One of the most dramatic moments in modern American political history came in the wee hours of July 28, 2017, when the country watched to see if the Senate would vote to repeal the Affordable Care Act — and send the country back to the days when premature death and bankruptcy were common due to lack of access to health insurance. Republicans had voted dozens of times to repeal the law they had hated, even calling it “Obamacare” as a kind of epithet, not realizing the program would become popular and forever be associated with the popular Democratic president who signed it.
That night, the vote on the floor was called the “skinny repeal,” a transparent gimmick intended to force GOP House members on the other side of the Capitol to come up with something better, even though their previous attempts had been failures. The Republican caucus was unified with three exceptions. Lisa Murkowski of Alaska and Susan Collins of Maine were opposed. Only Arizona Sen. John McCain remained uncommitted. If he voted no, it would defeat the bill 51-49.
McCain was suffering from brain cancer and had dealt with a lifetime of health challenges due to his injuries as a POW in the Vietnam War. He understood the stakes, and he had a gift for drama. When he walked on to the floor that night, he knew his vote would be one of the defining moments of his career. When his name was called, McCain didn’t say anything. He simply walked up to the desk and gave a thumbs down, effectively ending the GOP’s relentless, years-long attempts to repeal Obamacare.
Eight years later, the GOP — the party that has spent decades trying to privatize Social Security and Medicare — is trying a different approach: Destroying the program by increments, one painful piece at a time. They ended the individual mandate, which would have made everyone participate — and kept premiums lower while covering people who don’t realize that bad things can happen to them too. They hobbled the Medicaid expansion from the beginning, and more recently they cut that program drastically under the One Big Beautiful Bill Act, which is conveniently set to take place after the 2026 midterms, revealing that they know just how unpopular and cruel those cuts will be. They made it more difficult to enroll, forcing people to manually sign up every year instead of being automatically enrolled. And now they are allowing the ACA subsidies to expire, hiking premiums to unaffordable levels for millions of people.
The GOP’s philosophy was perhaps best captured by Medicare and Medicaid head Dr. Mehmet Oz, who said Sunday on Fox News, “If you really want to drop the cost of health care in America, get healthier.”
It took Democrats decades to pass universal health care legislation, which was famously the dream of President Harry Truman. In 1994, the Clinton administration’s attempt at health care reform failed, largely due to Republicans being unwilling to negotiate. There were subsequently some successes at the state level, most notably in Massachusetts under GOP Gov. Mitt Romney, who passed a program with some elements that appealed to Republicans. Democrats thought Romney’s template might offer a way to attract GOP support in Congress.
When Barack Obama won the White House in 2008, the country was in the midst of a severe economic crisis and a painful recession. Job losses exacerbated a health care crisis that had been growing for decades. A system dependent on employer-provided health insurance left tens of millions of Americans unable to afford it on their own — if they could qualify at all.
When Democrats stated their intentions to finally pass health care reform, Republicans refused to participate. But Democrats had been given a mandate by voters, along with large majorities in both houses of Congress. For months they held hearings, consulted experts, drafted policies and debated, trying to form a consensus as a party, and with the public. There were pro-life members who refused to allow abortion coverage, progressives who wanted a public option and conservative senators who wanted less coverage and regulation. Across the country, the newly-formed Tea Party was staging a tantrum, and giving the media the thrilling political theater they craved.
Still, largely due to the leadership of House Speaker Nancy Pelosi, D-Calif., Democrats managed to pass the Affordable Care Act with the understanding that it was only a “starter home,” as Obama referred to it — a framework on which to build over time. Important regulations such as requiring insurers to cover people with pre-existing conditions, allowing kids to stay on their parents’ policies until they were 26 and requiring some basic kinds of coverage were the plan’s foundation.
Many Democrats hoped they could eventually provide a public option, which would essentially allow people to opt-in to Medicare. The party also wanted to raise the subsidies that helped people pay for the insurance on the exchanges, as most agreed the original formula would not be sufficient over time to cover all the program’s eventual recipients. In 2021, as the Covid-19 pandemic precipitated yet another economic crisis, leaving many out of work and needing to buy into the program, Democrats were finally able to increase those subsidies for millions of people through the American Rescue Plan.
Now, after these hard-fought gains, Republicans are at it again. They are recycling their absurd health care “alternatives” at a time when the government has completely lost touch with anything resembling reality or responsibility. This time, they might just get them passed.
President Donald Trump has apparently decided that he can take one of his faux-populist stances by promoting the idea of sending subsidies directly to Americans instead of the “big bad insurance companies,” allowing Americans to negotiate with the corporations on their own. Setting aside the notion that individuals can negotiate the cost of their health care, this daft idea offers no explanation as to how it’s supposed to save people money. They would still have to kick in their own share of higher premiums.
It’s clear that Trump doesn’t understand anything about insurance — but then some Republican senator doctors apparently don’t either. In a speech on the Senate floor, Kansas Sen. Roger Marshall complained that 40% of people insured under Obamacare don’t file any claims, which means they shouldn’t be on the program. Then there is a more serious proposal by Louisiana Sen. Bill Cassidy, who wants to send Trump’s subsidies to a mandatory Health Savings Account, which experts warn would end up collapsing the ACA Marketplaces.
But not to worry. Sen. Rick Scott, R-Fla., says he’s writing the legislation and that he’s an expert. He once ran HCA, the country’s largest for-profit health care company — until he resigned in 1997 during a federal investigation. In 2003, the company was found to have defrauded Medicare and had to pay $1.7 billion, then the largest fine in U.S. history.
Republicans openly admit they want people to pay high deductibles and have terrible coverage because they think it will make them more “responsible.” During a presidential debate in 2011, Rep. Ron Paul, R-Texas., a medical doctor, was asked if society should just let people who don’t have insurance die, and his fans in the audience yelled “yeah!” He suggested that charity could pick up the tab but that really, people just need to be responsible for themselves.
Paul’s response was honest, what most Republicans are unwilling to admit they believe: If you aren’t rich enough to afford high premiums, or to pay for your own health care if you get sick and insurance refuses to cover you, then you have failed to adequately care for yourself and you should just have to suffer the consequences. All of Trump’s phony paeans to populism can’t hide his real intentions.
Salon
