After years of angry opposition, fiery speeches, and showy, going-nowhere votes, Congressional Republicans finally clenched their angry, shaking hands on the throat of the Affordable Care Act — Obamacare — as the Senate, then the House, voted to repeal the 2010 law one week before Donald J. Trump was sworn in as president.
Well, that’s the alternative reality of what they did. What they actually did was a whole lot less.
In fact, the Jan. 12 Senate vote gave the green light to a later, simple-majority vote to repeal. It was a classic Senate maneuver to snuff out any chance Democrats might try to save the ACA through filibuster.
The Jan. 13 House vote was less technical and more gassy.
“This law is collapsing while we speak,” announced Speaker of the House Paul Ryan before the vote. So, in order to save it from its own death, the House must vote to kill it “before things get worse.”
Real target
The House vote didn’t just kill Obamacare; in fact, that was its secondary target.
The primary target of the vote was a “bare bones” budget bill — “The worst budget we’ve seen since I’ve been in Congress,” said Michigan’s Justin Amash, a tea party leader — that proposes to add a whopping $9.7 trillion to the federal deficit.
Big unknown
Famously absent from either “repeal and replace” vote was one hint, word, sentence or paragraph on how the red-hot repealers would replace the not-yet repealed ACA.
The House did promise to keep the most popular parts of the law: Children can stay on their parents’ health care plans until age 26 and the ban that denies anyone health care coverage because of pre-existing conditions.
The Senate vote, interestingly, promised neither.
Republicans, however, now claim to be working diligently on a replacement plan they say will deliver better coverage for less money and less government interference than Obamacare. Stop talking, replied Democrats, and show America what you have.
More than a month after the votes, though, the replacers still have no replacement. That is understandable because, after all, they’ve embarked on a near-impossible task: build a better, cheaper ship out of one they’ve already set on fire while at sea carrying more than 20 million Americans. That’s going to be either a very neat trick or a very mean one.
Rural ripples
Whatever and whenever the new Obamacare alternative is introduced, rural America has a lot riding on it.
Especially the sick, because being sick in rural America is a bad bargain compared to being sick anywhere else in America, writes Tim Size in a recent online edition of The Daily Yonder.
“A new study from the federal Centers for Disease Control (CDC),” notes Size, “shows that Americans living in rural communities are more likely to die prematurely from the top five causes of death — heart disease, accidents, stroke, cancer, and respiratory disease — than their urban counterparts.”
The reasons for the divergence, he explains, are many.
Here are two: Fewer than half as many doctors per 10,000 rural residents than city dwellers and only one specialist per 100,000 rural people while the same number of metro Americans have access to eight.
Rural Americans accept these differences and most know these divides will never be fully bridged. It’s part of today’s rural reality; a bad part.
What no American should accept, however, is a rewrite of the Affordable Care Act that makes health care less accessible and less affordable. That’s especially true for rural Americans who started this year’s repeal-and-replace race well behind everyone else.
If Obamacare needs to be fixed, fix it. If it needs to be fully replaced, replace it.
Break it though, and more than 20 million Americans, rural and urban, old and young, Republican and Democratic, rich and poor, sick and healthy will suffer.
