US Republicans struggle to pass healthcare bill
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Senate Republican leaders face an increasingly arduous struggle this week as they try to pass a bill to drastically change President Barack Obama’s keynote healthcare law – exposing the GOP’s ideological fissures.
Five Republicans have explicitly stated their opposition to the bill as it stands. Others began expressing doubts and concerns over the weekend.
GOP Senate Majority Leader Mitch McConnell unveiled the bill on Thursday. He and close colleagues drafted it in secret – suggesting foresight of the current maelstrom surrounding it. McConnell wants a debate and vote by the end of the week.
President Donald Trump tweeted his support of the bill on Saturday: “I cannot imagine that these very fine Republican Senators would allow the American people to suffer a broken ObamaCare any longer!”
Concerns on opposite sides
At this stage, four Republican Senators – Rand Paul, Ted Cruz, Mike Lee and Ron Johnson – have declared their opposition to the bill on the basis that it does not go far enough to move away from Obama’s Affordable Care Act, popularly known as Obamacare.
Dean Heller is a GOP Senator representing Nevada, a swing state that plumped for Hillary Clinton in last year’s Presidential election; home to many low-income citizens who have benefitted from Obamacare. Hence the clear incentive behind his outspoken opposition to the bill as it stands. “It’s going to be very difficult to get me to a ‘yes’,” he said. Lambasting the bill as “simply not the answer”, he specified his concerns that “there isn’t anything in this bill that would lower premiums” that Americans pay for health insurance.
Senator Susan Collins – a Republican representing the Democrat-leaning state of Maine, arguably the last remaining Republican in Congress to exemplify traditional Eisenhower-style centrism – expressed her misgivings about the bill on Sunday. Appearing on ABC’s ‘This Week’, she said she worries about “what it means to our most vulnerable citizens”. Alaska’s GOP Senator Lisa Murkowski has also made her concerns clear. Notably, in February she joined Collins in voting against confirming President Trump’s nomination of Betsy DeVos – a right-wing figure popular among most Republicans – as Education Secretary.
Ben Sasse of Nebraska – perhaps the Senate’s most outspoken GOP critic of Trump – is yet to lend the bill his support, while Rob Portman of Ohio is concerned that the bill does not offer enough support for victims of his state’s opioid epidemic. A further 27 Republican Senators are undecided and have not indicated that they are leaning towards a ‘yes’.
Big changes from Obamacare
The proposed legislation unveiled by McConnell is similar to the House bill – under which the non-partisan Congressional Budget Office says 23 million Americans would lose their health insurance – which narrowly passed through the Republican-controlled House of Representatives last month. Tellingly, the Senate Republican leadership sought to sideline the likeness of the two bills, proclaiming at the outset that they were starting from scratch, not building from the unpopular House legislation.
The Republican Senate Bill would slash funding for Medicaid, the government health programme for disadvantaged citizens, which provides care for one in five Americans. It would end the legal requirement that people have health insurance, which pushes down costs for citizens with pre-existing health issues by ensuring that insurance companies have a large pool of healthy people buying premiums.
States would be free to get rid of many benefits required under Obamacare, such as emergency treatment, mental health services and maternity care. It would also abolish most of the tax rises that fund Obamacare’s Medicaid expansion – effectively creating a large tax cut for the well-off while discouraging states from expanding the programme. The annual income limit for unprosperous Americans to receive benefits to help pay for health insurance would fall from 400 percent of the poverty line to 350 percent. Insurers would be allowed to charge older citizens five times as much as younger ones, as opposed to three times under Obamacare.
New tax credits are supposed to make up for the shortfalls these measures would create, although they are less generous than Obamacare’s system of subsidies. The Senate bill would ban the use of these credits to fund insurance bans that cover abortion. It would also prohibit funds from going to Planned Parenthood, the US’s largest single provider of reproductive health services, including abortion and contraception. Senators Collins and Murkowski have stated their opposition to any restriction of federal funding to the organization.
A partisan Senate
All Democrat Senators oppose the bill. There are 100 US Senators, of which 52 in the current chamber are Republican. The Democrats have 46 seats and 2 independents who caucus with them – including Bernie Sanders, the ferociously Brooklyn-accented talisman of the American Left. The Senate has long been seen as the loftier, statelier chamber of Congress; in contrast to the historically more partisan House of Representatives. From the days of the Founding Fathers to the recent past, deliberation and consensus building across party lines was a hallmark of the Senate’s legislative style. But in a sign of the now gargantuan divides and bare-knuckle rivalry between the red and blue parties, the idea of a Democrat lending support to a GOP bill on healthcare seems unthinkable.
A common feature of Republican politicians is an often inexhaustible penchant for flauntingly nailing their colours to the mast of conservative political philosophy. But as their Senate leaders are finding on the issue of healthcare, the ‘Grand Old Party’ is host to divergent – some would say incompatible – notions of what exactly conservatism means.
