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- The Forecaster
I was transfixed by the drama in Washington, D.C., as Republicans slugged it out over how to make good on their promise to repeal and replace the Affordable Care Act.
When the vote was scheduled on the House floor, I checked my smartphone for updates compulsively. It reminded me of the weeks after the 2000 election, when I was glued to CNN as the courts argued about hanging chads and other election irregularities in Florida, keeping Americans in suspense about who would be our next president.
This time, the side I was rooting for won. Well, maybe. Let’s just say it could have been worse.
Although in a sense, we all lost this time because the political chaos revealed that the president of the United States doesn’t have a clue about how to govern in a democracy, even when his own party controls both elected branches of Congress.
President Trump is a newbie at this. He may get better with practice, but maybe not. He probably has never had to build consensus at anything, let alone a major legislative change. His admirers saw this as refreshing and potentially a game-changer in paralyzed Washington politics. But his style of negotiating, perhaps wily and effective in the real estate world, is limited to cajoling and threatening.
As someone who worked for Congress for years and now serves as a state representative, I can tell you this does not work with legislators. We owe alliance first to our constituents and we guard our constitutional role fiercely.
More significant for the future, Trump never understood the complexities of our health-care system or the ACA, nor has he showed any interest in mastering the subjects.
To win support from leery legislators, you have to understand what is important to each and what they are willing to give up. That means getting into the weeds, as they like to say at the Statehouse. Likewise, you must understand your own priorities. In the end, it was clear that the president’s only goal was to chalk up a win and avoid embarrassment. That is not policy. That is narcissism.
Trump was willing to trade away practically everything that made the ACA valuable to millions of Americans – subsidies that made insurance more affordable, and the requirement that insurance cover “essential health benefits,” including care for childbirth, prescription drugs, substance abuse, emergency room treatments and mental health.
His bill would have made Medicaid (known here as MaineCare) a federal block grant amount instead of a share of a health care costs for the poor. The result: states would have to either pick up the difference or curtail services dramatically. Inadequate federal funds for Medicaid and Medicare would also result in cost shifting to people who pay for private insurance, since padding the price for aspirins or MRIs, etc., is the only way hospitals and other health providers can recover the cost of uncompensated care. Since being uninsured often simply means people will not get care, many will suffer and die.
The conservative wing of the Republican Party essentially wanted pure repeal. It turned out to be much harder to get than they thought.
First, after seven years, Obamacare had become a part of the social landscape. Although much of the ACA does not directly apply to most Americans (who are covered by employment-based private insurance), the law changed the way Americans think about health insurance by establishing the bottom line for what real insurance has to cover. Many also had friends and relatives who depended on and valued the ACA.
Another wake-up call was the finding of the non-partisan Congressional Budget Office that the Republican bill (both the original and the revision) would result in 24 million Americans not being insured.
When the CBO report came out and when the right-leaning Freedom Caucus of Republican representatives insisted on peeling away the so-called essential health benefits required of insurance under the ACA, and Trump and House Speaker Paul Ryan agreed, moderate Republicans and a huge percentage of the public balked.
After the bill died, former President Obama said, “This fight was about more than health care – it was about the character of our country.” While the most identifiable barrier to enactment of this flawed legislation was the unyielding stance of the 30-something number of Freedom Caucus members, it also demonstrated that Americans have a bigger heart and more independent mind than many imagined.
State Rep. Janice Cooper is a Yarmouth Democrat who represents House District 47 (Yarmouth, Chebeague Island, Long Island).