This is an archived article that was published on sltrib.com in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
WASHINGTON — Focus, America, focus. The most urgent task right now is to make sure a stake is driven through the heart of the Republican effort to gut Medicaid and balloon the ranks of the uninsured.
I know that the Russia investigations are charging ahead, with Capitol Hill appearances by members of President Trump's inner circle scheduled for next week. I know that Trump gave an unhinged interview to The New York Times on Wednesday, bizarrely undermining his own attorney general. I know that one of the few remaining giants in Washington, Sen. John McCain, R-Ariz., has received a tough medical diagnosis.
There will be time to digest all of that. At present, however, health care is still the main event.
Keep in mind that this isn't the first time the GOP's gratuitously cruel effort to "repeal and replace" the Affordable Care Act has looked dead. Back in March, House Speaker Paul Ryan called off a showdown vote and glumly declared, "We're going to be living with Obamacare for the foreseeable future." But he managed to get a revised bill passed in May, prompting President Trump to hold a sophomoric victory rally at the White House.
That bill would have caused 23 million people to lose health insurance over a decade and slashed Medicaid spending by more than $800 billion, according to the nonpartisan Congressional Budget Office (CBO). The action then shifted to the Senate, which came up with legislation that would grow the numbers of uninsured by 22 million and cut Medicaid by $772 billion. Experts who tried to parse the details gave differing opinions on which version was more heartless.
Senate Majority Leader Mitch McConnell's attempt to ram through his monstrosity collapsed in a heap last weekend, as both the far-right and moderate wings of the GOP caucus balked. In desperation, McConnell then proposed an approach that Trump once ruled out but now eagerly embraces: Repeal the Affordable Care Act now and worry about replacing it later.
According to the CBO, taking the repeal-only route would mean 17 million more uninsured within a year and 32 million more in a decade. Insurance premiums would soar, and in more than half the nation's counties there would be no insurers willing to service the individual market. Appalling.
McConnell's gambit appeared to fail Tuesday when three GOP moderates — Susan Collins of Maine, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia — announced they would vote no. Their stance means McConnell lacks the votes even to open debate on repeal-only, let alone pass it. That should be the end of the story.
But it would be a mistake to take anything for granted. Senate naysayers are under tremendous pressure to give in, and the reason has nothing to do with health care. It's pure politics.
For seven long years, since the day the Affordable Care Act was passed, Republicans have been vowing to eradicate it "root and branch," as McConnell likes to say. And for seven long years, the GOP has reaped political benefit from that categorical promise — while giving no serious thought to what a replacement system would look like.
Obamacare, you will recall, was once Romneycare; it was fashioned after a system Mitt Romney successfully implemented when he was governor of Massachusetts. It is based on ideas originally developed at the conservative Heritage Foundation, ideas the Republican Party once liked — until President Obama embraced them.
While Obama was in office, Republicans in Congress could blithely pass repeal bills knowing the president would never sign them. Now that Trump sits in the Oval Office with pen in hand, however, repeal becomes a real possibility — as do the awful consequences.
McConnell says he will bring the bill up for a vote next week anyway. In effect, he threatens to call the opponents' bluff. Fortunately, they do not appear to be bluffing. There is no indication that a lunch Wednesday for GOP senators at the White House — at which Trump basically threatened revenge against anyone who votes no — or a smaller gathering of senators later that evening changed any minds.
But the right-wing message machine will continue to loudly accuse no-voters of committing political treason. So it is more important than ever to remind senators that the repeal-and-replace bill is monumentally unpopular — polls last week showed its approval rating between 12 percent and 17 percent — and that the legislation's cost would be paid in human suffering. We would return to the days when medical expenses were the leading cause of personal bankruptcy.
Keep the pressure on. The war is not yet won.