President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law on March 23, 2010. And from the moment his pen left the paper, Republicans have been doing everything in their power to undermine it. They voted dozens of times to repeal all or parts of the bill, finally getting a bill for total repeal on Obama's desk in 2016 (which he promptly vetoed). They smeared the law with lies about "death panels" for the elderly. They made repealing Obama's signature law (which, while undoubtedly flawed, still provided coverage to millions of Americans who would otherwise be unable to afford it) a central tenant of every campaign run in the last seven years. And now, with control of both houses of congress and a Republican in the White House, they finally have the ability to end this tyrannical example of "socialized medicine."
And, like the dog who finally catches the car, they haven't the faintest clue what to do with it.
I'll admit it, the schadenfreude is strong. After watching Republicans rend their garments and gnash their teeth for the better part of a decade while ranting about how this law threatens American civilization as we know it, watching them fumble their first real opportunity at doing something about it in such spectacular fashion is enjoyable.
As it turns out, the biggest problem with the so-called American Health Care Act (AHCA) presented by the Republicans in congress and supported by the White House is a simple one: surprisingly, people really like having health insurance! And while it was easy to bluster about repealing the ACA when they knew it wasn't actually going to happen, the GOP is finding it a lot more difficult when their actions will directly impact the coverage of millions of their constituents.
But they had to try, right? They couldn't just ignore their biggest ongoing political initiative of the last seven years. And so they wrote a bill (in secret, leading to a comical episode with Rand Paul and Democratic representatives scouring the Hill for this enigmatic piece of legislation), and it was finally released to the public.
And everyone hates it. Conservatives hate it because it doesn't go far enough in repealing the Medicaid expansion and creates a tax incentive for coverage (because if there's one thing the House Freedom Caucus hates, it's poor people buying health insurance). Republicans in Medicaid-expansion states hate it because cutting coverage for a huge chunk of your electorate isn't a sound political strategy. The fact that the Democrats hate it goes without saying. It was such a divisive issue that the party's main strategy appeared to be just putting the bill on the floor as is and daring Republicans to vote against it.
And then the Congressional Budget Office released their appraisal of the bill, and everyone saw this:
That first chart is the hay-maker, reflecting the two biggest figures coming out of the CBO report: 14 million people losing coverage by 2018 and 24 million by 2026 under the AHCA. But the second chart hit me the hardest. Under the AHCA, a lower-income senior citizen would see a 750% increase in his or her annual premiums, resulting in healthcare costs exceeding 50% of income! "But that person will still have access to health insurance," exclaims the GOP in defense of this atrocity. But as Bernie Sanders has become fond of saying, there's a difference between having access to buying a $10 million dollar home and feasibly being able to afford it.
So what happens next? At this point, no one knows. The White House and Congress are supposedly working together on amendments, but every shift the bill takes to the right risks losing more GOP support from the center, and vice versa. The sides are already bickering, with conservatives telling moderates to get in line and moderates complaining that the White House and Republican leadership is only open to amendments that shift the bill further to the right. It's entirely possible that they won't be able to make any meaningful changes to the law they long ago designated as public enemy number one.
But that does not mean we can let up the pressure. After taking town halls by storm during the last congressional recess and demanding answers and accountability from representatives on both sides of the aisle, it is imperative that we carry that energy forward. The Republican party is looking to strip health care from millions of the most vulnerable Americans and use the profits to give a gigantic tax break to the wealthy. It is up to us to prevent that from happening.
Hell, if we keep it up, maybe one day we can even join the rest of the civilized world and get a true universal health care system. Then we could finally stop ranking dead last among developed nations.
If Donald Trump can win a presidential election, anything is possible.