What’s Next for the Health Care Debate?
A Demand for Process and Transparency
While the Senate was voting on the motion to proceed with the straight repeal plan that would eliminate coverage for millions of Americans, I was in the exam room of my doctor’s office, and using my newly-acquired Medicaid for the first time. How did I feel?
Suffice it to say that my blood pressure wasn’t its usual 110/70.
Amid the polarizing and at times heart-wrenching health care debate, I have a number of things at stake. As a political scientist who works on health politics and policy among other things, I know a lot about the research. I know that there is greater access to care and self-reported quality of health among those who acquired insurance thanks to the Affordable Care Act. I also know that the congressional norms of transparency and legislative hearings for significant legislative efforts such as this, and the (theoretically) important role of constituents’ public opinion in shaping legislators’ behavior, have been ignored during the efforts to pass a bill. However, the Republican majority faces a real obstacle: while they campaigned on a pledge to repeal Obamacare, not only was their replacement plan garnering pitiful public support, but voter approval for Obamacare had also reached historic high marks. Thus, the leadership in both houses is faced with an unusual dilemma: whether to break a signature pledge or respond to current sentiments.
I am also a partisan. In my work on Democratic political campaigns, I have emphasized Congress’s moral imperative to reject efforts that undermine the health care of millions of vulnerable citizens. Grassroots mobilizing that has emphasized a moral stance has influenced legislators, especially those who are up for reelection in 2018 or 2020. This seriousness of purpose among activists is a stark contrast to a bill whose actual contents sparked little conversation more serious than the delightful game of guessing which notoriously bad movies had Rotten Tomatoes ratings better than Trumpcare’s polling numbers?
I am also a patient, with chronic illnesses dating back to early childhood. I watched with grave – and highly personal — concern as Congress presented new plans that might decimate Medicaid, undermine protections for those with preexisting conditions, or dismantle essential health benefits. On January 19, 2017, my protest at Trump Tower was interrupted by texts from my doctor instructing me that, based on my latest test results, I should proceed to the emergency room. The following week, I watched President Trump’s inauguration from a hospital room, knowing that the policy issue on which my life most depends was at stake. And as congressional Republicans advanced policies that the CBO found would result in tens of millions of sick and poor Americans losing coverage, my position as a lecturer at Yale was not renewed, leaving me to rely on Connecticut’s Medicaid expansion for the health care on which I rely heavily. I joined the chorus of patients around the nation rallying – pleading – with Congress to preserve the Affordable Care Act.
There are issues on which we can reasonably expect that the parties will diverge, based on different visions about the proper scope of government intervention. Some view the Democratic Party as being overly paternalistic, not enabling states and the private sector to innovate in ways that work best for them. Others view the Republican Party as not working adequately to invest in government protections to which people should be entitled regardless of where they live.
Health care – how it is paid for, managed, and allotted — will continue to be a focus of disagreement. But the preservation of basic transparency, responsiveness, and decency when millions of people’s health care – and indeed, our lives – is at stake is where we need to draw the line. And despite some Republicans’ purported opposition to deep cuts to Medicaid and undermining opioid addiction treatment, as millions of Americans stayed up way past their bedtime to watch, all but three Republicans voted to cross this line between the hours of 1 and 2 a.m.
After seven years of Republican opposition to the Affordable Care Act and allegations that it was “rammed down throats” (despite Democrats holding over 100 bipartisan hearings), we might have expected more transparency as Republicans began to craft their replacement plan. The ideal of political responsiveness to constituents ought to have persuaded members of What we got was hypocrisy. Rampant opposition to the bill in town halls, protests, and outreach to congressional offices ought to have persuaded Congress to rethink the legislation. Popular sentiment should at minimum have led them to hearings that might have facilitated transparency and legislative improvements.
While as a patient with chronic illness I am relieved that 51 senators voted against hastily-crafted legislation with the potential to harm millions, it is deeply disturbing – both from the perspective of health policy and from the standpoint of democratic accountability – that the bill came so close to passing as it did, given such malevolent conditions.
As the Senate finally announces its plan to hold bipartisan hearings on health care, President Trump has simultaneously threatened to sabotage the stability of the Obamacare market by discontinuing cost-sharing reduction (CSR) payments to low-income patients. Senators would do well to learn their lesson from the recent failed efforts at repeal, and instead work toward bipartisan solutions that stabilize the health insurance market – in broad daylight.
Miranda Yaver has a Ph.D. from Columbia University; she is a political scientist and a writer in New Haven, CT.