Health Care: A Political Showdown

Unpacking the GOP’s “repeal and replace” efforts

Illustrator: Katie Heywood

Obamacare, Better Care, Graham-Cassidy, the Skinny Repeal. The legislative titles churned the airwaves this summer as Republicans and Democrats alike debated the future of American health care, an increasingly divisive issue.

With a Republican in the White House and Republican majorities in the House and Senate, “repeal and replace” should be easy. But this summer, Republicans tried not once, twice, or even three times to repeal the ACA; they proposed a total of four replacements, and each one failed. Some, like Graham-Cassidy—the most recent bill—didn’t even make it to a vote.

Healthcare is undoubtedly complicated. It has to be because it affects each and every American. It took Democrats 18 months to pass the ACA, yet Republicans have tried to repeal and replace in a matter of weeks. This accelerated approach has left some Republicans nervous about voting for haphazard bills. How can they support something they have barely had time to read? But there are other issues too.

Although separate, all “repeal and replace” bills so far have fit a similar mold. To illustrate this point, let’s unpack the most recent attempt: Graham-Cassidy.

Graham-Cassidy gets its name from the two senators sponsoring the bill: Lindsey Graham, a South Carolina Republican and Bill Cassidy, a Louisiana Republican. The bill aims to turn the ACA’s federal funding for healthcare into money that would be given to each state in a block grant. States would then be allowed to make their own rules about healthcare. Although this might seem like empowerment, states could save money by offering fewer benefits for residents, or by cutting funding for programs like Medicaid.

Here are the three largest areas of concern:

1. Medicaid
Medicaid is important. This federal and state insurance program provides health care for 20 percent of all Americans, 40 percent of children, half of all births, 60 percent of nursing home expenses, and 25 percent of mental health care, according to National Public Radio. Graham-Cassidy would change Medicaid’s structure by giving states control over how they spend its federal funding. The bill also cuts Medicaid funding over time. While this bodes well for states like Texas, which have reduced Medicaid programs, states with larger programs like California and New York will face cuts.

2. Pre-existing conditions
Pre-existing conditions (alcohol or drug abuse, cancer, mental disorders, diabetes, dementia, the list goes on and on) are at the heart of the healthcare debate. The ACA guarantees coverage to people with pre-existing conditions. Although this has been one of the ACA’s most popular facets, the Republican bill would allow states to waive this requirement. This would bring healthcare back to a time before the ACA when insurers could refuse people with pre-existing conditions or charge them higher premiums.

3. Essential health benefits
While the ACA guarantees insurers will cover 10 “essential health benefits” ranging from maternity and emergency care to mental health, hospitalization, and prescription drugs, Republican proposals allow states to opt out of these requirements.

Some Republicans recognize the drawbacks to their bills. However, they also worry about confronting their constituents in 2018 elections without success or even progress on the “repeal and replace” front. For seven years, Republicans at all levels have been promising to dismantle the ACA. Now they have had their chance(s), and failed. Republicans need to remember that all good things take time. They need to incorporate voices and input from the American people, those who will be affected every day by the bill passed in Washington.

The “repeal and replace” efforts affect all Americans. Although most college students (at least those younger than 26) would not be significantly affected by any of the proposed bills, they would raise costs for those older than 65. Plus, anyone with a pre-existing condition, disability, or mental illness would be at the mercy of a state government’s ruling on essential benefits and pre-existing conditions. All things considered, we all know someone who would be impacted by the GOP’s Better Care, Graham-Cassidy, or the Skinny Repeal. Nonetheless, health care does not need to be a partisan issue. Democrats and Republicans can reach across the widening political divide and work together to create a new and better solution that can help us all.