Creating a better healthcare system – one that works for everyone – is no easy task, and it takes time.
On the campaign trail, President Trump promised that he would repeal Obamacare “very, very quickly.” Thus emerged the American Health Care Act, also known as “Trumpcare,” which subsequently failed and was pulled. What went wrong with this promised bill that republicans had hoped for since Obamacare was passed?
The Basics of Trumpcare
Trumpcare had 3 main pillars:
- Continue Obamacare’s subsidization of private health plans,
- Shrink Medicaid by about 25% over a decade, and
- Provide tax breaks to the rich.
Accordingly, it would have benefited the wealthy at the expense of the working class and the sick. Yet, it would also have conserved Obamacare’s overall organization and let many of its regulations intact.
Was Trumpcare Simply Obamacare 2.0?
The moderate nature of the bill led to its downfall. The continuation of Obamacare’s organization and regulations alienated far right conservatives, especially members of the “House Freedom Caucus,” a group among the most conservatives of House Republicans. Yet the benefits to the wealthy at the expense of the poor eliminated any chance of support from the left.
Conservatives contended that it would only be by eliminating Obamacare’s various insurance regulations – including the one that requires that plans cover “essential health benefits” like hospitalizations, maternity care and medicines – that premiums would fall. Because these regulations were left intact, many republicans doubted whether Trumpcare would actually work the way they wanted.
Obamacare has never been hugely popular, and it has never worked as well as its architects hoped. Millions of Americans don’t like it and, even now, there are parts of the country where the markets are struggling to survive.
However, the program has provided security and access to care for millions of others. More importantly, it has shifted the expectations of what government should do, and of what a decent society looks like.
Trumpcare’s failure wasn’t just about the rushed process. It was about policy, and a failure to realize just how profoundly the Affordable Care Act has changed public expectations for how the US health care system operates.
Many Republicans had also convinced themselves that nobody who had insurance through the Affordable Care Act liked it. The media coverage made it easy to believe this. Stories of people losing their old plans or paying more for new ones were all over the press. Stories of people saving money, or getting insurance for the first time, were much harder to find.
However, surveys showed that the majority of people getting coverage through the Affordable Care Act were actually satisfied with it – and quite a few were deeply grateful. In the last few months, these stories became part of the conversation, opening many eyes to the effects of Trumpcare.
The Downfall of Trumpcare
Support for the legislation began to plummet. By the end, the GOP bill had support from just 17% of the population – much less than Obamacare, at its worst, ever polled.
Passing the bill would have almost surely produced a massive political backlash, because taking health insurance away from millions of people – depriving people of healthcare because they have a pre-existing condition or because they don’t have enough money to pay for it – is no longer acceptable.
It was the status quo until 2010, but nationally, there is very little enthusiasm for going back.
Nobody questions that Obamacare requires reinforcement and repair, that someday may need total replacement. Conservatives and liberals each have plenty of ideas along those lines. But the standard for judging any of these proposals, or some bipartisan comparison of them, will be the same one that Trumpcare failed to meet: Does it protect the people who need protection? Does it improve access to care? Does it reduce financial insecurity? Does it move the US closer to a system where all Americans truly have a way to get the medical care they need – at a price they can afford?
The true legacy of Obamacare is the principle that everybody should have health insurance. Erasing that is not something that can happen by Trumpcare in 63 days.
*This blog is the third blog in a 3-part Healthcare Series. The first blog featured information on Seema Verma, the new Chief of Centers for Medicare & Medicaid Services. The second blog featured President Trump’s plans for Medicare.