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Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.
Outrage of the Month: House Passage of Trumpcare
Health Letter, June 2017
Michael Carome, M.D.
On May 4, in what would more appropriately be called the Outrage of the Decade, Republicans in the U.S. House of Representatives — spurred on by President Donald Trump, Vice President Mike Pence and U.S. Secretary of Health and Human Services Thomas Price — passed the morally bankrupt legislation known as the American Health Care Act of 2017 (AHCA). This bill, which narrowly passed by a vote of 217 to 213, would have devastating — and, in some cases, fatal — consequences for millions of vulnerable Americans who would be thrown off the health insurance rolls, while at the same time rewarding corporations and the rich with huge tax cuts.
Republicans initially tried to ram an earlier version of the AHCA through the House in March, but that attempt imploded because the bill lacked the support of the party’s more moderate and more conservative members. According to an analysis by Physicians for a National Health Program, the March version of the bill, which was crafted in secrecy and without public committee hearings, would have:
- Slashed funding for the Medicaid expansion, which has provided coverage to more than 10 million poor adult Americans in 31 states;
- Sharply curtailed the tax credit subsidies available under the Affordable Care Act (ACA or Obamacare) to lower-income consumers, particularly older adults, to purchase health insurance;
- Ended the ACA’s cost-sharing subsidies for copayments and deductibles for lower-income people, increasing the cost of care for those with chronic medical conditions;
- Replaced the ACA’s “individual mandate” penalty on uninsured individuals with a 30 percent surcharge on insurance premiums for those who experience a lapse in insurance coverage, which is a common occurrence;
- Reduced taxes on pharmaceutical (nearly $25 billion over 10 years), medical device (nearly $20 billion) and health insurance (nearly $145 billion) corporations;
- Provided tax reductions totaling $275 billion over 10 years to the wealthiest 2 percent of Americans; and
- Continued to channel billions of taxpayer dollars through wasteful private health insurance companies.
On March 13, the nonpartisan Congressional Budget Office (CBO) released its analysis of the March version of the AHCA, and the forecast for many of the most vulnerable Americans was grim: The CBO estimated that in 2018, 14 million more people would be uninsured under the AHCA than under Obamacare and that this number would rise to 21 million in 2020 and 24 million in 2026. The CBO also projected that Medicaid spending would be reduced by a net $880 billion over the next 10 years.
A nationwide survey of American voters that was conducted in March revealed overwhelming opposition to the bill, with 56 percent expressing disapproval of the AHCA and only 17 percent voicing approval. One out of seven Americans predicted that they would lose their health insurance coverage under the Republican health care plan.
On March 24, facing withering public opposition to their deplorable bill and, more importantly, a revolt by both conservatives and moderates within their own party, Republican leaders pulled the AHCA from the House floor moments before a scheduled vote.
But by late April, House Republicans resurrected Trumpcare by adding even more harmful provisions that made the legislation more attractive to conservative Republicans who had opposed the original version. The new bill retained most of the odious parts of the March version and also included provisions that would allow states to obtain waivers from the Obamacare mandates for insurers to cover certain essential health benefits —including emergency services, maternity care and mental health and substance abuse treatments. Another new waiver provision under Trumpcare would permit insurers to charge significantly higher premiums for people with preexisting conditions, likely making health insurance unaffordable for many patients with chronic or serious illnesses, such as diabetes or cancer.
Following the May 4 House vote to pass the AHCA, House Republicans gathered at the White House with Trump, Pence and Price in a disgusting display of gleeful celebration. Photos of the event showed those gathered laughing and smiling about their cruel legislation.
Clearly, Trump, Pence, Price and the House Republicans don’t care about the poor, the sick and other vulnerable people who will suffer needlessly because they can no longer obtain health care. They only care about rewarding corporations and wealthy individuals whose health care is not threatened by the AHCA.
This battle has now shifted to the Senate. We can only hope that at least a few Republican senators will have the moral fortitude to drive a stake into the heart of Trumpcare and bury it forever.