Disagreement Between Congressional Republicans Over Paul Ryan’s GOP Health Care Bill Bring to Mind the 1993 Battle Over Clintoncare
Throughout his presidential campaign, Bill Clinton ran on the promise of fixing a broken health care system in America. His main objective: to implement a universal health care policy. Sure, it’d been brought up several times throughout the course of history – notably starting around the early 1900s after the election of Teddy Roosevelt – but Clinton was poised for success…or at least he should have been.
Health care costs were on the rise, the majority of the American public supported health care reform, and the Democratic Party held majorities in both chambers of Congress; yet, in spite of a health care bill put forth by the Democratic president’s administration, health reform failed to make Clinton’s presidential legacy. And so, too, will happen to President Trump and Congressional Republicans if they fail to make compromises and continue with their inter-party bickering and finger-pointing.
“President Clinton vowed to get health reform going in his first 100 days in office, but a crisis in Somalia and the war over NAFTA [the North American Fair Trade Agreement] delayed it,” said Daniel Dawes, a healthcare administrator, attorney and author of 150 Years of Obamacare. During the creation of the Affordable Care Act / Obamacare, Dawes founded and led the National Working Group, a coalition of more than 300 national organizations that worked to make sure ACA included the right equity provisions for various vulnerable groups (including racial and ethnic minority groups, women, and LGBT people). “On the contrary, Trump did deliver on his promise to tackle health reform in his first 100 days.” In spite of doing so, last week’s Trumpcare/Ryancare failures could mean Trump will follow the same path as Clinton if Congressional Republicans and the President can’t come to agreements henceforth (on healthcare or otherwise).
Trumpcare Is Dead and Obamacare Stays (for Now)
In what seems unimaginable for a seven-year battle between Congressional Republicans and Obamacare, Rep. Paul Ryan (R-WI) failed to garner enough Republican support for his health care bill last week, officially landing a major hit to Trump’s repeal-and-replace agenda. With House sentiment on Trumpcare looking grim late Wednesday and into early Thursday, a House vote initially set for that Thursday was delayed to Friday and then ultimately canceled when both Ryan and Trump agreed that the bill be withdrawn. Effectively, this means that Obamacare will continue to exist (at least for now).
On Friday afternoon, the House Speaker expressed his disappointment but emphasized that they (House Republicans/the House/Congress) would use this as a learning moment as the House moves on to other issues, and officially tabled the health care debate:
“Doing big things is hard,” said Ryan. “We will need time to reflect on how we got to this moment, [and] what we could’ve done to do it better. But, ultimately, it all comes down to a choice: Are all of us willing to give a little to get something done? Are we willing to say ‘yes’ to the good – to the very good – even if it’s not the perfect [solution]?”
But while some can celebrate the failure of Ryan’s health care bill, this doesn’t mean that Obamacare will remain the law of the land for good. Neither the President’s administration nor Congressional Republicans have any incentive to prevent ACA from completely falling apart. Speaking on ABC’s This Week, Freedom Caucus Chair Mark Meadows (R-NC) said: “It’s incumbent upon those two [Republican] groups – the conservative and the moderates – to come together, hopefully in the coming days, to find consensus [on health care reform].”
Conservative Republicans VS Moderate Republicans
“[President Trump’s] given the Republican party for the first time since George Bush an opportunity – with control of the House, and the Senate and the White House – to actually sign-off on dreams that we’ve had that we never thought could come true. He’s reminded us of that,” said Rep. Chris Collins (R-NY) to the press after a closed-door meeting last Tuesday morning between the President and House Republicans at the Capitol.
Such rhetoric failed to hold-up by the end of last week, though. In spite of repeated attempts by both Ryan and Trump to get enough votes to support the American Health Care Act, efforts to appease both conservative Republicans and more moderate Republicans led to the bill’s inevitable withdrawal.
To greater understand the issue of why AHCA failed, you have to understand the two different perspectives that pulled on opposite ends of Trump and Ryan. Some of these major points include:
- Largely represented by the Freedom Caucus, led by Mark Meadows;
- Pretty much scoffed at the Congressional Budget Office’s analysis (the CBO report showed that approximately 24 million fewer people would be insured by 2026 under the bill compared to Obamacare);
- Didn’t think Ryan’s health care bill did enough to get rid of Obamacare’s regulations, calling it “Obamacare 2.0” and “Obamacare Lite”;
- Wanted an end to Medicaid expansion beginning in 2018 and include more work requirements;
- Sought to limit health care plan offerings, opposing coverage for substance abuse and maternity care; and
- Preferred a clean or full repeal of ACA.
