Will Obamacare survive Trump?

Photo by LaDawna Howard. Creative commons license.

In a heartbreaking blow to American freedom, the presidency and Congress (both the House and Senate) are now under Republican rule. This may have been the establishment’s “finishing move” against the Affordable Care Act, A.K.A. Obamacare.

“They have a death blow to the Obamacare health coverage expansion,” says John McDonough, a professor at Harvard University. McDonough also assisted in the Senate with the Affordable Care Act.

This is a terrifying reality for many Americans who depend on on Obamacare. It isn’t just a handful of people that will be affected, either — 22 million Americans will lose healthcare if the Affordable Care Act is repealed.

The President-elect, Donald Trump, has sworn that his first act as President will be to dissolve Obamacare. Even prior to the election, Republicans had figured out how to repeal it. Sadly, this has been a constant fight since President Barack Obama introduced the health care proposal. He initially introduced a much more substantial health-care system, which was practically gutted and stripped by the time it ended up available to the masses.

Last January, Congress passed a reconciliation bill that eviscerated Obamacare’s expansion of Medicaid and private health insurance subsidized by the federal government. Obama was able to repeal it once it reached him, but this simple act showed that Republicans could pass a bill with a majority vote, despite a filibuster.

Sound funky? Well, it’s because most bills require 60 votes to overcome filibusters. However, if it merely relates to spending, a majority vote is sufficient. That process is known as reconciliation. From there, bills are approved by a parliamentarian (currently Elizabeth MacDonough), who then certifies that the content has an impact on the budget, which makes it possible to use reconciliation. The parliamentarian office also refers bills to the appropriate committees on behalf of the Senate’s presiding officer, but they have no power. They are only there to advise, though the presiding officer almost always takes the parliamentarian’s advice.

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“Practically, you can’t turn everything off immediately,” Chris Condeluci tells Vox. Condeluci worked as tax and benefits counsel for the Senate Finance Committee’s Republicans during the initial Affordable Care Act debate. “The GOP doesn’t want to get beat up over kicking 20 million people off of insurance.”

What this means is that the GOP is going rip Obamacare apart piece by piece, like meth heads extracting copper wiring from a house.

Last October, Republicans introduced a bill that fit the parameters for reconciliation. HR 3762 was introduced in the House of Representatives on October 16, 2015, by Rep. Tom Price (R-GA).

HR 3762 takes away the tax credits for low- and middle-income Americans to purchase insurance at the end of 2017. The bill also ends Affordable Care Act’s Medicaid expansion at the same time. In doing so, this gives the GOP two years of wiggle room to come up with an alternative. It also repeals Obamacare’s mandate and ends many of the taxes that keep it going. Those consisted of a Medicare payroll tax that was focused on the wealthy at a rate of 0.9 percent on those who make $200,000 yearly or $250,000 per household, as well as health insurers, hospitals and medical device manufacturers. You know — the people with the deep pockets.

So, here we are: a plan to repeal, but what is out there to replace Obamacare for the 22 million people who would be left without insurance?

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Sadly, the answer is not much. The GOP knows that they do not want Obamacare, but there isn’t an alternative. It’s kind of like trying to feed an angry child who has a very simple palate — nothing nutritious, and the same old crap to fill an empty void.

“I don’t think the two [repeal and replace] would come in tandem,” Condeluci says of the predicament. “Replace needs to be litigated to a greater degree than it has before.”

According to Vox, House Republicans outlined their Obamacare replacement plan in a document published this summer called “A Better Way.” Many health policy proposals that have become common in conservative plans, like block-granting Medicaid and allowing insurance sales across state lines, are included within it. Trump, too, has a bullet-pointed list of what he would like to see for health care reform, but it is likely that he will lean on Congress to flesh it out just as the previous administration did with the Affordable Care Act.

“Rising prescription drug prices has been an issue that resonated,” Larry Levitt, senior vice president at the Kaiser Family Foundation, told the San Francisco Chronicle. “Republicans are much less likely to go after high drug prices than a Clinton administration would have.”

We’re left in a lurch — they want to repeal Obamacare, which will cause many, many Americans to lose health care, yet Trump has promised to cover all Americans with a different, “better” plan.

“I am going to take care of everybody,” Trump told 60 Minutes . “I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

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