In 1986, as a part of the Budget Reconciliation Act, President Ronald Reagan signed into law the Emergency Medical Treatment and Active Labor Act. This legislation guaranteed any hospital emergency room that accepted Medicare are required to provide treatment to all others regardless of legal status, citizenship, or payment ability. There were no reimbursement provisions and hospitals could not transfer or discharge patients needing emergency treatment once the patient was deemed to be a non-payer. This led to last option care for many middle-class families who could not afford healthcare.
Ronald Reagan is the last Republican President to expand some access to national healthcare. Amazing isn’t it, given the right’s adoration for this man? With the current House and Senate bills, Republicans are taking the country back 30 years where Reagan’s law will once again be primary care for many. Medicaid will still be available for the poor, so the proposed repeal of Obamacare will hit working and middle class families hardest.
For the past seven years, discussion around repeal has been the norm with little solutions offered for replacement. President Trump’s comment, “who had any idea healthcare could be this complex?” speaks volumes about how the GOP has managed the issue. When Republicans were out of power the continuous divisive rhetoric fueled reelection bids and ignited the base. Governing is hard. It requires measured solutions. It requires compromise. Republicans are being asked to produce a clear path forward and instead they give the same tired talking points.
The recent CBO report debunked many Republican claims surrounding the current health care law (you can read the report here). Obamacare is not on the verge of collapsing unless subsidies are removed by current proposed legislation. Yet this is an effective strategy for the GOP. Republicans love to point out how inefficient government is and then spend their time working to reaffirm this claim (E.g. Jason Chaffetz highlighting a lack of security in Benghazi, right after his committee pulled funding for security in Benghazi).
The reason Republicans are having such a hard time coming up with productive legislation is many of their best ideas are already implemented in our health care system. Exchanges? Republican idea. Mandates? Republican idea. Subsidies? Republicans called them vouchers, but yes, their idea too. In 1984 Senator John Chafee introduced legislation (co-sponsored by Orrin Hatch) that basically proposed a version of Obamacare 30 years prior. These ideas were a model for Governor Romney’s healthcare legislation in Massachusetts and were implemented into the ACA to win support across the aisle. Remember, President Obama ran on single-payer care in 2008 so ACA legislation was designed to bring both parties to the table. In the end, Obamacare is nothing more than a golden parachute for private industry. It pushes individuals to purchase coverage on open markets and uses tax dollars to subsidize their privatized care. Why Republicans never embraced this plan is a testament to how partisan we have become.
The current House and Senate proposals are partisan bills designed to win elections, not to improve our nation’s healthcare. President Trump called the House bill “mean” and the Senate bill is no different. Cutting $400-$500 billion from Medicaid spending, giving that money to millionaires, and claiming improved healthcare is fuzzy math. Other suggestions like selling insurance across state boundaries are misleading because insurance companies would never offer such plans (can you imagine a Manhattan resident trying to buy insurance from a company that priced insurance in Iowa?). Rand Paul’s insistence on expanding health savings account is a good idea, but it has negligible impact on individuals currently receiving subsidized payments on the exchanges. Same with trading subsidies for tax credits ― you must pay federal taxes to receive credits.
What we all agree on is Obamacare needs improvements. Let’s start there. The current structure enables privatized markets and we need mechanisms to drive additional competition. Republicans are out of partisan options, but not out of time to revive the compassionate conservatism Reagan enshrined.