Full-blooded neoliberals, Paul, Cruz, Lee and Johnson consider the Senate measures too weak because of their commitment to drastically reducing the role of government in America. Theirs is the ideology of ‘rugged individualism’. They believe that the only authentically American economic system is one in which the government plays as limited a role as possible. In their ideological vision, there is little place for state help for the disadvantaged, whether on healthcare or welfare.
An evolving GOP
The apotheosis of Republican centrism was the 1950s. In 1964, the epitome of that era’s moderate, East Coast patrician GOP, New York Governor Nelson Rockefeller ran for President. He was expected to be a shoo-in for the Republican nomination. But he lost to Barry Goldwater, a hitherto unknown Arizona Senator who exemplified the ideology of ‘rugged individualism’ – proposing to slash taxes and remove the legacy of President Franklin D. Roosevelt’s ‘New Deal’ programmes of state help for the disadvantaged. Goldwater’s success showed tremendous appetite among the GOP base for hardline neoliberal economic policies.
“In your heart, you know he’s right,” was a signature Goldwater campaign slogan. “But in your guts, you know he’s nuts” was the retorting slogan of his opponent, Democrat President Lyndon B. Johnson, who won the election by a landslide before creating Medicare and Medicaid, paving the way for Obamacare nearly 50 years later. It transpired that ‘rugged individualism’ was not as popular as government help to provide healthcare for the disadvantaged and the old.
Ronald Reagan, Republican president from 1981 to 1989, shifted the GOP’s centre of gravity to the right, with his election winning prowess and unimpeachable charisma. His tax slashing economic policies entrenched ‘rugged individualism’ as the GOP’s axiomatic mentality on the economy – although, notably, he did not remove the healthcare entitlements created by Johnson in the ’60s. Another key to his electoral successes, like that of President Richard Nixon, was that he understood that a significant number of Americans, especially between the two coasts, will vote for a socially conservative GOP for emotional reasons of cultural identification. Millions of voters in states such as Alabama and North Dakota may well benefit from Democrat policies, especially on healthcare – but they will often vote for socially conservative, neoliberal Republicans because of notions of socially liberal coastal elites sneering at them.
Although an approach of small government for the boardroom and big government for the bedroom may seem to have an underlying contradiction, from Reagan onwards Republican neoliberals have presented economic ‘rugged individualism’ alongside support for notions of ‘family values’, packaging the two stances as part of a coherent ideology of conservatism by aligning them as two parts of the same traditional American mentality.
A troubled party base
The Great Recession of 2007-9 gave the slow but steady decline of American manufacturing thanks to globalisation and automation an acute immediacy for the millions of low- to middle-income Republican voters. Since then, one can discern an increasing mismatch facing the GOP. On the one hand we have the party’s post-Goldwater orthodoxy. On the other we have the socio-economic reality lived in by a key group it relies on to win elections: low- to middle-income whites in heartland states. The mortality rate of middle-aged whites with no more than a high school education rose by 22.3 percent between 1999 and 2013. That statistic is an astonishing symptom of a socio-economic crisis – especially seeing as the mortality rate of middle-aged whites with at least a BA degree declined by 24 percent during the same period. It also shows why the mismatch between the GOP and its base is epitomised on the issue of healthcare.
In 2009 – as the grassroots right-wing Tea Party movement was at its zenith, and as Obama’s plans for his signature healthcare bill were moving forward amid much publicity – at a town hall meeting in North Carolina Congressman Robert Inglis was told to “get your government hands off my Medicare!”. Inglis politely explained that, actually, the government provides Medicare, but the concerned citizen did not believe it. The same year, an indignant opponent of government-provided healthcare wrote to President Obama: ‘I don’t want government-run health care. I don’t want socialized medicine. And don’t touch my Medicare.’”
The role of Trump
Such voters may hate notions of ‘Washington’ and the ‘liberal elite’, but they like the healthcare coverage they get thanks to these bogeymen. Whether by accident or design, Trump understood that. On the campaign in 2016, Trump promised not to cut Medicare or Medicaid. Whether by accident or design, the ideological platform he offered ripped up the post-Goldwater GOP approach, and in doing so, targeted white, low-to-middle income, heartland America with unprecedented success.
It may be that Trump’s White House is too dysfunctional to produce a healthcare reform bill of its own, leading him to leave it to the rather different Republicans on Capitol Hill. But Trump won thanks to the kind of voters who benefit from government-ensured healthcare – the relatively disadvantaged and the old in states like Michigan and Pennsylvania.
Moderate Republicans are a lot less numerous and a little less moderate since the days of Eisenhower and Rockerfeller. They have also kept their heads down – especially since the rise of Tea Party neoliberal purists like Cruz and Paul. But – especially after Trump’s campaign promises broke with neoliberal dogma – the number of Senators expressing concerns for the vulnerable affected by the GOP bill with shows an emboldened moderate Republican wing.
Within the GOP and its base, forces are pulling the party in wildly divergent directions. Mitch McConnell faces a Herculean task in getting the healthcare bill through the Senate.