- Largely represented by the Tuesday Group, led by Rep. Charlie Dent (R-PA);
- Took the CBO report seriously in their decision to vote for or against the bill, with concerns that the bill would leave many of their constituents uninsured;
- Believed the Trumpcare bill would make health insurance less affordable for many, with specific concerns over the bill’s proposed plans for less funding to help the poor and elderly;
- Thought issues like maternity care and reproductive rights should be dealt with separately and not inclusive to the bill; and
- Didn’t think there was enough flexibility and resources for states that had expanded Medicaid.
Clintoncare: Failure of Congressional Democrats
“Just as it was in the spring of 1993, transforming the American healthcare system is tremendously complicated,” said Ted Chan, founder and CEO of CareDash, a healthcare review platform that aims to provide consumers with transparency on the quality of doctors and hospitals. “[President] Clinton had promised both deficit cuts and guaranteed health insurance for all Americans, but likely overestimated the actual belief the populous had in that.”
The first few months are arguably when the President has his (or her) greatest influence – if they don’t act quickly (as Trump did), then they risk the chance of facing greater barriers later on. Yet, as Chan reiterated, both Trump and Clinton were elected with less than a majority of the popular vote (Clinton held 43 percent electoral plurality), which likely contributed to both Clintoncare’s and Trumpcare’s inevitable failures.
During his first week of office, President Clinton convened the Task Force on National Health Care Reform led by his wife, Hillary Clinton, to craft a proposal for health care reform. According to Dawes, Clinton did what she could to include all the various interests in putting together the bill – bringing in 500 stakeholder groups to discuss reform of the American health care system. “The problem that Trump is running into is that there’s no ownership interest in this bill because they have not brought all the appropriate parties to the table.”
Similar to Trump’s administration throwing support for Ryan’s health care bill, the Clinton administration supported a bill by Sen. George Mitchell:
“Clinton’s White House threw support behind Sen. George Mitchell’s Health Security Act[…]which was essentially the plan that the White House had come up with,” said Dawes. “During that time, other [Congressional Democrats] had introduced bills that did not receive the support of the White House. That is similar to what has happened here. There had been several other major proposals from [Congressional] Republicans on health reform during Trump’s presidency that did not receive support from the White House.”
When not all ideas are incorporated into a proposal, it makes sense why factions within the Republican party contributed to AHCA’s withdrawal (as it did with the Democrats and the Health Security Act). Chan adds that closed-door negotiations and lack of transparency in both instances contributed greatly to their overall failures:
“Similar to Republicans today, the plan was worked on in relative secrecy and when released, significant issues emerged. Costs were unclear and that alienated conservatives, the health insurance industry, as well as those further left who preferred a single-payer system.”
In the end, Democrats in Congress failed to reach some kind of an agreement. Soon after, Democrats lost the majority in both the House and the Senate, and Clinton lost supporters for his administration’s inability to put forth a working legislation. Dawes warned that Trump should pay attention to that trajectory.
So, What Now?
“[Republicans] should start from scratch and they need to address the main arguments that consumers had against Obamacare – the fact that premiums had risen to the point of being unaffordable for people,” said Dawes. “People don’t generally hate Obamacare, they are just exhausted with having to pay high premiums for insurance and making the choice between those premiums and other household expenses.”
Rising premiums and high deductibles continue to be the biggest concerns for those purchasing health insurance. According to Dawes, in order for the President and Congressional Republicans to gain popular support, they need to put together a health reform plan that specifically addresses the cost issue for consumers and put forth a plan for more affordable health insurance. In order to do this, all sides have to be more transparent and inclusive. “Obama was able to overcome because he was as inclusive as possible,” said Dawes.
In an article for The New England Journal of Medicine this January, former President Barack Obama wrote:
“What the past 8 years have taught us is that health care reform requires an evidence-based, careful approach, driven by what is best for the American people[…]Health Care reform isn’t about a nameless, faceless ‘system.’ It’s about the millions of lives at stake — from the cancer survivor who can now take a new job without fear of losing his insurance, to the young person who can stay on her parents’ insurance after college, to the countless Americans who now live healthier lives thanks to the law’s protections. Policymakers should therefore abide by the physician’s oath: ‘first, do no harm.’”
If Republicans want to positively change America’s health care policy, then they need to get better at coming together for the sake of their constituents: the American people.
The views expressed here are those of the author and do not necessarily represent or reflect the views of Healthcare, Inc. and HealthCare.com.