I’d like to open by recognizing that while the American Health Care Act (AHCA) has been predicted to have potentially devastating effects on the American health care system, the Affordable Care Act (ACA or Obamacare) faced similar, but less severe, criticism while it was being passed into law. However, it has still managed to extend health care coverage to over 20 million more Americans since it passed in 2010. It’s easy to criticize the early days of legislation, and the law that is passed generally is not the same as what comes out of the House. This commentary may take some satirical, left-leaning standpoints on the issues discussed, but the criticism is not exclusive to this bill and can be translated also into a criticism of the ACA. This commentary is not meant to be about a comparison to previous health care institutions, rather it’s meant as a critiquing of the situation, and actual legislation, in which the AHCA was passed.
Since the ACA was passed in 2010 under President Obama, Republicans have been salivating at the idea of getting rid of it; the phrase “repeal and replace” quickly became more common at campaign speeches than old white dudes. The 2016 election marked the beginning a potentially historic presidency. After Donald Trump was elected as our 45th President of the United States, the Republican party finally had their chance to fulfill this partisan wet dream and systematically re-structure our federal health care plan, and I’m not going to lie, I was excited. I had spent the past seven years watching Republican campaign rallies where the politicians condemned Obamacare and its strict mandates, they promised to give people the freedom have the coverage that they wanted and nothing more, all while lowering premiums. Pretty sweet, right? Even though I supported the ACA I was truly looking forward to what the G.O.P. had to offer, but like Trump’s 100th day celebration theme, “Promises made, promises kept”, they shit the bed with it.
Healthcare was the first big policy push of the Trump administration and the Republican controlled congress, and what happened was, quite honestly, hilarious. The circus that is Republican healthcare has had three acts so far. The first started once Trump took office: he looked to his Republican congress (specifically Speaker Paul Ryan) to propose their long-awaited healthcare revamp, to which they replied “oh shit, we were supposed to come up with that?”. It quickly became clear that although the overhaul of American healthcare had been a campaign promise of most Republican candidates since 2010, none of them had actually come up with any other ideas in those seven years.
The week in March leading up to the deadline for both the congressional budget and an outline for the new healthcare plan made it clear how unprepared the Republicans were for having to put their money where their mouths were. The first draft of the bill was roughly five pages long, and looked like they had printed out the default “legislation” template in Microsoft Publisher and forgotten to, quite literally, fill in the blanks. The first incarnation of the bill was sparse, to say the least, with brief generalizations of what actual law they intended to include, and then followed almost every section of the proposal with a “to be continued” statement. That’s right, under their seven-year time crunch, the best that Republicans had come up with was essentially a drunk guy’s defense when he’s about to try something stupid and his friend points out what could go wrong: “I don’t know man, let’s see what happens”.
Following the initial flop of the draft, the second version of the bill came into the public eye. This was the first time that America had seen a new, legislatively explicit proposal for replacing Obamacare. Trump and Ryan scrambled to rally Republican support for the bill: Trump took his iconic, totally ethical approach of threatening Republican congressmen with their jobs if they didn’t support the bill, while Paul Ryan chose a different approach: giving congress his best puppy-dog eyes to try and fill the cute cop, corrupt cop archetype. I may jest at their tactics, but I can’t argue with their success. Oh, wait, yes I can… the bill was a complete flop. Ryan wound up pulling the bill from the Republican controlled house floor before it could be voted on due to a lack of party support. This opposition came from both sides: more moderate conservatives argued that it didn’t provide necessary coverage, while the further right republicans argued that under the new proposal, the federal government maintained too heavy of a hand in regulating the healthcare industry. This, in combination with the Congressional Budget Office’s evaluation of the bill claiming it would potentially leave over 20 million more Americans without healthcare over the next four years than under the ACA, made the bill widely unpopular even with republican constituent; because who doesn’t want more expensive health care that covers less? This spectacular embarrassment was a huge hit for Speaker Ryan and the Trump administration, but the Republicans had been talking about this opportunity for seven years so there was no way they were going to stop here. If conventional methods of passing the bills they wanted didn’t work, why not use the element of surprise?
In the most recent version of the AHCA, the republicans sold-out and let the man get to them. They revised and amended in an open, bi-partisan environment, in a respectable time frame to generate enough support for the bill to pass in the House. Wait, no, they did the opposite. The republicans apparently forgot that television was a thing in 2010 and chose to do exactly what they had criticized when Democrats passed Obamacare in the house: they snuck it through. Republicans quickly amended the bill behind closed doors and then pushed it to a vote on the floor before anyone could react to it – a move heavily criticized many times by then Senator Paul Ryan in 2010. Many House Republicans that voted yes even admitted that they hadn’t even read the bill, making the AHCA the legislative equivalent of the Apple terms of service agreement. The kicker beyond the means in which the bill was passed, was that the concerns about the lower coverage rates as well as proposed tax breaks for the wealthy, two of the biggest concerns expressed in various town hall meetings with representatives after the first flop of the bill, were not changed in this version.
The entire process of “repeal and replace” has been a series of flops and ploys by the Republicans. The way in which they approached healthcare reform is a laughable display of partisan politics. It became a battle for party superiority rather than policy, which is a large part of why I don’t think that the AHCA will be beneficial for American healthcare. This bill became a symbol of Republican partisanship long before its inception. This was made clear right off the bat by how unprepared Republicans were for having the ability to replace it, and was only reinforced by the tactics they chose to use to force the bill through the house. Healthcare affects every American, and therefore I think that it should be a non-partisan issue, but Republicans politicized it with the AHCA. In my opinion, the AHCA is a huge step backwards in healthcare policy, and additionally the process in which it was passed reinforces party politics and partisan thinking in a particularly sensitive area of political ideology. Overall, I think the AHCA will be a detriment to the American healthcare system, and was ultimately toxic to our legislative system.