HealthCareReforminAmericanPolitics1

CommunityProblemReport:HealthCareReforminAmericanPolitics
RebecaE.VergaraGreeno
UniversityofTexasatElPaso
HealthCareReforminAmericanPolitics2

Abstract

FollowingtheimplementationoftheAffordableCareAct(ACA),U.S.healthcare

expenditureshavecontinuedtorise,approachingnearly18%ofthenationsGDP.The

lawhasbeensubjecttoscathingcriticism,tothepointthatCongressattemptedtorepeal

ordefundthebillover50timesundertheObamaadministration.However,evenwitha

RepublicandominatedCongressandExecutiveBranch,therushtorepealandreplace

hasbeenstalledastheduetolackofsupportintheSenate.Thefailureoflawmakersto

createaviableandpracticalsolution,evenwithcongressionalmajorities,isatestament

tothecomplexityofhealthcarereform.AsimplerepealoftheACAwouldresultin

millionsofAmericanslosinghealthcoverageandbillionsofdollarsworthofinvestment

lost.Meanwhile,noreformwhatsoeverwouldbringtheU.S.towardsunsustainable

levelsofhealthcarespending.ItisimperativethattheAmericanpublicbecomemore

conscientiousoftheseissuesandfocustheirenergyonfindingviablesolutionstotackle

healthcareinflationwithoutstrippingaccessawayfromthemostvulnerablepopulations.

Thisinvolvesamoreactivevoterbasethatfocusestheirsupportonrepresentativesthat

arewillingtoproposeevidencebasedpoliciesandbeopentosolutionswithbipartisan

support.
HealthCareReforminAmericanPolitics3

Introduction

DuringthefirstmonthsofTrumpspresidency,radicalchangessurroundinghot

topicssuchasimmigrationandtradehavesweptthecountry.However,oneheatedissue

hascometoanapparenthaltinCongress:healthcarereform.Followingthe

implementationoftheAffordableCareAct(ACA),thelawhasbeensubjecttoscathing

criticism,tothepointthatCongressattemptedtorepealordefundthebillover50times

undertheObamaadministration(Levin,2017).Now,evenwithaRepublicandominated

CongressandExecutiveBranch,therushtorepealandreplacehasbeenstalledasdue

tolackofsupportintheSenate.Thefailureoflawmakerstocreateaviableandpractical

solutionisatestamenttothecomplexityofhealthcarereform.Whileasimplerepealof

theACAwouldresultinmillionsofAmericanslosinghealthcoverageandbillionsof

dollarsworthofinvestmentlost(CongressionalBudgetaryOffice,2017),sittingidlyby

wouldallowtheU.S.governmenttowardsunsustainablelevelsofspending(Brill,2015.)

Congresssinabilitytopassanysignificantlegislationreflectsdivisionnotonlyacross

partylinesbutalsowithinthedifferentfactionsofbothmajorparties.Thispaperwill

attempttounderstandthecauseofthesepoliticalriftsandwillanalyzethefeasibilityof

bothpartisanandbipartisanhealthcareproposalsinthecurrentlandscapeofAmerican

politics.

TheHistoryofHealthcareGridlockinCongress
HealthCareReforminAmericanPolitics4

GridlockisafamiliaroutcomeinU.S.healthpolicy.Presidentshavelong

struggledtotranslatetheircampaignpromisesintolegislativesolutionwithbipartisan

support.Thefirstattempttoimplementauniversalhealthcareproposalinthepostwar

eraoccurredduringHarryTrumansadministration.Opponentsoftheproposal,including

theAmericanMedicalAssociation(AMA),denounceditas"socializedmedicine,"and

thebilldiedinCongress.Later,underPresidentJohnsonsadministration,aDemocratic

supermajorityinbothhouseswasusedtoquicklysteamrolllegislationforMedicareand

MedicaidprogramsdespitevocaloppositionfromtheRepublicanPartyandtheAMA.

Howeverthesenewprogramsonlyprovidedcoveragefortheelderly,poor,anddisabled,

anditwasnotlongbeforecallsformorecomprehensivehealthcoverageproposalsbegan

tosurface(Cassanego,2011.)Unfortunately,universalcoverageplansfromboththe

NixonandCarteradministrationsfailedtogarnersupport,whileBillClintonscampaign

toenactuniversalinsuranceendedinpoliticaldisaster(Starr,2017.)

Eventhemostrecenthealthcarereform,theAffordableCareAct,approved

strictlyalongpartylines,barelypassedwithafinaltallyof60to39.Afteryearlong

negotiationsforthisbill,notasinglerepublicanofferedtheirsupport,andevensome

DemocraticSenatorsshowedhesitation.PresidentObamawasforcedtoshiftfocusfrom

bipartisanship,tosimplyconvincingmembersofhisownpartytovoteforthebill(Kirk,

2010.)

