Image: Indivisible Pasco greets Representative Gus Bilirakis with a die-in at his new office opening.
May 4, 2017 was a day of infamy in the House of Representatives—and, no doubt, will long be remembered. On that day, Republicans eked out a narrow House floor passage of the GOP health bill. The vote occurred even though few read the bill, and it was rushed through before a non-partisan Congressional Budget Office (CBO) analysis could be prepared.
We do know, however, that the bill would cause tens of millions to lose health insurance. It also would make coverage unaffordable for people most in need of care—especially those with pre-existing health conditions like cancer, heart disease, diabetes, and mental health problems. And it would take away over $800 billion in health care funds intended for the poor, transferring most of them to tax give-aways for the wealthy and special interest groups.
The harmful votes cast that day, and the galling Rose Garden celebration President Trump held with House Republicans immediately thereafter, must not, and will not, be forgotten or forgiven during the next two election cycles.
To ensure that result, grassroots activists across the country launched a campaign to hold House Republicans accountable. The “Payback Project”—spearheaded by Indivisible, MoveOn, Town Hall Project, and Women’s March—is making sure House members can’t hide from this vote or from their constituents. Voters will repeatedly be reminded how their representative jeopardized their families’ health care and lives, promoting electoral repercussions that will be intense.
The bill already is opposed by larger margins than the Affordable Care Act (ACA) ever was!
As these important accountability efforts move forward, it will be no less crucial for activists to focus on round two of the legislative process: Senate consideration of the health bill. Since Republicans only have a bare Senate majority, this is where our active opposition has its greatest prospects for success. We must focus like a laser beam on the biggest stakes of that debate, of which at least five concerns will arise that deserve highest-priority advocacy.
Protecting the Safety-Net Medicaid Program
The first and foremost concern must center on the Medicaid safety-net. The program provides health insurance for more people than any other payer, covering approximately 72 million—more than one out of five U.S. residents. All program enrollees have very low incomes. Half are children. Others are mainly seniors (especially those requiring long-term care) and people with significant disabilities. Medicaid, therefore, covers America’s most economically needy people.
As the GOP’s House bill reflects, the Senate’s Medicaid debate will focus on two main issues: (1) whether the expansion of the program—which accounted for more than half of the 20 million uninsured people who gained health coverage through the ACA—will be rolled back; and (2) whether the program will be restructured in a way that would drastically cut safety-net coverage in states across the country.
The ACA’s Medicaid expansion allows states to set program eligibility standards at 138 percent of the federal poverty level, a modest $16,400 in annual income for a person living alone. The District of Columbia and 31 states have chosen to do so, including states represented by 20 Republican senators. Activists must work to ensure that those senators protect their impoverished constituents by opposing any rollback of the new standards.
Some of those senators, who want to appear like they are protecting their constituents, have already telegraphed the “compromise” they will push —delaying Medicaid cuts a few years rather than oppose them. This is a pure sell out! They must be reminded, over and over again, that a delayed cutback is still a cutback – and it will cause enormous, permanent damage.
Even more troublesome, the House restructured Medicaid by an unprecedented capping of program funds. It would radically change how the program has operated since its inception in 1965. Instead of ensuring that all eligible low-income people are able to enroll in coverage, it inevitably would create program waiting lists, reduce program benefits, and force people to pay unaffordable premiums and other out-of-pocket costs. It is a huge cutback and must be stopped!
Ensuring Health Coverage is Affordable
The ACA makes health insurance affordable by providing premium subsidies to more than four out of five people enrolled in the new marketplaces. It does so on a sliding scale, providing the most help for those in greatest need. These subsidies, along with the Medicaid expansion, are the two most significant ACA provisions that enabled 20 million to gain health coverage.
The House bill, however, would slash these subsidies: It would no longer allow subsidies to be based on economic need, and it caps them at artificially low levels so that premiums become unaffordable once again. It also increases premiums for people between the ages of 50 and 64, forcing them to pay five times more than young people. As a result, lower-income people and near-seniors will be priced out of health coverage—very harmful changes requiring strong opposition when they are debated in the Senate.
Protecting People with Pre-Existing Health Conditions
The most popular ACA provision, which President Trump and Republicans boasted would be retained, protects people with pre-existing health conditions from discrimination by insurance companies. The House bill, however, makes a nullity of this protection. While insurers would still be prohibited from denying coverage to people with illnesses and disabilities, the bill allows insurers to charge much higher, discriminatory premiums, making coverage unaffordable for people most in need of care. This must be prevented in the Senate bill.
Republicans deceptively claim they are protecting people with pre-existing conditions by creating so-called “high-risk pools.” But pre-ACA history shows that segregated pools like these will not work. They are considerably more expensive because less healthy people inevitably have more, and considerably higher, health claims. As a result, such pools typically require much higher premiums and provide much lesser coverage—and these problems won’t be rectified by the mere pittance appropriated for those pools in the House bill. This ruse must be defeated.
Guaranteeing Meaningful Coverage
Insurance is only meaningful if it covers all essential health services, and the ACA guarantees that virtually all such services must be covered. The House bill would eliminate this guarantee by allowing insurers in various states to strip key benefits—like maternity and mental health care—from their coverage. This change will also be debated in the Senate, and it must be defeated.
Funding Planned Parenthood
Planned Parenthood, with approximately 650 clinics and other facilities, is the largest provider of reproductive health services in the U.S. It is a key deliverer of care for millions of women. The House bill, however, defunds the organization. This short-sighted proposal will be debated once again in the Senate, and it too must be defeated.
In sum, activists’ efforts will be critical in the weeks ahead. Activists must repeatedly insist that their senators fulfill the following admonitions:
- Don’t cut the safety-net Medicaid program;
- Don’t reduce premium subsidies for moderate-income families or increase premiums for the near-elderly;
- Don’t discriminate against people with pre-existing health conditions;
- Don’t take away essential health benefits from insurance coverage; and
- Don’t defund Planned Parenthood.
If we succeed with this agenda, we will restore peace of mind for families across the country. By winning on these issues, we can ensure that—contrary to the mean-spirited GOP House bill—families will get the care they need when they need it.