The Affordable Care Act Lives to Fight Another Day

PIP eNews readers will no doubt be familiar with the roller coaster ride the Affordable Care Act (ACA) has experienced at the hands of a Republican-led Congress in recent weeks and months. While Republicans in the House of Representatives were able to coalesce around a repeal and replacement of the existing law — which has been responsible for extending health care to 10 million previously under- or uninsured people — the Senate has been unable to agree on a several proposals for repealing or replacing. In a dramatic vote on July 28, a mere three Republican Senators successfully blocked efforts to pass a last-gasp proposal to change only a few key provisions of the ACA in order to keep this issue alive by moving legislation into a conference committee with the House. But the drive to deny insurance to some 22 million people does not end there.

In the days following the July Senate vote, the White House insisted that members go back to the drawing board to come up with some — any — scheme to repeal or replace. Some members of Congress insisted that, no matter how unpopular replacement of the ACA had suddenly become with an American public that had come to realize its benefits for them, it was critical that the Republican party keep its promise to take people’s health insurance away from them. That left two Senator Lindsey Graham to float the bad idea of block granting federal funds to the states to let them decide what kind of health care system they wanted. Doing so would have the effect of capping the number of low-income people with access to Medicaid and reduce their medical benefits significantly.

By August 1, however, the appetite of Republican leadership, including even of the White House, for prolonging this legislative fight at the expense of working on other issues important to the party, seemed to have dissipated. What, then, lies ahead?

The President has made it clear that he intends to allow the ACA to fail, and to help make it fail, no matter the consequences for access to health care and the well-being of millions of Americans. And indeed, there are many things that he has directed to happen administratively to undermine the ACA. These are primarily targeted at damaging the health care exchanges established by the ACA to help people whose incomes are too high to qualify them for the Medicaid program, but who still need federal subsidies to help them pay premiums for private insurance. The administration has cut back on advertising and outreach to encourage sign-ups for the exchanges, and it has threatened to cut back on subsidies — a threat that is destabilizing the exchanges as insurance companies worry about their profitability. Insidious actions on the part of the President, to be sure. Fortunately, however, one court decision has asserted that the administration does not have the power to deny the subsidies, which are part of established law. Hopefully, other judicial decisions will help to put a stop to the President’s actions.

In one hopeful bit of news, a handful of members of Congress are talking about the need for a bi-partisan effort to identify and address legitimate problems with the ACA, in particular to assure the strength of the health care exchanges. Democratic lawmakers have heretofore been reluctant to make any amendments to the law precisely because doing so would provide Republicans with the opportunity to repeal or gut it. Led by Senator Lamar Alexander, the current conversation about amending may have a good effect, but it too could be used by proponents of repeal and replacement to further destabilize the entire health care system.

In a shocking and cynical “you couldn’t make this stuff up” development in early August, however, Mitch McConnell may have devised a plan to get the one Senate vote he needs to repeal and or replace the ACA. West Virginia Governor Jim Justice recently switched party affiliation from Democrat to Republican. President Trump is considering appointing Democratic West Virginia Senator Joe Manchin to become Energy Secretary after he moves the current Secretary, Rick Perry, to head the Department of Homeland Security. General John Kelly headed Homeland Security until he recently became Chief of Staff at the White House. This game of musical chairs would allow Governor Justice to appoint a Republican Senator to the vacant West Virginia seat — an appointment that would give McConnell the one additional vote he needs to deny health insurance to millions of Americans.

The razor-thin margin of victory for supporters of universal health care in the Senate resulted in large part from a massive, grassroots uprising generated in recent months by scores of national groups that fought for and have defended the ACA since 2010. Considering that, with the election of Donald Trump and strengthened Republican membership in Congress resulting from last November’s election, it was almost taken for granted that the ACA was history, this organizing effort was historic.

Project Inform certainly played a supportive role, and we are extremely grateful to our supporters who pitched in with calls to their Senators and Representatives to impress upon them the importance of the ACA to the health of this nation. Unfortunately, however, the daggers will always be out for this important law, and continued vigilance will be necessary.

For the time being, Project Inform and our advocacy partners will monitor the actions of the Trump administration and Congress in order to comment on organize our constituents to oppose any credible efforts to reduce health care coverage for ALL Americans, including people with and at risk for HIV and hepatitis C.