FollowingthepassageoftheACA,publicapprovalofthebillquicklyplummeted

(Kirk,2010).ManyAmericansdisagreedwiththehealthinsurancemandate,which

issuedapenaltyforthosewhoremaineduninsured.Othersblastedtheprogramfor
HealthCareReforminAmericanPolitics5

increasinglyhighpremiumsanddeductibles,despitesomeoftheplansbeingsubsidized.

Outcriesintensifiedinthefallof2013whenmillionsofAmericansreceivedcancellation

lettersfromtheirinsurersforplansthatdidnotcomplywithcertainpolicieswithinthe

ACA(Lubby2017.)Meanwhile,Politifact,apopularmediafactcheckeroperatedbythe

TampaBayTimes,namedPresidentObama'sclaimthat"Ifyoulikeyourhealthcare

plan,youcankeepit"theLieoftheYearfor2013,whichfurthertarnishedthepublics

perceptionofthelaw(Holan,2013.)

TheAffordableCareActandRepealandReplace

ThebiggestdividebetweensupportersandopponentsoftheACAisthelackof

agreementonwhatthelawtriestoaccomplish.Forthosewhobelievetheprimarygoalof

thelawwastobringhealthinsurancetomoreAmericans,Obamacarecertainly

succeeded.Morethan20millionAmericansgainedhealthcoveragethroughthelaw

(Black,2017).Forthosewhobelievetheprimarygoalofthelawshouldhavebeento

makehealthinsuranceaffordableforallwhowantit,thenObamacarewasnotsuccessful.

HealthcareintheUnitedStatescontinuestobeoneofthemostexpensiveintheworld,

and28.5millionAmericansstillremainuninsured(KaiserFamilyFoundation,2016.)

Asis,theU.S.spendsnearlytwiceasmuchonhealthcarepercapitarelativeto

otherOECDcountriesbutstillexperiencesequaltoworsehealthoutcomes(PeterG.

PetersonFoundation,2015.)TheACAsinsuranceexchangesalsoremainvulnerable,

overtakenbyhighpremiumincreasesduetolackofcompetitionbetweeninsurers.Both

theuncertaintysurroundingtheACAsfateandlossofprofithavecausedinsurersto

eitherincreasetheirpremiumsorexittheHealthMarketplacesaltogether.Ifnochanges
HealthCareReforminAmericanPolitics6

aremade,somestatesmaynotbeleftwithanyMarketplaceplansinthenearfuture

(Levin,2017.)

Politiciansfrombothpartieshaveconsistentlycalledforreformbuthaveonly

givenabstractproposalstoimprovethesevariouspitfalls.WhenPresidentDonaldTrump

tookoffice,theGOPwasdeterminedtodoleoutrepealandreplacelegislationand

reversehealthpoliciesfromtheObamaadministration.However,lessthantwoweeks

afterintroducingtheirfirstalternativeproposal,theAmericanHealthCareAct(AHCA),

theTrumpadministrationandHouseGOPleadershipdecidedtowithdrawthebill

withoutholdingavoteduetolackofsupport.Asecondversionofthebillbarelypassed

throughthehouse,andisunlikelytopasstheSenatewithoutmajorrevisions.

Theprecisereasonsforoppositionweredescribedsuccinctlyinanarticlewritten

byDr.JonathanOberlanderinTheNewEnglandJournalofMedicine:

TheRepublicanplangeneratedaperfectstormofopposition.Itspromiseto
contractinsurancecoverageandtherebyreducerevenuestothehealthcare
industrydrewfirefromhealthsystemstakeholders.Governorsofbothparties
objectedtothestaggeringMedicaidcuts.Thebillwastoomoderatefor
conservativemembersofCongress,tooconservativeformoremoderate
Republicans,andtoopartisanforDemocrats.Thesubstantialpremiumincreases
forolderAmericansinruralareaswouldhavehurtaconstituencythathelped
electTrump.Andtheplansthreattounsettlethestatusquo,cuthealthbenefits,
andincreasethecostsofpurchasingindividualinsurancealienatedthepublic.

TheRepublicanPartysfailuretoadvancetheAHCAnotonlyreflected

ideologicalpolarizationbetweenthetwoparties,butalsointrapartydivisionswithinthe

GOPitself.TheHouseFreedomCaucusviewedtheinitialhealthbillasObamacarelite
HealthCareReforminAmericanPolitics7

anddidntbelievethebillwentfarenoughinderegulatinghealthcaremarkets,reducing

spending,andlimitingMedicaidexpansion.MeanwhilelessconservativeRepublicans

worriedtheywouldlosepublicsupportinupcomingmidtermsforpassingabillthatthey

believedwouldraisecostsforolderAmericans,limitinsurancebenefits,andincrease

consumersoutofpocketexpenses.Duetothesedisagreements,theHouseendedup

losingvotesfrombothfactionsoftheRepublicanPartyduringthefirstroundofvoting

(Oberlander,2017.)

