The Spineless Cruelty Of The U.S. Congress

It Won’t Repeal Or Repair The ACA – Just Destabilize It And Hurt Constituents
By Ron Shinkman

Republicans in the U.S. Senate recently quashed weeks of bipartisan talks to strengthen the Affordable Care Act. They did so to engage in yet another mashup of kabuki theater and musical chairs to try and repeal the ACA yet again.

                Once again, the effort fell short when Majority Leader Mitch McConnell scrapped a vote this week. And once again, what has been the law of the land for nearly a decade will continue to bleed out from the thousands of cuts inflicted upon it.

                First, Congress is not likely to ever repeal the ACA, not with the Graham-Cassidy bill or any other vehicle. Although it voted dozens of times to repeal the law when Barack Obama was in the White House, lawmakers did so knowing it would be vetoed. It was safe posturing for its low-information voter base. But some five-dozen of those repeal votes over the years have primed their supporters for the real thing. And when the cross between a Creamsicle and the Stay Puft Marshallow Man was recently installed into the White House, those lawmakers were instantly thrust into an untenable position.

                That’s because Donald Trump makes most low-information voters look like Rhodes scholars. Moreover, he is so pathologically determined to get a “win” he would sign any repeal bill into law, no matter how disastrous it would be for the country in the following months and years.

                Were repeal to occur, it would mark the first time in the nation’s history a working safety net program (the ACA does work, despite what Boxed News and the Wall Street Journal editorial page say) was ended. It’s uncharted territory, but the navigational math is straightforward: You cannot take away healthcare from 20 to 30 million of your constituents and expect them to vote for you – or your party – ever again.

                But in the years since the U.S. Supreme Court made the Citizens United decision the law of the land, many members of Congress now rely on ultra-wealthy sponsors to get them elected and re-elected. Those sponsors are legally U.S. citizens, but they are not entwined in the fabric of American life. Instead, they want a country reshaped completely in their image, where they pay no taxes and those not as rich as them are treated as their subjects. Therefore, the ACA must go – and be part of a larger plan to fund tax cuts to people who would never spend that windfall in 1,000 lifetimes.

                So, the members of the Senate have to go along with this kabuki theater to please their billionaire sponsors. Otherwise, they risk having to get jobs that lack the power and ego gratification of being a U.S. Senator.

                Which is where the musical chairs come in. It was John McCain who gave the thumbs-down on the last repeal effort in July, and he stuck with it for Graham-Cassidy. Lisa Murkowski from Alaska and Susan Collins from Maine are other GOP nays. Their positions are not quite as safe as McCain’s, but they come from moderate states. Alaska expanded Medicaid under the ACA, and Maine will do so a nanosecond after its maniac governor Paul LePage departs office, assuming funding is still available to do so.

                For safety sakes, Rand Paul from Kentucky and Ted Cruz from Texas also said they were “no” votes. Both want to run for President one day. Neither can be involved with repealing a law a majority of Americans now say they support.

                So, this rotating college of naysaying senators means a repeal vote in the Senate will always be at least one shy of bringing in Vice President Mike Pence to break a tie. That’s the closest the Senate can come to satisfying their donors and base while not dooming its members to irrelevance.

                But that comes at a steep cost to everyone who is not a U.S. Senator or a billionaire – many insurers had to price in the risk of a repeal into their 2018 rates, and in some instances that translated to hikes well into the double-digits (by contrast, premiums for group coverage are rising on average only about 3-5%).

                And the ongoing repeal drama is also giving cover to the egregious ways the Trump administration has inflicted damage on the ACA, such as refusing to commit to funding cost-sharing payments, cutting the open enrollment period in half, and vivisecting it further with planned downtime for the federal exchange website for “maintenance.” Most of these downtimes are on the evenings and weekends, when most people have the spare time to comparison shop and buy their insurance. The “maintenance” issue is easily the greatest lie surrounding the ACA since Sarah Palin’s death panel claim, and yet it is barely getting any attention from the media, despite the potential for wreaking huge damage on 2018 enrollment figures – and creating yet another pretense to renew the repeal efforts.

                What’s the end-game here? The GOP wants to kill the ACA, but can’t risk doing so completely, so it will settle on ritualistic maiming. One hopes if and when a sane individual occupies the White House again, there will be a renewed focus on getting more people insured and cutting out-of-pocket costs. Or if the ACA eventually dies from all the abuse and neglect heaped upon it, single-payer is really the only alternative left. It’s a solution many Americans deserve – and a nightmare for the GOP for which it should deserve full blame if it ever comes to fruition.


Ron Shinkman is the Editor of Payers & Providers.