[메디컬리포트=Maricor Zapata 기자]
Thursday marks another major step in the partisan battle over healthcare reform in the U.S.as the Senate Republican healthcare bill made its reappearance in search of a majority vote that is absolutely requisite to repeal and replace Obamacare.U.S.Senate Majority Leader Mitch McConnell, architect of the Senate version of this bill, rolled it out once before already and rescinded it for further tweaks upon realizing that the bill simply did not have enough Republican votes to form the majority needed.Now, every vote counts as the GOP looks for all of its senators to switch to support for this altered version.
CNN reports that one of the GOP holdouts, Sen.Lisa Murkowski of Alaska, “was unhappy that reporters had seen a summary distributed to lobbyists before she had seen the bill.” Murkowski said, “I think that as a courtesy to those of us who are actually making the decisions that we would actually have an opportunity to see it first.” Republican senators, instead, ran the bill by insurance industry lobbyists first, and Murkowski took offense because it implies that the party’s primary concern is with what the corporations want before dealing with what everyday citizens want.
The new version remains impeccably similar to the first version and still only a stone’s throw away from the House bill presented earlier this year; the latter of which U.S.President Donald Trump himself called “mean.” There are, however, a few major changes to this version of the GOP Senate healthcare plan, chief among which is the inclusion of Texas Sen.Ted Cruz’s amendment to let Obamacare insurance providers also offer cheaper, bare-minimum policies as well.
Cruz’s amendment is intended to garner greater support from conservatives, but it is expected to be difficult for moderates to swallow.The Democrats have been nonnegotiable on this idea from the beginning with their argument that it defeats the purpose of the currently cheapest policies because they are meant to serve not only as the floor in terms of cost but also in terms of the minimum level of healthcare benefits that those who qualify for Obamacare can receive in light of the fact that qualifying requires income below the federal poverty line.
Undermining that minimum level of benefits simply to lower costs, liberals argue, only makes it more likely that poor people do not receive all that they need because of financial pressures to simply accept less benefits, and this same amendment is also viewed by policy experts and industry pundits as the primary means by which healthcare premiums could be increased for patients with pre-existing conditions, which is one of the biggest sticking points for moderates.
Both the House and Senate GOP health plans have made it possible for insurers to raise premiums for the policies of people with pre-existing conditions, which one of Obamacare’s most popular provisions disallowed outright because it ensures that insurance companies have to insure everyone—no questions asked—regardless of whether or not someone is already afflicted with illness of some kind.Under each iteration of the Republican Party’s health plan thus far, a diagnosis for multiple sclerosis, for example, affords insurers the opportunity to raise premiums, which Democrats point out only increases the financial burden on those who are already facing significant medical bills for an extended period to come.
Pulling moderates over to support the Republican healthcare plan has not been, heretofore, Mitch McConnell’s focus for getting the 50 votes needed to pass the GOP healthcare bill.He and other architects of the bill have been concentrating, instead, on gaining the support of holdouts within their own party by tweaking the bill in such a way as to nudge them toward voting affirmatively.Such holdouts include staunch opponent, Sen.Rand Paul of Kentucky, Maine Sen.Susan Collins, Arizona Sen.Bill Cassidy and to a lesser extent, Sen.Jeff Flake of Arizona.
Sen.Paul is presumed to still be against the bill but has not said as much publicly since the new version was put forward; many consider his vote decided simply on the merit of his saying previously that he wouldn’t support even a motion to debate it on the floor.Sen.Collins was only slightly less adamant in saying she wouldn’t support the motion to proceed without the Congressional Budget Office [CBO] indicating Medicaid cuts would be less severe. “The only thing that can change that is if the CBO announcement, which come out on Monday, indicates that there would be far fewer in Medicaid than I believe there are now,” said Collins.
Liberals frequently ask why Republicans are unable to simply repeal and replace Obamacare as they’ve vowed to do since Obamacare became law in 2010, deeming seven years more than adequate time to determine what needs to be done.The reason Republicans find it so difficult to pass legislation on healthcare reform post-Obama, though, is because many Republican representatives and senators fear they will lose their seats if they support legislation that blatantly robs their constituents of fundamental healthcare benefits.
Under Obamacare, Medicaid was expanded to operate based on an uncapped matching formula wherein each state receives Medicaid funding from the federal government based on however much that state spent on Medicaid operations the previous year; conservatives reasonably and justifiably criticize this as incentivizing states to increase their Medicaid spend each year, so the Republican healthcare plan proposes a Medicaid block-grant system instead, which provides each state with “a set, finite grant from the federal government to spend on their Medicaid programs,” according to Matthew Glans, legislative specialist on finance and insurance for The Heartland Institute.
“Although the programs would have to abide by several guidelines, the states would be allowed to customize their programs to fit their needs and goals.If a state were to decide to expand its Medicaid program to a larger population, it would be able to do so, but if the costs of the program exceed the grant, the state would pay the difference,” Glans says.Conservatives see this as a means of returning power to the individual states, which gels with the overall Republican philosophy of less intervention on the part of the federal government in the governance of states and the lives of ordinary people.
In every legislative action, one of the most important aspects is what kind of behavior it incentivizes, and many feel that block grants systematically incentivize less spending on Medicaid in general as opposed to refinancing entire other programs both related and unrelated to healthcare just to maintain the same level of coverage provided by Obamacare.
Each version of the Republican healthcare plan thus far this year in their attempts to repeal and replace Obamacare have included a block grant system for Medicaid, but too many Republicans are unwilling to support such a system because they fear the consequences of voting in favor of legislation that incentivizes the curtailing of state spending on Medicaid programs.If citizens lose their health insurance, they won’t be able to overlook it, and they’ll hold their representatives accountable if those representatives supported whatever legislation is responsible.
Republican lawmakers in the 32 states that accepted the Obamacare Medicaid expansion using the uncapped matching formula (blue states), therefore, risk losing their seats when their constituents retaliate for their loss of healthcare.The other 19 states, however, are states in which Republican governors refused the Medicaid expansion in the first place, and those are the states in which Obamacare was not funded enough to benefit everyone optimally.As such, Obamacare is unpopular in those states, and representatives from those states cost their constituents very little that they haven’t already lost if they support the new GOP healthcare plan.This is what pressures Republican congressmen and women to oppose their own party’s proposed American Health Care Act.