ThemostcurrentversionoftheAHCAwouldalsohavesomedisconcerting

consequencesifpassedintolaw.Whilethebillwouldlowertaxesforhighincome

individualsandwouldremovetheunpopularmandate,itwouldalsoallowforstatesto

rollbackcertainprotectionsforthosewithpreexistingconditionsandseverelydecrease

Medicaidfunding(CongressionalBudgetaryOffice,2017)Thelegislationwouldallow

insurerstochargeolderconsumersuptofivetimesmorethanyoungerconsumers,

therebymakinginsuranceplansunaffordableforthedemographicmostlikelytosuffer

fromhealthillnesses.TheCBOreportprojectedanincreaseintheuninsuredpopulation

by24million.Duetotheseconsequences,theGOPlegislationisunlikelytogainsupport

fromDemocratsormoderateRepublicansintheSenate.Overcomingthisoppositionand

passinglegislationthroughbothchambersofCongresswillbeadifficulttaskforallof

theaforementionedreasons.

Conclusion:StepsForward
HealthCareReforminAmericanPolitics8

AsU.S.healthcareexpendituresapproachalmost18%ofthenationsGDPwith

nosignsofslowing(Fuchs,2013),theAmericanpublicshouldbeconscientiousofthese

issuesandfocustheirenergyonfindingviablesolutionstacklinghealthcareinflation

withoutstrippingaccessawayfromthemostvulnerablepopulations.Difficultiesarise

whendiscussingthedirectionofhealthcarereformprimarilyduetoideological

differencesbetweenpartiesandtheinfluenceofoutsidespecialinterests(Kirk,2010.)On

awhole,theRepublicanandDemocraticPartiesalongwiththeirconstituentshave

fundamentallydifferentgoals:onehopestoreversecourseonObamacarelegislationand

deregulatethehealthcaremarket,whiletheotheraimstoexpanduponsubsidiesinthe

currentsystemandincreaseregulations.Ashistoryhasshown,findingasolutionthat

encompasseselementsofthesetwocontradictorysolutionsisincrediblydifficult.

Themostpragmaticcourseofactionmaybetostartwithsmallerscalesolutions

thataddressthecoreissuesofhealthcareinflationandhavemajoritysupportfromthe

public.Toprovidejustoneofmanyexistingexamples,bothpartiesadvocateforgreater

healthcaretransparencytoencourageproviderstodeliverhigherqualitycareand

encourageconsumerstomakebetterhealthcaredecisions.Solutionscouldincludepay

forperformanceinitiativesandredesigningcopaysanddeductiblessothatpatientsare

moreawareoftheactualhealthcarecosts.Manyhealthcareprovidershavealso

advocatedfundingpreventivehealthcareinitiativesthatincreaseaccesstoprimarycare.

Inthisway,patientsarelesslikelytoletsmallhealthproblemssnowballintolarger

healthconcernsthatrequiremoreexpensiveemergencyattention(Koh,2016.)
HealthCareReforminAmericanPolitics9

Responsibilityalsoliesonthevotertochooserepresentativesthatrealize

effectivehealthcarereformwillnotoccurwithoutbipartisancompromise.Forthepast

decade,thepoliticalatmospherehasbeenoneofobstructionanddisagreement.Itisclear

fromourcurrentcondition,thatneitherpartyhasconstructedaperfectsolution,and

neitherpartyiscompetenttodosoonitsown.Thewillingnesstouseevidencebased

policiesandbridgegapsbetweenthetwopartiesideologiesisavaluablequalitythat

shouldbesoughtafterinourrepresentatives.Votersmustbeencouragedtobemore

activelyinvolvedinthepoliticalprocesssothattheycanchooseflexiblelawmakersthat

willbestrepresenttheirinterests.

References

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ourbrokenhealthcaresystem.NewYork:RandomHouse.

Black,D.(2017,March20).H.R.1628115thCongress(20172018):AmericanHealth

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https://www.congress.gov/bill/115thcongress/housebill/1628

Cassanego,S.(2011,November11).TheHistoryofHealthCareReform:WhereWe've

ComeFromandWhyItMatters.RetrievedMay13,2017,from

https://sites.duke.edu/sjpp/2010/thehistoryofhealthcarereformwhereweve

comefromandwhyitmatters2/

BudgetaryandEconomicEffectsofRepealingtheAffordableCareAct.(2017,March

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Dubay,C.(n.d.).AfterRepealofObamacare:MovingtoPatientCentered,Market

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Fuchs,V.(2013,July11).TheGrossDomesticProductandHealthCareSpending.

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http://www.nejm.org/doi/full/10.1056/NEJMp1305298#t=article

Holan,A.(2013,December12).LieoftheYear:'Ifyoulikeyourhealthcareplan,you

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