| Perspectives on Texas

U.S. House Republicans betrayed their constituents when they voted to pass the American Health Care Act (AHCA), which threatens millions of Americans’ health coverage. While Obamacare was widely criticized for failing to control costs, most Americans valued its guaranteed coverage. Health care isn’t just a privilege like buying a new car; rather, it’s a right, on similar footing with life, liberty, privacy and freedom of speech.

The AHCA cut everything that was good about Obamacare:

• Coverage of pre-existing conditions
• Medicaid expansion to anyone within 138 percent of the federal poverty line
• Economic subsidies for people who must buy health insurance on the private market
• Availability of mental health and drug addiction services
• Coverage of most prescription medications
• The elimination of lifetime caps on health care services, which are devastating for the sickest Americans

The rollback of Medicaid expansion is especially concerning because the House Republicans cut over $800 billion of health coverage from our most vulnerable, poorest, and sickest in order to fund a future tax cut for the wealthiest 1 percent.

Now, the setting moves to the U.S. Senate, where Majority Leader Mitch McConnell faces the unenviable task of amending the bill so that it’s politically palatable enough to keep at least 50 of the 52 Senate Republicans on board. It’s going to be a tough sell for several Republican senators, including Utah’s Mike Lee and Arizona’s Jeff Flake, both of whom are up for re-election. And considering that Pennsylvania and Ohio are heavily dependent on federal Medicaid dollars, can Pat Toomey and Rob Portman afford to strip health care from a large number of their constituents?

McConnell may already have made a mistake by appointing a working group of 13 men — and no women — which could be offensive to Susan Collins (Maine) and Lisa Murkowski (Alaska). This is especially true given the current crisis of women’s health in this country, as we’re the one of the only developed countries where the maternal death rate rose from 2000-2014, including doubling in Texas over that time period and then doubling again in the two years since Gov. Greg Abbott refused federally funded Medicaid expansion.

Given that the current version of the AHCA cuts federal funding for Planned Parenthood in the first year and prohibits the use of federal tax credits to buy insurance that includes abortion coverage, along with allowing states to waive an Obamacare provision that required insurers to cover maternity care, revising the bill to adequately address women’s health and reproductive care is critical to its viability. McConnell would be wise to solicit input from Collins and Murkowski if he wants to keep their votes.

McConnell certainly is walking a tightrope here because the House must still approve the amended version, and if the Freedom Caucus concludes that it provides too many entitlements, they likely won’t accept it. Given this possibility, it’s doubtful that McConnell even wants to try to work with Senate Democrats, who won’t approve the bill unless it’s completely overhauled in a manner that makes it unacceptable to House Republicans.

The saddest aspect of the AHCA debacle is that we’ve gone backward as a country. Obamacare taught us that in a health care system that operates via a private, for-profit health insurance mechanism, there are only two options: guaranteed coverage with high costs or insufficient coverage with lower costs. Americans have finally accepted that our society is better off with guaranteed, universal coverage, so the logical next step for Congress should have been to devise a mechanism to lower costs, either through a single-payer Medicare-for-all system or reorganizing private insurance companies as nonprofits.

Congress should also be considering a unified health system, whereby the federal government oversees the administration of health care under one set of rules (instead of leaving oversight to the individual states). A unified system can enforce quality and cost-saving measures, such as compatible electronic medical records that reduce medical errors and costly duplication of tests and services. Regardless of how much the Senate manages to water down the worst aspects of the AHCA, we won’t be getting anywhere close to the progress we deserve in our health care system anytime soon.

The for-profit health insurance industry is the primary reason why we spend a higher percentage of GDP on health care than any other developed country in the world, yet we’re ranked near the bottom on nearly every measure of quality of care, including life expectancy. And Republicans in Congress appear to prefer to line the pockets of their rich donors rather than work towards a health care solution that upends this corrupt system in order to finally deliver Americans universal, affordable coverage.