stingier benefits—meaning more Social Security taxes would be generated—their interpretation was millions of people would be forced to keep working and postpone taking Social Security because they’d need the money for escalating medical costs.
There were similarly stark second-day analyses, such as the bill’s impact on veterans. While most military veterans are covered by Veterans Administration health care, not all of them are—just as their family members aren’t—meaning another key constituency, military families, would be hurt by an Obamacare repeal.
“Not all veterans are eligible to receive health care through the VA,” explained VetVotes.org’s Will Fischer. “The Affordable Care Act has resulted in the number of veterans in this country going without insurance to drop drastically. Next, while many veterans are eligible, and do receive high quality health care at the VA, spouses, children—they can’t go to the VA. If we see a repeal of the Affordable Care Act we will also see the number of veteran family members in this country going without insurance to increase.”
Analyses like these prompted a growing number of Republican senators to distance themselves from the House bill by early Tuesday—a gesture that isn’t quite saying they would vote no, but signaling that Ryan’s Obamacare repeal wasn’t going to fly in the Senate. With 52 Republican senators, Obamacare’s defenders need only three Republican defectors to block any repeal bill. Vox counted 12 Republicans expressing a range of doubts as of Tuesday.
Republicans Still Have Ways to Gut Safety Nets
So the question that emerges is not just whether the House repeal effort will be stopped in wholesale fashion, as was the case when Democrats controlled the Senate and held the White House veto pen, but what can Republicans do to modify the House’s draconian approach and pass GOP Senate muster?
In the short run, it is possible GOP infighting could kill the repeal effort outright, as arch right-wingers, those in the House Freedom Caucus and ideologues like Sen. Rand Paul, R-KY, are saying Ryan’s repeal doesn’t go far enough. As the Washington Post reported, “most of the changes that the White House seems to be talking about to get House Freedom Caucus members onboard will worsen the coverage numbers and make it harder to win over GOP senators.”
But that scenario is perhaps too wishful for this Congress and administration. There are other ways hardcore right-wingers whose professed desire to rein in spending—regardless of real-life harms—might come on board.
It’s important to remember that Ryan’s bill isn’t only about gutting Obamacare, which extended health coverage to 19 million people. As CBO noted, within a decade 24 million people would lose coverage. That additional 5 million figure comes from cutting Medicaid, whose beneficiaries include children, the elderly on long-term care and other poor people. Ryan’s bill will bring down the federal deficit by nearly half a trillion dollars, CBO’s analysis said, including $880 billion in Medicaid cuts over the next decade.
There are other ways to eviscerate this safety net program that could become part of any Senate “fix” of the House’s errant repeal bill. On Monday, the Senate confirmed Seema Verma as the next administrator of the federal Centers for Medicare and Medicaid Services, the agency that allocates $1 trillion annually for health care for one-third of all Americans. Verma previously restructured Indiana’s Medicaid program—under then-governor Mike Pence—by imposing punitive private-sector practices on that state’s program that “cut” costs: requiring recipients to pay premiums, contribute to private health savings accounts and lose their coverage if a payment was late.
Speaking from the floor Monday, Sen. Maria Cantwell, D-WA, noted that Verma “made millions of dollars in consulting fees by kicking poor, working families off of Medicaid for failure to pay monthly contributions similar to premiums,” the New York Times reported. Weeks before at her Senate confirmation hearing, Verma suggested that insurance not be required to include maternity care. The new Secretary of Health and Human Services, Tom Price, has praised that approach as giving states “greater flexibility.”
What this means is that the Republican war on safety nets is really just beginning. The House’s cruel Obamacare repeal bill is an opening shot in a much longer and larger political battle—as if kicking 19 million people off Obamacare isn’t enough. The Republicans holding the real reins of powers—in Congress via lawmaking and executive branch via rulemaking—aren’t considering human needs first. Where they aren’t citing ideological goals like federal debt reduction to cut off safety net subsidies, they’re looking to destroy these programs by penalizing their participants—as Verma did in Indiana—and they’re also allowing their political sponsors to make money by privatization, as Verma also did by requiring state Medicaid recipients to contribute to health savings accounts.
The Republican effort is needlessly preying on the most vulnerable among us while enriching GOP allies (by repealing Obamacare taxes on the wealthy and medical industries, or though privatization). No matter what happens to Ryan’s Obamacare repeal legislation, this political struggle to preserve social safety nets is only beginning.