Universal Healthcare Inches Forward

Doctors, insurance companies, hospitals and large pharmaceutical companies have been traditional opponents of any form of ubiquitous universal healthcare.  There were well over sixty Republican congressional efforts to overturn the 2010 Affordable Care Act (ACA, also called “Obamacare”), and obviously none succeeded. 

Doctors, insurance companies, hospitals and large pharmaceutical companies have been traditional opponents of any form of ubiquitous universal healthcare.  There were well over sixty Republican congressional efforts to overturn the 2010 Affordable Care Act (ACA, also called “Obamacare”), and obviously none succeeded.

Doctors, insurance companies, hospitals and large pharmaceutical companies have been traditional opponents of any form of ubiquitous universal healthcare.  There were well over sixty Republican congressional efforts to overturn the 2010 Affordable Care Act (ACA, also called “Obamacare”), and obviously none succeeded. 

In 2012, the U.S. Supreme Court (National Federation of Independent Business v. Sebelius) ruled that the ACA was supportable as a “tax” but not as a “mandate” for state expansion of Medicaid. Almost half of the states (all Republican led) thereafter announced that they would exercise their right under that ruling to opt out of Medicaid expansion, leaving almost 5.9 million of our nation’s poorest without access to affordable health insurance. But Republicans still wanted total repeal.

 In 2017, using the budget reconciliation process to sidestep a Democratic filibuster, Congress eliminated the individual and employer mandate from the ACA (via the 2017 Tax Cuts and Jobs Act). Republicans were chipping away at the ACA. Total repeal? Also in 2017, the last serious GOP effort to repeal the ACA Senate died when it was clear that GOP Senator and Arizona Republican John McCain, joined by two other Republicans, opposed that bill.

Then in early 2018, 20 red states, later joined by the Trump administration, filed a lawsuit (Texas vs United States) claiming that when Congress ended the mandatory participation requirement, that it effectively defunded the ACA, which represented a de facto repeal. After the 2018 mid-terms, two states pulled out of the litigation, leaving 18 states still in the mix. Almost immediately after taking office, the Biden administration pulled the Department of Justice’s support of these states, which won initially at the federal trial court level (in Texas). 

At oral arguments immediately after the November election (11/10), GOP hopes seemed to fade further as even the Republican-appointed Chief Justice noted to the Texas AG: “I think it’s hard for you to argue that Congress intended the entire act to fall if the mandate was struck down when the same Congress that lowered the penalty to zero did not even try to repeal the rest of the act.” That the Court would sustain a repeal of the ACA and leave approximately 23 million Americans without healthcare now seems a very remote possibility.

Although many Republicans still oppose the ACA, claiming that like Social Security and Medicare (some even claiming public education), the ACA represents creeping socialism, polls show that a majority of Americans support ACA. To get the actual definition of what “socialism” really means, not as the flagrant misuse of the English language, see my December 17th Socialism, Communism and Social Programs blog, with some pretty ordinary dictionary breakdowns. But with our experience with the pandemic, we have gone through some startling realizations.

First, it was the federal government that a. the Trump administration subsidized development of the vaccines and b. through expansion from the Biden administration, paid for the actual inoculation. Second, family practitioners and even some specialists noted a distinct downturn in patients willing to visit their offices – they were “COVID-scared” – for routine check-ups and even for emergency necessities. Incomes for so many doctors simply dried up. Some hospitals began to struggle under the strain. As COVID exploded, tons of uninsured patients were ferried in – ambulatory, car, Uber and, too many, by ambulance. Third, even for those with “good policies,” many discovered that between deductibles and co-pays they still faced staggering medical bills. See my January 31st 3.4 Times What Medicare Approves blog. In short, some of the bastions opposing universal healthcare are changing their minds.

Further, the United States has passed trillions and trillions of dollars in COVID stimulus and recovery bills, showing how woefully unprepared we were for this pandemic… and any other medical catastrophe we just might face in the immediate future. Europe, Australia, Canada, New Zealand, Japan, Korea, etc. already had safety nets and universal healthcare in place, which did not require the same massive new spending bills that poured out of the US Congress.

Just as the brouhaha against Medicare ultimately subsided, so it seems the GOP mantra to repeal the ACA is sliding into a milder form of containment. Doyle McManus, writing for the March 17th Los Angeles Times, reminds us: “Ronald Reagan, then a budding politician, campaigned furiously against the proposed health insurance program for senior citizens in 1961, warning that it would be a fatal step toward socialism. President Lyndon B. Johnson, a Democrat, ignored Reagan’s complaints and pushed Medicare through Congress in 1965. Within three years, the program was so popular that the next Republican president, Richard Nixon, never even tried to dismantle it…

“The $1.9-trillion COVID relief bill that Congress passed last week [second week of March] did a lot more than provide pandemic aid: It also included the biggest expansion of Obamacare in the program’s history. And here’s what was strange about that: Republicans raised hardly any objections.

“From the Affordable Care Act’s passage in 2010 through President Trump’s failed reelection campaign last year, GOP politicians have vowed to repeal the federally run insurance plan. But the last time Republicans really tried to scrap Obamacare was in 2017, and that attempt failed. Since then, their attacks have been little more than lip service.

“In his many speeches last week denouncing President Biden’s COVID relief bill, Senate Republican leader Mitch McConnell mentioned Obamacare only once, and then only to complain that the program was becoming too generous to upper-income families. House Republican leader Kevin McCarthy of Bakersfield, once a leader of the anti-Obamacare jihad, didn’t mention the program at all.” The United States remains the only developed country on earth without universal healthcare. Our per capita medical expenditures are more than double the average in that developed world, and our life expectancy statistics – the metric of a successful healthcare system – were falling even before the pandemic. How did the ACA change, and what does the future hold?

“Biden eliminated the income cap and imposed a ceiling of 8.5% on the share of income that a family would be asked to spend on premiums. That new provision is temporary, which makes it likely Congress will debate it again just before the 2022 midterm election. But will Republicans really want to propose clawing subsides back from middle-income families right before an election?

“Now Biden wants to expand the program further — not only by making the increased subsidies permanent, but also by adding a government-administered insurance policy (known as a “public option”) and perhaps by allowing people under 65 to buy into Medicare. Polls suggest that both of those proposals are broadly popular — but the public option is likely to draw strong opposition from hospitals and doctors, because they fear it will create downward pressure on their prices.” McManus. 

We can expect lockstep GOP opposition to such expansion, but many believe that the massive GOP loss of House seats in the 2018 mid-terms was significantly related to GOP attempts to dismantle the ACA. GOP opposition to healthcare comes at a steep price. Their opposition will undoubtedly be a fighting point until universal healthcare becomes an American reality. An inevitability.

I’m Peter Dekom, and it is time to ramp up a path to universal healthcare and join the rest of our peer nations in what should be a 21st century right… and not a privilege for those who can pay for it.